Patient navigation to improve outcomes among low-income women in the postpartum period - PROJECT SUMMARY
The postpartum period – often called the “fourth trimester” – is a time of rapid and intense change in the life of a
woman and her family, and uptake of health care during this transition is critical to optimizing women's long-term
health and the health of their subsequent pregnancies. The importance of postpartum care has been reinforced
by professional organizations, yet postpartum care in the United States remains inadequate. Substantial
racial/ethnic and socioeconomic disparities in health care uptake, quality, and outcomes exist. Improving health
for all women requires the development of new, more comprehensive approaches to postpartum and
interconception care. One potential model may be patient navigation, which is a barrier-focused, longitudinal,
patient-centered intervention that offers support for a defined set of health services.
This proposal summarizes a 5-year research plan to evaluate whether implementation of a postpartum
patient navigation program improves health outcomes among low-income women. We previously
developed a postpartum patient navigation program, called Navigating New Motherhood (NNM), which
introduced a clinic-level intervention in which a patient navigator assumed postpartum supportive and logistical
responsibilities for low-income women. In this observational investigation, navigation was associated with
improvements in outcomes (retention in care, contraception uptake, vaccination, and depression screening)
compared to those of a historical cohort. We now propose to test the efficacy of the updated NNM model –
called “NNM2” – via a randomized trial. We will randomize 400 pregnant or postpartum women with publicly-
funded prenatal care to NNM2 navigation versus usual care (1:1). Women randomized to navigation will be
provided intensive, individualized, one-on-one navigation services through 12 weeks postpartum and, based on
individual needs, ongoing, tapered navigation through one year postpartum. Participants will undergo surveys,
interviews, and medical record review at 4-12 weeks and 1 year postpartum.
Aim 1 will evaluate whether the navigation program improves clinical outcomes at 4-12 weeks postpartum as
measured via a composite of health status that includes retention in care, receipt of recommended counseling
(anticipatory guidance), receipt of desired contraception, postpartum depression screening and care,
breastfeeding initiation and maintenance, and receipt of indicated preventive care. Aim 2 will evaluate whether
NNM2 improves patient-reported outcomes using both qualitative and quantitative methods. Aim 3 will evaluate
provider experiences via focus groups and surveys. Completion of this study will fill an evidence gap by
demonstrating whether postpartum patient navigation is an effective mechanism to improve women's short- and
long-term health, enhance health care utilization, and improve patient and provider satisfaction.
