Community-based High Risk Pregnancy Screening And Management Mode

ObjectivesThe early detection and screening high-risk pregnancy is the fundamental purpose and core of maternal health-care system. Theoretical and empirical study found that the early detection of high-risk pregnancy is not satisfied, which rooted in the limitations of existing high-risk pregnancy screening management model. Current model is based on the supply side which not only no distinguishes differences between the reality of community and medical center, but also failed to fully mobilize demand side. Therefore in order to achieve the purpose of the screening and management of high risk pregnancy and break through the limitations of existing model, this study explored the community-based model. The mode emphasizes community as a platform, thus based on the reality of community conditions, the study developed community technology; the mode emphasizes demand-side participation, thus based on the actual cognitive of demand side, the study developed the self-screening technology; the mode emphasizes the mutual participation, thus the study developed the intervention program to make sure the operate mechanism to assess the value of mode, the study carried out intervention and evaluation in pilot areas, meanwhile to transform the cognitive of pregnancy risk, the study established pregnancy risk index model, and software packaging through interventions results.MethodsGuided by principles of the health technology assessment, evidence-based medicine and behavior change theory, the study developed the community-based high-risk pregnancy technology, in the methods of literature quantitative analysis, individual interview, group interview, qualitative and quantitative multiple demonstration, field study, the health belief model, KAP theory, generalized linear models, software development and so on. Among these, the methods of literature quantitative analysis and individual interview played the role in the first and second part of the paper (High-risk pregnancy screening and management Status and High-risk pregnancy risk factors research), while the methods of individual interview, group interview, qualitative and quantitative multiple demonstration and field study were used in the third and fourth part (High-risk pregnancy community screening technology and High-risk pregnancy self-Screening technology), and the methods of group interview, field study, the health belief model, KAP theory were applied to the fifth part (Community-based high-risk pregnancy mode intervention and evaluation), and the methods of generalized linear models and software development were adopted in the sixth part (Pregnancy risk index model software).Outcomes(1) High-risk pregnancy screening and management StatusThrough the literature review, the study summarizes the status of high-risk pregnancy research. The study also found out current high-risk pregnancy health care through the baseline survey to 402 pregnant women and the focus group interviews to 5 community health centers. The results showed that the limitations of the existing high-risk pregnancy screening and management mode as follow:(1) For the supply side, it lacks the consideration of community health institution conditions; (2) For the demand-side, there is no pregnancy risk self-screening tool. The results suggest that it needs to establish community-based high risk pregnancy screening and management mode, which needs to develop targeted screening and management technologies for both the supply and demand side, that is developing high-risk pregnancy community screening scale for the supply side, developing high-risk pregnancy self-screening scale and related education materials for the demand side, and then, integrating the above two key technologies which lead to the formation of existing screening management processes with building a platform and operating mechanism for the intervention of the supply and demand side together.(2) High-risk pregnancy risk factors researchThrough the literature on 164 domestic articles and 27 domestic and foreign high-risk pregnancy screening scales, the study found the current high-risk pregnancy-related risk factors, and sorted the risk factors and analyzed the common risk factors. The study found that there are many pregnancy risk factors, and each risk factor can lead to different illness, and for each risk factor, the specific index are also different, and thus it needs to establish scientific criteria for the specific risk factors. In addition, most of the risk factors can be prevented, thus the preventive risk factors results should be the research priorities. The results provide the technical support for the follow-up study.(3) High-risk pregnancy community screening technologyThe study aims to develop the community-based high-risk pregnancy screening scale in according to the principles of "scientific, operational, timeliness" and also considering the basic conditions such as personnel, equipment of community health centers.In the development phase, the study analyzed the domestic and foreign high risk pregnancy screening scale, obstetric books and documents in accordance with the framework, the scale index, rating, etc. In the demonstration phase, the study used two rounds mode (expert evaluation and institutional evaluation) in order to demonstrate the scientific and institutional nature of the Screening scale. Expert evaluation used the focus group interview and nominal group technique, organized a total of 10 obstetric and healthcare experts. Institutional evaluation used the survey to organize 49 experts from 37 institutions of Shanghai Jiading District, Changzhou and Beijing Chaoyang District. In the Evaluation phase, the study chose 6 maternal and child health agencies from Shanghai and Jiangsu and respectively investigated 46 and 235 pregnant women using the screening scale to test the scale’s Reliability and Validity. The survey results showed that the reliability (Cronbach’s Alpha=0.954) and validity (sensitivity= 89.7%, specificity= 99.5%, Youden index= 0.89. Kappa= 0.921) were fine.(4) High-risk pregnancy self-Screening technologyThe study aims to develop a screening scale for the pregnant women not only as a maternal health care tool to increase the pregnancy knowledge and the awareness of self-care of pregnant women, but also as a screening tool to help them detect high-risk pregnancy in time, and gradually build a maternal healthcare supplier-demander mode to reduce the harm of high-risk pregnancy.In the development phase, the study analyzed the domestic and foreign high risk pregnancy screening scale, obstetric books and documents in accordance with the framework, the scale index, rating, etc. In the demonstration phase, the study used three rounds mode (expert evaluation, institutional evaluation, demander evaluation) in order to demonstrate the scientific, institutional and easy-understanding nature of the Screening scale. Expert evaluation used the focus group interview and nominal group technique, organized a total of 10 experts. Institutional evaluation used the survey to organize 44 experts from 37 institutions of Shanghai Jiading District, Changzhou and Beijing Chaoyang District. Demander evaluation used the survey to investigate 542 women. In the Evaluation phase, the study chose 6 maternal and child health agencies from Shanghai and Jiangsu and investigated 235 pregnant women using the screening scale to test the scale’s Reliability and Validity. The survey results showed that the reliability (test-retest reliability> 0.7) and validity (sensitivity= 84.6%, specificity= 74.5%, Youden index= 0.58, Kappa value= 0.41) were fine.The study developed the high-risk pregnancy family guidance which explained the risk factors and guided individuals and families how to use the table and take measures to the screening results. The study used survey to demonstrate the scientific and operational nature of the guidance, results showed that the experts agreed the significance of the guide, and revised several statements of the entry.(5) Community-based high-risk pregnancy mode intervention and evaluationTo build the platform and operating mechanism, in terms of the target, content, frequency and timing, tools, the fifth part integrated the two technologies for the supply and demand sides, and formed the intervention program. To verify the model, the study used a quasi-experimental intervention design, and made the baseline, process and terminal assessment in the pilot areas of Jiading District of Shanghai, Changzhou City of Jiangsu Province, and Chaoyang District of Beijing. The baseline assessment for 55 maternal health care providers and 542 demanders in the 16 pilot communities of the three pilot areas, analyzed the institutional conditions and the understanding of high-risk pregnancy of supply and demand side. The process assessment, through the 32 interventions, seven technical exchange presentations, stage follow-up assessment of 186 pregnant women, and case studies of four communities in the pilot areas, found that the intervention programs made good results, both the managers and supply-side actively created conditions to promote the progress of the intervention, and demand-side greatly improved screening awareness. The terminal assessment, through over 1 year of follow-up survey of 1115 intervention objects and 829 objects in the control group in the three pilot areas, showed that intervention made a well effect, all supply-side and 99.5% demand-side satisfied with the intervention programs, both sides improved their awareness of screening management technology, and the demand-side succeeded in the great change of cognition, attitude and behavior of the pregnancy risk factor.(6)Pregnancy risk index model softwareThe Study found a deviation of cognition of pregnancy risk existed in the demand-side. While demand-side considered the pregnancy risk high or not high (0/1). Therefore, once high risk was failed, the demand-side always neglected the potential risk, which used to leading a patient conflict. In order to solve the problem, the sixth part made efforts in the development of pregnancy risk index model, in which, the classification of 0 or 1 is converted to the specific risk index from 0 tol. The study made use of 1632 surveys over 1 year of follow-up, to build the pregnancy risk index model, and calculated the coefficient of risk influencing factors. Then, by simulating the data, the model was software packaged, with VBA function, which laid a foundation for the application of the technology.ConclusionsTo achieve the purpose of screening of high risk pregnancy management and break through the limitations of the current mode, the study explored the supply-based and demand-based high risk pregnancy screening technologies, and integrated the two technologies into current management process with the formation of community-based high risk pregnancy screening mode. To verify the value of the mode, the study carried out pilot intervention and evaluation. To change the cognitive bias of demand-side on pregnancy risk, the study established the pregnancy risk index model, and simulation library demonstrated its better judgment and prediction ability, the study used Excel VBA data processing platform to form the pregnancy risk model software.InnovationThe methodological innovation of the study is to build the ideas, procedures and methods of how to select, demonstrate and evaluate the community-based high-risk pregnancy screening and management technology. Technologically innovation lies in based on the community reality, we developed a community-based high-risk pregnancy screening and management tool; based on the maternal symptoms of pregnancy, we developed a high-risk pregnancy self-screening tool. The integrated innovation of this study is based on technology, we organic integrated the technologies into existing management processes, and form a community-based high-risk pregnancy screening and management intervention programs, and establish pregnancy risk index model, and software packaging using the intervention follow-up data.