Implementation research priorities for addressing the maternal health crisis in the United States: Results from a modified Delphi study

Abstract

Abstract Background: Maternal health outcomes in the United States are far worse than peer nations. Increasing implementation research in maternity care is critical to addressing quality gaps and unwarranted care variations. Implementation research priorities have not yet been defined or well represented in the plans for maternal health research investments in the United States. Methods:This descriptive study used a modified Delphi method to solicit and rank research priorities at the intersection of implementation science and maternal health. A purposeful, yet broad sample of researchers with relevant subject matter knowledge was identified through searches of published articles and grant databases. Through two sequential web-based surveys, participants submitted and ranked implementation research topics with five areas specific to implementation research: practices to prioritize for (1) broader implementation or (2) de-implementation, and research questions about (3) determinants of implementation, (4) implementation strategies, and (5) research methods/measures. Results:Eighty-two researchers, predominantly female (90%) and white (75%), volunteered to participate. Sixty completed at least one of two surveys. The practices that participants prioritized for broader implementation were improved postpartum care, perinatal and postpartum mood disorder screening and management, and standardized management of hypertensive disorders of pregnancy. For de-implementation, practices believed to be most impactful if removed from or reduced in maternity care were cesarean delivery for low-risk patients and routine discontinuation of all psychiatric medications during pregnancy. The top methodological priorities of participants were improving the extent to which implementation science frameworks and measures address equity and developing approaches for involving patients in implementation research. Conclusions: Through a web-based Delphi exercise, we identified implementation research priorities that researchers consider to have the greatest potential to improve the maternity care quality in the United States. This study also demonstrates the feasibility of using modified Delphi approaches to engage researchers in setting implementation research priorities within a clinical area.