Lois McCloskey1, Judith Bernstein2, Ndidimaka Amutah-Onukagha3, Jodi Anthony4, Mary Barger5, Candice Belanoff6, Trude Bennett7, Chloe E Bird8, Denise Bolds9, Burke-Weber Brenna6, Rebecca Carter10, Ann Celi11, Breanna Chachere12, Joia Crear-Perry13, Chase Crossno14, Alba Cruz-Davis15, Karla Damus16, Alissa Dangel17, Zendilli Depina6, Phyllisa Deroze18, Colette Dieujuste19, Annie Dude20, Joyce Edmonds21, Daniel Enquobahrie22, Ebosetale Eromosele6, Erin Ferranti23, Mary Fitzmaurice24, Christina Gebel25, Linda Goler Blount26, Ann Greiner27, Sue Gullo28, Amy Haddad29, Nneka Hall30, Arden Handler31, Irene Headen32, Lisa Heelan-Fancher33, Teri Hernandez34, Kay Johnson35, Emily Jones36, NeKeshia Jones37, Stacey Klaman7, Barbara Lund38, Monica Mallampalli39, Lilly Marcelin40, Cassondra Marshall41, Bridgette Maynard6, Shondra McCage42, Suzanne Mitchell43, Rose Molina44, Suzi Montasir45, Jacinda Nicklas46, Alyson Northrup29, Anna Norton47, Ebere Oparaeke6, Athena Ramos48, Sue Rericha47, Elena Rios49, Joan Rosen Bloch50, Cassie Ryan21, Suzanne Sarfaty43, Ellen Seely11, Vivienne Souter51, Martina Spain6, Randiesa Spires52, Suzanne Theberge53, Tamara Thompson54, Madi Wachman55, Tina Yarrington43, Lynn M Yee56, Chloe Zera57, Janine Clayton58, Christina Lachance59. 1. Community Health Sciences Department, Boston University School of Public Health, Boston, Massachusetts(b) The names and affiliations of all authors in the Bridging the Chasm Collaborative are listed in Table 1.. Electronic address: loism@bu.edu. 2. Community Health Sciences Department, Boston University School of Public Health, Boston, Massachusetts(b) The names and affiliations of all authors in the Bridging the Chasm Collaborative are listed in Table 1. 3. Tufts University School of Medicine. 4. Mathematica. 5. University of San Diego, Hahn School of Nursing. 6. Boston University School of Public Health. 7. University of North Carolina Gillings School of Global Public Health. 8. The RAND Corporation. 9. Bold Doula. 10. Tulane University School of Public Health. 11. Brigham and Women's Hospital, Harvard Medical School. 12. Boston Medical Center, Perinatal Quality Improvement Network. 13. National Birth Equity Collaborative. 14. University of North Texas Health Sciences Center/Texas Christian University School of Medicine. 15. Regis College School of Health Sciences. 16. Boston University Medical Campus, Office of Human Research Affairs. 17. Tufts Medical Center. 18. Black Diabetic Info.com, DiabetesnotDefeated.com. 19. Simmons University School of Nursing. 20. University of Chicago School of Medicine. 21. Boston College Connell School of Nursing. 22. University of Washington School of Public Health. 23. Emory University N. H. Woodruff School of Nursing. 24. Centering Healthcare Institute. 25. March of Dimes, Massachusetts. 26. Black Women's Health Imperative. 27. Primary Care Collaborative. 28. Ariadne Labs. 29. Association of MCH Programs. 30. Quietly United in Loss Together (QUILT). 31. University of Illinois at Chicago School of Public Health. 32. Drexel University Dornsife School of Public Health. 33. University of Massachusetts, Boston School of Nursing. 34. University of Colorado School of Nursing. 35. Johnson Group Consulting. 36. University of Oklahoma Health Sciences Center, Ziegler College of Nursing. 37. Health Resources in Action. 38. Fresenius Medical Care. 39. HealthyWomen. 40. Resilient Sisterhood Project. 41. University of California, Berkeley School of Public Health. 42. Chicksaw Nation Department of Health. 43. Boston University School of Medicine. 44. Beth Israel Deaconess Medical Center / The Dimock Center. 45. YMCA. 46. University of Colorado School of Medicine. 47. DiabetesSisters. 48. University of Nebraska Medical Center. 49. National Hispanic Medical Association. 50. Drexel University College of Nursing and Health Sciences. 51. University of Washington School of Public Health, ACOG. 52. iCare Connect Healthcare, Inc. 53. National Quality Forum. 54. Mother Earth Doula Care. 55. Boston University Center for Innovation in Social Work and Health. 56. Northwestern University, Feinberg School of Medicine. 57. Beth Israel Deaconess Medical Center, Harvard Medical School. 58. NIH Office of Research in Women's Health. 59. HRSA Office of Women's Health.
Abstract
BACKGROUND: Many pregnant people find no bridge to ongoing specialty or primary care after giving birth, even when clinical and social complications of pregnancy signal need. Black, indigenous, and all other women of color are especially harmed by fragmented care and access disparities, coupled with impacts of racism over the life course and in health care. METHODS: We launched the initiative "Bridging the Chasm between Pregnancy and Health across the Life Course" in 2018, bringing together patients, advocates, providers, researchers, policymakers, and systems innovators to create a National Agenda for Research and Action. We held a 2-day conference that blended storytelling, evidence analysis, and consensus building to identify key themes related to gaps in care and root causes of inequities. In 2019, more than 70 stakeholders joined six working groups to reach consensus on strategic priorities based on equity, innovation, effectiveness, and feasibility. FINDINGS: Working groups identified six key strategic areas for bridging the chasm. These include: 1) progress toward eliminating institutional and interpersonal racism and bias as a requirement for accreditation of health care institutions, 2) infrastructure support for community-based organizations, 3) extension of holistic team-based care to the postpartum year and beyond, with integration of doulas and community health workers on the team, 4) extension of Medicaid coverage and new quality and pay-for-performance metrics to link maternity care and primary care, 5) systems to preserve maternal narratives and data across providers, and 6) alignment of research with women's lived experiences. CONCLUSIONS: The resulting agenda presents a path forward to remedy the structural chasms in women's health care, with key roles for advocates, policymakers, researchers, health care leaders, educators, and the media.
BACKGROUND: Many pregnant people find no bridge to ongoing specialty or primary care after giving birth, even when clinical and social complications of pregnancy signal need. Black, indigenous, and all other women of color are especially harmed by fragmented care and access disparities, coupled with impacts of racism over the life course and in health care. METHODS: We launched the initiative "Bridging the Chasm between Pregnancy and Health across the Life Course" in 2018, bringing together patients, advocates, providers, researchers, policymakers, and systems innovators to create a National Agenda for Research and Action. We held a 2-day conference that blended storytelling, evidence analysis, and consensus building to identify key themes related to gaps in care and root causes of inequities. In 2019, more than 70 stakeholders joined six working groups to reach consensus on strategic priorities based on equity, innovation, effectiveness, and feasibility. FINDINGS: Working groups identified six key strategic areas for bridging the chasm. These include: 1) progress toward eliminating institutional and interpersonal racism and bias as a requirement for accreditation of health care institutions, 2) infrastructure support for community-based organizations, 3) extension of holistic team-based care to the postpartum year and beyond, with integration of doulas and community health workers on the team, 4) extension of Medicaid coverage and new quality and pay-for-performance metrics to link maternity care and primary care, 5) systems to preserve maternal narratives and data across providers, and 6) alignment of research with women's lived experiences. CONCLUSIONS: The resulting agenda presents a path forward to remedy the structural chasms in women's health care, with key roles for advocates, policymakers, researchers, health care leaders, educators, and the media.
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