Compared to their higher-income counterparts, lower-income pregnant patients served at Dartmouth Health (DH) OB/GYN practices are more than 1.5 times more likely to have a preterm birth or low birthweight infant. To address the potential contribution of unmet social determinants of health (SDOH) needs during pregnancy to these and other suboptimal perinatal outcomes, DH recently launched a program of universal SDOH screening and referral to needed resources during prenatal and postpartum visits at its Lebanon, Concord, Nashua, and Bedford/Manchester OB/GYN sites. To facilitate implementation, ensure the quality and sustainability of this new program, and optimize care for our patients, we will evaluate the effectiveness of this SDOH screening and intervention program over the next 18 months. Using a mixed-methods approach, we propose to evaluate the a) acceptability of screening for patients, b) factors limiting and facilitating SDOH screening and referral performance, and c) impact on clinic and provider workflows.

Funding Source: Point 32 Health

Principal Investigators: Alka Dev (TDI) and Daisy Goodman (DH)

Research Team: Sophia Allen, Chelsey Canavan, Kathleen Robie, Beatrice Ngugi

Expanding access to effective, culturally-appropriate mental health care within and beyond the formal health system is critical to reducing the burden of adverse postpartum mental health outcomes in NH. For postpartum people to make informed choices regarding their mental health needs, dissemination of findings related to CER/PCOR-based mental health care must include community-wide dissemination—and implementation—designed and guided by patients and families to ensure access and quality and promote equity.  We aim to build a community-focused dissemination infrastructure in collaboration with Norther New England Perinatal Quality Improvement Network (NNEPQIN) for disseminating research-based innovations aimed at improving access to and quality of care and reducing disparities, with an initial focus on postpartum mental health.

Funding Source: Eugene Washington PCORI Engagement Awards Program, Patient-Centered Outcomes Research Institute

Principal Investigator: Alka Dev (TDI), Daisy Goodman (DH), Trinidad Tellez (Community)

Research Team: Lisa Lamadriz, Sophia Pérez

Studies on place-based inequity describe how inequity varies across neighborhood or area. Incorporating concepts of structural racism and structural sexism, we seek identify how individuals at the intersection of gender and race/ethnicity-based minoritized status are affected by the inequity burden. This project is guided by the question: How can intersectionality inform the assessment of area-level disparities in maternal and infant health outcomes? We aim to generate an empirical measure of intersectional inequality that captures contextual pathways through which structural inequity influences maternal and infant health outcomes among Black and Brown individuals. The measure will be made publicly available.

Principal Investigator: Alka Dev

Research Team: Sophia Pérez, Chris Leggett