Policy change is not enough: engaging provider champions on immediate postpartum contraception

Okoroh, Ekwutosi M.; Kane, Debra J.; Gee, Rebekah E.; Kieltyka, Lyn; Frederiksen, Brittni N.; Baca, Katharyn M.; Rankin, Kristin; Goodman, David A.; Kroelinger, Charlan D.; Barfield, Wanda D.

doi:10.1016/j.ajog.2018.03.007

Cited by 48 publications

(47 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The relatively small differences and low rates in contraception outcomes suggest the limitations of prenatal care to support postpartum contraception choice. While South Carolina's Medicaid reimbursement policy supporting immediate postpartum LARCs went into effect in 2012, we expect adoption and implementation varied during the study period and by provider (this data was not available) [35,36]. Our preferential within-cluster matching approach controls statistically for provider differences.…”

Section: Discussionmentioning

confidence: 99%

The effects of CenteringPregnancy group prenatal care on postpartum visit attendance and contraception use

et al. 2020

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

Section: Discussionmentioning

confidence: 99%

The effects of CenteringPregnancy group prenatal care on postpartum visit attendance and contraception use

et al. 2020

View full text Add to dashboard Cite

show abstract

“…As a case example for better understanding champions, we examined implementation of recommended immediate postpartum contraceptive services. Champions appear to play a powerful role in implementing this evidence-based practice [14][15][16]. Immediate postpartum contraception involves the insertion of a longacting reversible contraceptive (LARC; e.g., intrauterine device or contraceptive implant) during hospitalization for childbirth.…”

Section: Introductionmentioning

confidence: 99%

“…Immediate postpartum contraception involves the insertion of a longacting reversible contraceptive (LARC; e.g., intrauterine device or contraceptive implant) during hospitalization for childbirth. Although national guidelines recommend universal access to this service, it is provided almost exclusively at a small number of "early adopter" academic medical centers [14,17], and immediate postpartum LARC utilization remains rare [17,18]. Implementation is complex, requiring coordination across settings (e.g., outpatient and inpatient) and often siloed stakeholder groups (e.g., providers, pharmacy, and billing) [15,16].…”

Section: Introductionmentioning

confidence: 99%

Champions in context: which attributes matter for change efforts in healthcare?

et al. 2020

View full text Add to dashboard Cite

Background: Research to date has focused on strategies and resources used by effective champions of healthcare change efforts, rather than personal characteristics that contribute to their success. We sought to identify and describe champion attributes influencing outcomes of healthcare change efforts. To examine attributes of champions, we used postpartum contraceptive care as a case study, because recommended services are largely unavailable, and implementation requires significant effort. Methods: We conducted a comparative case study of the implementation of inpatient postpartum contraceptive care at 11 U.S. maternity hospitals in 2017-18. We conducted site visits that included semi-structured key informant interviews informed by the Consolidated Framework for Implementation Research (CFIR). Phase one analysis (qualitative content analysis using a priori CFIR codes and cross-case synthesis) showed that implementation leaders ("champions") strongly influenced outcomes across sites. To understand champion effects, phase two inductive analysis included (1) identifying and elaborating key attributes of champions; (2) rating the presence or absence of each attribute in champions; and 3) cross-case synthesis to identify patterns among attributes, context, and implementation outcomes. Results: We completed semi-structured interviews with 78 clinicians, nurses, residents, pharmacy and revenue cycle staff, and hospital administrators. All identified champions were obstetrician-gynecologists. Six key attributes of champions emerged: influence, ownership, physical presence at the point of change, persuasiveness, grit, and participative leadership style. These attributes promoted success by enabling champions to overcome institutional siloing, build and leverage professional networks, create tension for change, cultivate a positive learning climate, optimize compatibility with existing workflow, and engage key stakeholders. Not all champion attributes were required for success, and having all attributes did not guarantee success. Conclusions: Effective champions appear to leverage six key attributes to facilitate healthcare change efforts. Prospective evaluations of the interactions among champion attributes, context, and outcomes may further elucidate how champions exert their effects.

show abstract

“…73 The successes of the earlier learning community offer a model for states to address complex public health issues requiring coordinated response across many sectors, agencies, and partners, a strength of a collaborative learning model. 69,71,74 The OMNI LC includes these components and requires multidisciplinary, multiagency state teams to participate in in-person meetings and virtual learning events 68 to implement systems change activities targeting OUD among pregnant and postpartum women and prenatal opioid exposure in infants. 67 To implement the OMNI LC, ASTHO partnered with a wide range of agencies and organizations, developed clear criteria for selecting states to participate in the activity, and identified core state team members critical for systems change.…”

Section: Using the Learning Collaborative Model As A Mechanism For Symentioning

confidence: 99%

Implementing a Learning Collaborative Framework for States Working to Improve Outcomes for Vulnerable Populations: The Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community

Kroelinger

Addison

Rodriguez

et al. 2020

Journal of Women's Health

Self Cite

View full text Add to dashboard Cite

The opioid crisis has impacted vulnerable populations, specifically pregnant and postpartum women, and infants prenatally exposed to substances, including infants with Neonatal Abstinence Syndrome. Lack of access to clinical and social services; potential stigma or discrimination; and lack of resources for provision of services, including screening and treatment, have impacted the health of these populations. In 2018, using a systems change approach, the Association of State and Territorial Health Officials (ASTHO) and the Centers for Disease Control and Prevention (CDC) convened an Opioid use disorder, Maternal outcomes, Neonatal abstinence syndrome Initiative Learning Community (OMNI LC) that included other federal agencies, national clinical and nonclinical organizations, and 12 state leadership groups. The purpose of the OMNI LC was to determine areas of focus and identify strategies and best practices for implementing systems change to improve maternal and infant outcomes associated with opioid use disorder (OUD) during the perinatal period. Activities included inperson convenings with policy goal action plan development, virtual learning sessions, intensive technical assistance (TA), and temporary field placements. The OMNI LC partnering agencies and state teams met bimonthly for the first year of the initiative. At the in-person convening, state teams identified barriers to developing and implementing systems change in activity-specific action plans within five areas of focus: financing and coverage; access to and coordination of quality services; provider training and awareness; ethical, legal, and social considerations; and data, monitoring, and evaluation. State teams also identified stakeholder partnerships as a necessary component of strategy development in all areas of focus. Four virtual learning sessions were conducted on the areas of focus identified by state teams, and ASTHO conducted three intensive TA opportunities, and five states were identified for temporary field placement. To successfully address the impact of the opioid crisis on pregnant and postpartum women and infants, states developed innovative strategies focused on increasing support, services, and resources. Moving forward, state teams will participate in two additional in-person meetings, continue to identify barriers to the work, refine and customize action plans, and set new goals, to effect broad-ranging systems change for these vulnerable populations.

show abstract

Policy change is not enough: engaging provider champions on immediate postpartum contraception

Cited by 48 publications

References 26 publications

The effects of CenteringPregnancy group prenatal care on postpartum visit attendance and contraception use

The effects of CenteringPregnancy group prenatal care on postpartum visit attendance and contraception use

Champions in context: which attributes matter for change efforts in healthcare?

Implementing a Learning Collaborative Framework for States Working to Improve Outcomes for Vulnerable Populations: The Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community

Contact Info

Product

Resources

About