Preterm births are responsible for 75 percent of neonatal mortality and one-half of long-term neurological impairments in children as well as a substantial portion of all birth-related short- and long-term morbidity. The preterm birth rate has risen 27 percent since 1981. The percent of preterm infants increased to 11.9 percent for 2001, the highest level in at least two decades accounting for more than 440,000 births annually. Preterm rates rose for each of the three largest racial/ethnic groups. Rates of low birth weight babies are higher in medically underserved and minority populations-even when issues such as access and insurance coverage are accounted for. Preterm births account for 30 percent of all health care spending on infants and 10 percent of spending for children. Timely screening and management of modifiable risks can reduce preterm birth risks and improve maternal and child quality of life. However, providing effective prenatal risk management systems to meet the unique needs of medically underserved populations is complex. The goal of this application is to develop a practical and easily delivered, evidence-based, computer-assisted intervention system to screen and assist medically underserved pregnant woman and their healthcare providers (HCPs) in managing modifiable conditions associated with increased risks of preterm births. (The HCPs will utilize this system with these patients to counsel patients on risk reduction changes the woman can make and refer when needed.) During Phase I, we will develop assessment and intervention materials (culturally and linguistically appropriate) for both Hispanic and African-American populations, complete computer programming and conduct acceptability testing during a routine 1st or 2nd trimester) prenatal care clinic visit. 20 African- American women and 20 Hispanic women will be randomly selected from outpatient clinics to complete an immediate and a short-term acceptability test. Physicians, nurse midwives and healthcare organization managers will also provide acceptability data. If Phase I acceptability tests are successful, PHCC LP will submit an application for a Phase II efficacy trial to further refine and test this system. ? ? ?
