patient-centered practice informs community-based health … · 2018-08-08 · •intrauterine...
TRANSCRIPT
![Page 1: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/1.jpg)
healthinstitute.Illinois.edu
“Patient-Centered Practice Informs Community-Based Health Research: The Development of I. D. E. A. to Improve Maternal Health Outcomes”
Karen Tabb Dina, School of Social Work
Brandon Meline, Champaign-Urbana Public Health District
David Huang, College of Education
![Page 2: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/2.jpg)
IHSI: Catalyzing, Supporting, and Uniting Illinois Health Sciences Research
![Page 3: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/3.jpg)
healthinstitute.Illinois.edu
In 1966, Dr. Martin Luther King Jr stated “Of all forms of discrimination and inequalities, injustice in health is the most shocking and inhuman”
Health disparities are large, persistent, and intergenerational
Promoting Local and Global Health Equity
![Page 4: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/4.jpg)
healthinstitute.Illinois.edu
“Patient-Centered Practice Informs Community-Based Health Research: The Development of I. D. E. A. to Improve Maternal Health Outcomes”
Karen Tabb Dina, School of Social Work
Brandon Meline, Champaign-Urbana Public Health District
David Huang, College of Education
![Page 5: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/5.jpg)
INTERDISCIPLINARY HEALTH SCIENCES INSTITUTE | MARCH 6, 2018 | KAREN TABB DINA | BRANDON MELINE | DAVID HUANG
THE DEVELOPMENT OF I.D.E.A TO IMPROVE MATERNAL
HEALTH OUTCOMES
PATIENT CENTERED PRACTICE
INFORMS COMMUNITY BASED
HEALTH RESEARCH
![Page 6: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/6.jpg)
DISCLOSURES
• NO CONFLICTS TO DISCLOSE
![Page 7: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/7.jpg)
INTERDISCIPLINARY TEAM
• School of Social Work
• Champaign-Urbana Public Health District
• College of Education
![Page 8: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/8.jpg)
SETTING
•Champaign-Urbana Public Health District
•Division of Maternal Child Health (MCH) of a public health clinic in Illinois.
•This clinic provides free and low-cost services to at-risk mothers living in Champaign County, including family case management, perinatal home visits, WIC (Women, Infant, and Children), immunizations, lactation, and nutrition counseling.
![Page 9: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/9.jpg)
UNIVERSITY-COMMUNITY PARTNERSHIP
•Community Engagement
• Improving Clinical Practice
•Broadening the Horizon of Public Health Districts and Research Involvement
![Page 10: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/10.jpg)
• RACE
• ETHNICITY
• INCOME
• PLACE
• LIFE
EXPECTANCY
DISPARITIES IN CHAMPAIGN COUNTY
![Page 11: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/11.jpg)
DISPARITIES IN CHAMPAIGN COUNTY
• RACE
• ETHNICITY
• INCOME
• PLACE
• LIFE
EXPECTANCY
![Page 12: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/12.jpg)
DISPARITIES IN CHAMPAIGN COUNTY
• RACE
• ETHNICITY
• INCOME
• PLACE
• LIFE
EXPECTANCY
![Page 13: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/13.jpg)
DISPARITIES IN CHAMPAIGN COUNTY
• RACE
• ETHNICITY
• INCOME
• PLACE
• LIFE
EXPECTANCY
![Page 14: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/14.jpg)
• AGE
• RACE
• ETHNICITY
• INCOME
• PLACE
DISPARITIES IN MATERNAL MENTAL HEALTH
![Page 15: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/15.jpg)
PERINATALMENTAL HEALTH DISORDERS
• Perinatal mental health disorders are the leading causes of maternal morbidity and mortality.
• Perinatal Depression
• Perinatal Anxiety
• Bipolar Disorder
• Perinatal Psychosis
• Perinatal Depression - 8-14%• 30-50% any treatment
![Page 16: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/16.jpg)
![Page 17: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/17.jpg)
• Preterm birth
• Lower birth weight
• Lower APGARs
• Intrauterine growth restriction
• Increased admission to NICU
• Excessive crying, more inconsolable
Beck CT et al 1995, Murray L 1992, Whiffen VE et al 1989, Lindahl V et al 2005, Misra et al 2003, Li P et al 2009, Bansil P et al 2010, Grote 2010,
Kurki 2000, Kozhimannil 2009, Dayan 2002, Marcus 2009, Raisanen et al 2014
UNTREATED PERINATAL DEPRESSION: NEONATAL RISKS
![Page 18: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/18.jpg)
• Gestational DM
• Substance use
• Poor nutrition, weight gain
• Poor prenatal care
• Preeclampsia
• Increased C-section
• Decreased pain tolerance
Marcus SM 2009, Kozhimannil 2009, Lindahl V et al 2005, Anderson 2004
UNTREATED PERINATAL DEPRESSION: OBSTETRIC RISKS
![Page 19: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/19.jpg)
• Bonding
• Breastfeeding
• Cognition and development
• Depression and suicide in offspring
UNTREATED DEPRESSION AND CHILDREN
![Page 20: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/20.jpg)
• Public health approach• State mandates to screen
for depression
• Perinatal Mental Health Disorders Prevention and Treatment Act of 2008
• Hotline for assistance
DEPRESSION SCREENING
![Page 21: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/21.jpg)
BARRIERS TO SCREENING
![Page 22: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/22.jpg)
PROVIDERS’ PERCEPTIONS OF SCREENING
![Page 23: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/23.jpg)
POORLY COORDINATED SERVICES
PRIMARY
CARE
COMMUNITY
MENTAL
HEALTH
SUBSTANCE
ABUSE
TREATMENT
SOCIAL
SERVICES
![Page 24: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/24.jpg)
INDENTIFYING DEPRESSION THROUGH EARLY AWARENESS (IDEA) WOMEN’S HEALTH COALITION est. 2017
• Who are we?• PATIENTS, researchers, clinicians, and
administrators.
• Collaborators come from:• Patients• Local non-for-profits• Treatment providers• University of Illinois-Urbana Champaign
(including students)• Champaign-Urbana Public Health
District• Promise Francis Nelson (FQHC)
![Page 25: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/25.jpg)
PATIENT CENTERED OUTCOMES RESEARCH INSTITUTE (PCORI)
PIPELINE
(TIER A)SCIENTIFIC PROPOSAL
• Authorized by Congress in 2010 as part of the Patient Protection and Affordable Care Act (PPACA)
• PCORI supports “research that addresses the questions and concerns most relevant to patients, and we involve patients, caregivers, clinicians, and other healthcare stakeholders, along with researchers, throughout the process”.
![Page 26: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/26.jpg)
PCORI Pipeline to Proposal and Research Engagement Awards
PIPELINE
(TIER A)
CAPACITY
BUILDING
WORKSHOP
SCIENTIFIC PROPOSAL
PERINATAL
DEPRESSSION
CER NETWORK
2017 2023
![Page 27: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/27.jpg)
![Page 28: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/28.jpg)
I.D.E.A. Women’s Coalition
<1 YEAR!• Awareness Campaign
• Research Development
• Activities:• Pregnancy Expo
• Town Hall
• Happy/Coffee Hours
• Advisory Board
• Maternal Mental Health Month
• Capacity Building Workshop
![Page 29: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/29.jpg)
PATIENT-ENGAGED RESEARCH CER
• Community Engagement
• Pregnancy Expo• Town Hall
• Coffee Hours
• Happy Hour
• Patients as Partners• Design
• Dissemination
• Capacity Building
• Comparative Effectiveness Research• Shared research questions
![Page 30: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/30.jpg)
PATIENT-ENGAGED RESEARCH CER
• Community Engagement• Pregnancy Expo
•Town Hall• Coffee Hours
• Happy Hour
• Patients as Partners• Design
• Dissemination
• Capacity Building
• Comparative Effectiveness Research• Shared research questions
![Page 31: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/31.jpg)
PATIENT-ENGAGED RESEARCH CER
• Community Engagement• Pregnancy Expo
• Town Hall
•Coffee Hours• Happy Hour
• Patients as Partners• Design
• Dissemination
• Capacity Building
• Comparative Effectiveness Research• Shared research questions
![Page 32: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/32.jpg)
PATIENT-ENGAGED RESEARCH CER
• Community Engagement• Pregnancy Expo• Town Hall• Coffee Hours• Happy Hour
• Patients as Partners• ADVISORY BOARD• Design• Dissemination• Capacity Building
• Comparative Effectiveness Research• Shared research questions
![Page 33: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/33.jpg)
EXPECTATIONS OF THE ADVISORY BOARD
• ENGAGE IN RESEARCH• COME UP WITH CER RESEARCH IDEAS
• Set a Governance Structure
• 1-3 hours per month
• Attend monthly meetings
• Complete action items (homework) between meetings
• Assist in building the coalition increasing membership
![Page 34: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/34.jpg)
COMPARATIVE EFFECTIVENESS RESEARCH
Comparing two or more options?
Studying the risks and benefits (outcomes) of the options?
Comparing options proven to be effective?
Assessing which options are better for your population?
![Page 35: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/35.jpg)
COMPARATIVE EFFECTIVENESS RESEARCH
Health topicPopulation who will
benefit from the research
Importance of CER idea to your
partnership(s)
Description of how the ideas may lead to a CER question
• CER ideas must be important to BOTH patients and researchers. Ideas must include all of the following:
![Page 36: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/36.jpg)
ORGANIZATIONAL DEVELOPMENT
• Best practice with multiple stakeholders
• Process-Oriented/Process Exploration
• Group decision-making
• Empowering underrepresented populations
• Documentation
Individuals Organizations Communities
![Page 37: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/37.jpg)
EDUCATIONAL INTERVENTIONS
• Stakeholders’ buy-in
• Learner-centered
• Formal and informal learning opportunities
• Transfer & transformation of performance at community level
• Evaluation for continuous improvement
Sustainable Transformational
Accessible
![Page 38: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/38.jpg)
THANK YOUKAREN TABB DINA, ASSISTANT PROFESSOR, UNIVERSITY OF ILLINOIS SCHOOL OF SOCIAL WORK
CONTACT: [email protected]
ACKNOWLEDGEMENTS:
PATIENT CENTERED OUTCOMES RESEARCH INSTITUTE
NATIONAL INSTITUTE FOR MINORITY HEALTH DISPARITIES
![Page 39: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/39.jpg)
• Grote, N. K., Simon, G. E., Russo, J., Lohr, M. J., Carson, K., & Katon, W. (2017). Incremental Benefit-Cost of MOMCare: Collaborative Care for Perinatal Depression Among Economically Disadvantaged Women. Psychiatric Services, appi-ps.
• Farr, S. L., Ko, J. Y., Burley, K., & Gupta, S. (2016). Provider communication on perinatal depression: a population-based study. Archives of women's mental health, 19(1), 35-40.
• Rossen, L., Hutchinson, D., Wilson, J., Burns, L., Olsson, C. A., Allsop, S., ... & Mattick, R. P. (2016). Predictors of postnatal mother-infant bonding: the role of antenatal bonding, maternal substance use and mental health. Archives of women's mental health, 19(4), 609-622.
• Fitelson, E., Kim, S., Baker, A. S., & Leight, K. (2011). Treatment of postpartum depression: clinical, psychological and pharmacological options. International journal of women's health, 3, 1.
• O'Hara, M. W., & Wisner, K. L. (2014). Perinatal mental illness: definition, description and aetiology. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(1), 3-12.
• Katon, W. J., & Seelig, M. (2008). Population-based care of depression: team care approaches to improving outcomes. Journal of Occupational and Environmental Medicine, 50(4), 459-467.
• Fellenzer, J. L., & Cibula, D. A. (2014). Intendedness of pregnancy and other predictive factors for symptoms of prenatal depression in a population-based study. Maternal and child health journal, 18(10), 2426-2436.
• Vesga-López O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS. Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry. 2008;65:805-815.
REFERENCES
![Page 40: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/40.jpg)
• Very preterm birth leading to mortality
• Tobacco and Alcohol Use
• Worsening Depression
• Suicide
• 20% postpartum deaths
DEPRESSION AND PERINATAL HEALTH OUTCOMES
Bottorf et al 2014, LaViest 2006, SUICIDE CITATION
![Page 41: Patient-Centered Practice Informs Community-Based Health … · 2018-08-08 · •Intrauterine growth restriction •Increased admission to NICU •Excessive crying, more inconsolable](https://reader034.vdocuments.us/reader034/viewer/2022042620/5f3cd34e15e3d52f943c8bcf/html5/thumbnails/41.jpg)
SCREENING TOOLS