Candidate: Michelle H. Moniz, MD, MSc is an obstetrician gynecologist and junior health services researcher focused on improving reproductive health care, especially for low-income women. Dr. Moniz's long-term career goal is to become an independent physician-investigator through development, implementation, evaluation, and dissemination of effective strategies to integrate evidence-based reproductive health services into routine clinical practice. Research Context: There is a critical need to improve access to evidence-based contraceptive care after childbirth, in order to decrease unintended pregnancy rates and improve reproductive health outcomes. One safe, effective strategy is to provide immediate postpartum long-acting reversible contraception (IPLARC) to interested women before they leave the hospital after childbirth. Currently, there is wide variation in provision of IPLARC in real-world settings due to a dearth of evidence-based guidance on successful implementation methods and strategies for monitoring service delivery.
Research Aims : The overarching goal of this proposal is to design, evaluate and disseminate evidence-based implementation strategies for IPLARC services. The study's specific aims are to: 1) Quantitatively evaluate current Medicaid claims-based approaches for measuring IPLARC provision; 2) Characterize successful IPLARC implementation experiences and develop an implementation toolkit; and 3) Evaluate the feasibility of this implementation toolkit for initiating IPLARC in a single new setting. Research Plan: Dr. Moniz will use current claims-based algorithms to measure IPLARC provision and compare findings to hospitals' self-reported provision rates. She will conduct in depth, qualitative study at 5 hospitals that have successfully implemented IPLARC services and 2 sites struggling with IPLARC implementation, in order to develop an implementation toolkit. She will then use mixed methods to evaluate the implementation toolkit's feasibility in a single new setting, in order to inform a future multi-center study. Career Development Plan: Dr. Moniz will develop expertise in: 1) claims-based monitoring of reproductive health services; 2) implementation science frameworks; 3) mixed methods; 4) responsible conduct of research. Dr. Moniz's training will be supported by highly experienced, interdisciplinary mentors; advanced didactic coursework; and participation in research and career development meetings/seminars within an ideal training environment. This award will enable Dr. Moniz to become an independent investigator and national leader in clinical service delivery and policies designed to improve reproductive health outcomes for low-income women.
Unintended pregnancy too soon after a prior birth increases the risk of pregnancy complications and negative health outcomes for women and children. Low-income women disproportionately face barriers to contraceptive access and higher unintended pregnancy rates. This research proposes to design, test and disseminate an implementation toolkit to help hospitals offer inpatient postpartum contraceptive care. Findings will help researchers, clinicians, and policymakers implement and monitor evidence-based contraceptive services, with a goal of decreasing the risk of unplanned pregnancy soon after childbirth and improving reproductive health outcomes, especially among vulnerable populations.