PROJECT ABSTRACT/SUMMARY
Perinatal outcomes in the United States rank below many other developed countries. National organizations,
such as the American College of Obstetricians and Gynecologists, have called for women to utilize the level
and provider of maternity services that meet their personal and medical needs. This leveled approach to care
requires consultation and collaboration among providers to ensure women receive appropriate services. While
national and international organizations have called for team-based maternity care, current models can
fragment services, increasing the risk of communication errors. Women can feel disenfranchised by models
that do not meet their needs and opt out of beneficial services altogether. Currently, there is not evidence on
effective interdisciplinary models of maternity care. The Collaboration for Antepartum Risk Evaluation (CARE)
study will use a randomized design to systematically test the effect of interdisciplinary consults on women and
providers. The two aims of the study are: (1) evaluate the effect of collaborative vs individual consults on
participant outcomes including communication quality (using the Communication Assessment Tool, team
version), maternal satisfaction (using a modified Satisfaction with Prenatal Care measure), semi-structured
interviews, adherence to the developed plan of care, and perinatal outcomes; (2) evaluate the effect of the
CARE clinic on providers using the Communication Assessment Tool team version, the AHRQ TeamSTEPPS
Teamwork perceptions questionnaire, and semi-structured interviews. The award will support three years of
research, training, and mentoring to assist Dr. Phillippi in becoming an independent investigator in patient-
centered health services research. The career development plan will expedite independence by increasing her
knowledge of: (1) design and conduct of implementation research, (2) maternal-child and interdisciplinary
health research, and (3) comparative effectiveness methods and measures to test patient-centered care and
communication. The plan includes research on the CARE model, targeted coursework, training in responsible
conduct of research, and structured mentoring. Dr. Phillippi's interdisciplinary mentorship team includes
national leaders in health services, implementation, and women's health research as well as experts in
biostatistics and publication. These diverse and experienced mentors will meet regularly with Dr. Phillippi to
provide guidance. Vanderbilt has a wealth of resources for new investigators including lectures, research
communities, and expert assistance, resulting in a K to R (equivalent) conversion rate of 72%. Vanderbilt's
extensive digital infrastructure, including an integrated electronic medical records system and a secure,
HIPAA-compliant research platform, facilitate health services research. The CARE study will provide valuable
information on effective models for patient-centered maternity care. The AHRQ K08 will allow Dr. Philippi to
implement the CARE study and facilitate her growth into a national leader in midwifery and health services
research.
