Pediatric Research in Office Settings (PROS)

1. Pediatric Research in Office Settings (PROS)

2. 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

3. 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?

4. Study Design • Prospective observational cohort study • 6,000 mother/infant dyads • Followed for first 4 weeks after discharge

5. Inclusion Criteria • Term babies (37+ weeks) • Birth weight  5 pounds • To be followed in PROS practices after discharge

6. 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

8. 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)

9. LANDmarks (1) • Practice Recruitment • Study Coordinator • Institutional Review Board at Hospital • Mother Recruitment • Hospital Obstetricians

10. Practice Recruitment • Demographic Questionnaire (1 per practice) and Practitioner Surveys (each clinician) • Maximum participation = 12 weeks • Enrollment = 8 weeks • Follow-up = 1 month • 8 weeks enrollment or 40 - 60 dyads (whichever is first) • Key questions for covering clinicians to minimize workload

11. Study Coordinator • Organize study materials at hospital(s) and office • Implement study • Mobile and Permanent Enrollment Logs • Maintenance List • Establish recruitment • Monitor ALL study details

12. 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

13. 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

14. Hospital Obstetricians • Engage OBs • Personal contact • Attend OB Dept. Meeting • Complete Obstetrical Questionnaire (OBQ) on mother's day of discharge • Endorsed by ACOG • Quick to complete

15. LANDmarks (2) • Data Collection on Day of Nursery Discharge • Hospital Nursery + OB Floor • Mothers at Home • At the Practice/Health Center • Incentives/Reimbursement

16. Data Collection on Day of Nursery Discharge • Mother completes enrollment questionnaire (MEQ) • Discharging pediatrician completes initial questionnaire (PracIQ) • Obstetrician completes obstetrical questionnaire (OBQ)

17. 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)

18. 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

19. At the Practice/Health Center • Permanent Enrollment Log • Maintenance List • One reminder phone call to mother on day 1 - 2 • MFQ 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

20. Incentives/Reimbursement • Family incentives • Newborn one-piece undergarment upon enrollment • AAP 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)

21. 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

22. 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)

23. For More Information About LAND... Please contact the PROS Central Office Phone: 800/433-9016, ext 7626 E-mail: pros@aap.org