Pediatric Research in Office Settings (PROS)

Introduction

Four million births each year in U.S. Decreasing lengths of postpartum stay Responsibility for health promotion and

monitoring shifts to outpatient Decision-making for readiness is complex

Research Questions How often do mothers, pediatricians, and

obstetricians agree on readiness for postpartum discharge?

What influences these perceptions of readiness? How do these perceptions impact health care

utilization, health outcomes, and health-related behaviors during the first four weeks after discharge?

How do these perceptions change over time?

Study Design

• Prospective observational cohort study

• 6,000 mother/infant dyads

• Followed for first 4 weeks after discharge

Inclusion Criteria

Term babies (37+ weeks) Birth weight 5 pounds To be followed in PROS practices

after discharge

Exclusion Criteria

Maternal chronic illness Twin or multiple birth Mother without a phone Infant in SCN 8 hours for medical reasons Major congenital anomaly Infants for adoption

L e n g t h o fS t a y

P r e n a t a l /I n - H o s p i t a l E d u c a t i o n

MaternalExperience

A n t i c i p a t e dP o s t p a r t u m

S u p p o r t

Biologic Vulnerability

P r a c t i t i o n e r /P r a c t i c e

C h a ra c t e r i s t i c s

M a t e r n a l R e a d i n e s sf r o m O b s t e t r i c ,

P e d i a t r i c & M o t h e r s 'P e r s p e c t i v e s

H e a l t h R e l a t e dB e h a v i o r s

H e a l t h C a r eU s e

SocialVulnerability

M a t e rn a lP e r i n a ta l

H e a l t h

In f a n t R e a d i n e s s f r o mP e d i a t r i c a n d M o t h e r s '

P e r s p e c t i v e s

P o s t p a r t u mS e rv i c e s

P o s t p a r t u mS u p p o r t

M a t e r n a lH e a l t h S t a t u s

In f a n t H e a l t h S t a t u s

A n t i c i p a t e d P o s t p a r t u m

S e r v ic e s

Confounders and Effect Modifiers

Outcomes Reflecting Readiness Assessed During Neonatal Period

C o n c e p t u a l M o d e l

Readiness for Discharge from Nursery

D e t e r m i n a n t s o f R e a d i n e s s

Data Collection: Overview• Demographics (1 practice form + 1 for each

clinician)• Day of discharge questionnaires (mother,

pediatrician, obstetrician)• Daily diary for first 2 weeks post discharge

(mother)• Brief encounter form with each office visit

(pediatrician)• 4 weeks after nursery discharge (mother,

pediatrician)

LANDmarks (1)

• Practice Recruitment

• Study Coordinator

• Institutional Review Board at Hospital

• Mother Recruitment

• Hospital Obstetricians

Practice Recruitment

• Demographic Questionnaire (1 per practice) and Practitioner Surveys (each clinician)

• Maximum participation = 12 weeksEnrollment = 8 weeksFollow-up = 1 month

• 8 weeks enrollment or 40 - 60 dyads (whichever is first)

• Key questions for covering clinicians to minimize workload

Study Coordinator

• Organize study materials at hospital(s) and office

• Implement studyMobile and Permanent Enrollment LogsMaintenance List

• Establish recruitment

• Monitor ALL study details

Institutional Review Board (IRB) at Hospital

• Need local IRB approval letter prior to study start

• Local Principal Investigator (PI) required

• Local application necessary for expedited or full review

• AAP IRB materials available to "cut and paste” into application

Mother Recruitment

• Approach mothers during postpartum stay

• Record mother/infant dyads on Mobile Enrollment Log

• Have mother sign consent form

• Discuss mother's enrollment packet

Hospital Obstetricians

• Engage OBsPersonal contactAttend OB Dept. Meeting

• Complete Obstetrical Questionnaire (OBQ) on mother's day of dischargeEndorsed by ACOGQuick to complete

LANDmarks (2)

• Data Collection on Day of Nursery Discharge

• Hospital Nursery + OB Floor

• Mothers at Home

• At the Practice/Health Center

• Incentives/Reimbursement

Data Collection on Day of Nursery Discharge

• Mother completes enrollment questionnaire (MEQ)

• Discharging pediatrician completes

initial questionnaire (PracIQ)

• Obstetrician completes obstetrical questionnaire (OBQ)

Hospital Nursery + OB Floor

• Mobile Enrollment Log - all eligible mothers

• Mother/infant dyad enrollment (LAND onesie)

• To be completed on day of discharge:Obstetrical Questionnaire (OBQ)Practitioner Initial Questionnaire (PracIQ; key

questions for covering clinicians)Mother’s Enrollment Questionnaire (MEQ)

Mothers at Home

• Mother’s Daily Diary (MDD) for 14 days post nursery discharge

• Mother’s Follow-Up Questionnaire (MFQ)

• OB Postpartum Follow-Up Visit Postcard

• Mothers receive AAP parenting book upon completion

At the Practice/Health Center

• Permanent Enrollment Log• Maintenance List

One reminder phone call to mother on day 1 - 2MFQ Reminder postcard at 3 weeks post-discharge

• Practitioner Encounter Questionnaire (PracEQ) to capture all visits

• Practitioner Follow-Up Questionnaire (PracFQ) at 4 weeks post nursery discharge

• Reimbursement to defray expenses

Incentives/Reimbursement

• Family incentivesNewborn one-piece undergarment upon

enrollmentAAP parenting book upon completion of the

Mother’s Daily Diary

• Practice reimbursement$30 for each mother/infant pair enrolled with

complete practitioner study materials (initial, encounter, & follow-up questionnaires)

LAND Study Funding

• Health Resources and Services Administration Maternal and Child Health Bureau (HRSA MCHB)

• AAP Friends of Children Corporate Fund

• AAP Friends of Children Research in Pediatric Practice Fund

Visit LAND on the PROS Web Page

For more information about the LAND Study, visit the PROS Web page.

• The PROS page is located on the American Academy of Pediatrics Web page at http://www.aap.org

• Click on Research, then click on PROS, then click on Life Around Newborn Discharge (LAND)

For More Information About LAND...

Please contact the PROS Central Office

Phone: 800/433-9016, ext 7626

E-mail: pros@aap.org