StartSmart(TM): Health Information Technology to Improve Adherence to Prenatal Guidelines (Colorado)

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Summary:

Many conditions and lifestyle factors during pregnancy impact a woman’s health as well as the health of her child--some effects lasting long after birth. Despite advancements in perinatal healthcare, infant morbidity and mortality have seen little improvement in this country, and rates of severe maternal morbidity have continued to rise. Evidence points to a link between poor perinatal outcomes and pregnancy health risks, and yet adherence to prenatal guidelines that address these risks is not optimal. In addition, pregnant women are not consistently counseled on protective factors that can influence pregnancy outcomes, such as immunizations, nutrition, physical activity, and sleep. The use of technology to generate individualized, evidence-based recommendations around pregnancy risk and protective factors may lead to improved outcomes.

This research developed and evaluated a mobile health application (app) called StartSmart, to improve screening, intervention, and referrals in the care of pregnant women.

The specific aims of the project were as follows:

  • Develop StartSmart™ to screen pregnant women for health risk and protective factors throughout pregnancy and to generate individualized, evidence-based recommendations for these factors. 
  • Alpha test StartSmart™ and refine technology based upon patient and provider feedback. 
  • Beta test and refine StartSmart™ based on patient and provider feedback on acceptability and usability. 

The researchers began by developing a prototype of StartSmart™ through an iterative process that incorporated patient and provider feedback in each phase. Development of the app was informed by consultation with expert clinicians, scientists, and patients, with a goal of optimizing screening of pregnant women for prenatal risk and protective factors. Features of the tool include the generation of clinical decision support, tailored patient recommendations, and provider prompts for brief motivational interviewing counseling. After the prototype was developed, patients and providers were interviewed to provide feedback. Researchers observed the use of the tool in the clinic setting and conducted process mapping to understand the impact on patient flow as well as workload for medical assistants and front desk staff. Future interoperability with electronic health records was tested by establishing StartSmart™ connectivity with a publicly available and Fast Healthcare Interoperability Resources-compliant server. The researchers hope that the tool can aid providers in addressing pregnancy risk and protective factors in an individual and targeted manner, which may improve maternal and child health.

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StartSmart(TM): Health Information Technology to Improve Adherence to Prenatal Guidelines - Final Report

Citation:
Gance-Cleveland B. StartSmart(TM): Health Information Technology to Improve Adherence to Prenatal Guidelines - Final Report. (Prepared by the University of Colorado under Grant No. R21 HS024738). Rockville, MD: Agency for Healthcare Research and Quality, 2019. (PDF, 1.14 MB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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