592 - Care Management for Mother-Infant Dyads: Stakeholder Perspectives

Poster Number: 592
Publication Number: 592.403

Emily Gregory, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Peter Cronholm, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Scott A. Lorch, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Lisa Levine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Adya Maddox, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; David Rubin, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Ann L. OSullivan, University of Pennsylvania, Phila, PA, United States; Alexander fiks, Children's Hospital of Philadelphia, Merion, PA, United States

Background: Pediatric health systems address the needs of children with medical complexity (CMC) with programs such as care management. Mothers of CMC may have unmet health needs but few care management programs jointly support the mother-infant dyad.

Objective: Explore stakeholder perspectives on the appropriateness and acceptability of expanding pediatric care manager roles to address maternal health care needs, in addition to child needs.

Design/Methods: We conducted semi-structed qualitative interviews with English-speaking clinicians and with women who had Medicaid-insured preterm infants enrolled in care management for CMC. We focused on CMC born preterm because of the prevalence of unmet health care needs among women after preterm birth. Interview guides explored acceptability and appropriateness of expanding roles for pediatric-based care managers to address maternal health and facilitators for success of a dyadic approach to care management. Interviews were audio recorded, transcribed, and coded using an integrated approach in which we coded a priori constructs and emergent themes.

Results: We interviewed 15 women after preterm birth and 24 clinicians from 12/2020 – 11/2021 until reaching thematic saturation. Clinicians included physicians, nurses (RN, NP, and midwife), and social workers in Pediatrics, Obstetrics, and Family Medicine at a pediatric health system and a geographically adjacent health system with a large labor and delivery service. Clinicians and women after preterm birth agreed that care management services would be accepted by mothers and appropriate given increased health care needs after preterm birth. Participants broadly agreed on ideal proficiencies for a successful dyad care manager, naming perinatal health expertise, shared experiences with program participants, and strong interpersonal skills. Women after preterm birth highlighted flexibility as a facilitator for success, and suggested tailoring timing and intensity to meet changing needs and preferences. Clinicians identified existing strategies, such as communication tools in the electronic health record and proactive tracking and outreach for high-risk patients, that could be deployed to share information across pediatric and adult settings and improve follow-up for dyad needs. Illustrative quotes are provided in Table 1.Conclusion(s): Maternal-infant dyad care management after preterm birth is acceptable and appropriate but may demand a range of skills from care managers. Health system strategies for communication and outcome monitoring could be applied to better support dyad health.
Table 1Illustrative quotes demonstrating themes regard dyad care management