1. Pediatric Research in Office Settings (PROS)

2. Introduction  Four million births each year in U.S.  Decreasing lengths of postpartum stay  Responsibility for health promotion and monitoring shifts to outpatient  Decision-making for readiness is complex

3. Research Questions  How often do mothers, pediatricians, and obstetricians agree on readiness for postpartum discharge?  What influences these perceptions of readiness?  How do these perceptions impact health care utilization, health outcomes, and health-related behaviors during the first four weeks after discharge?  How do these perceptions change over time?

4. Study Design Prospective observational cohort study 6,000 mother/infant dyads Followed for first 4 weeks after discharge

5. Inclusion Criteria  Term babies (37+ weeks)  Birth weight  5 pounds  To be followed in PROS practices after discharge

6. Exclusion Criteria  Maternal chronic illness  Twin or multiple birth  Mother without a phone  Infant in SCN  8 hours for medical reasons  Major congenital anomaly  Infants for adoption

8. Data Collection: Overview Demographics (1 practice form + 1 for each clinician) Day of discharge questionnaires (mother, pediatrician, obstetrician) Daily diary for first 2 weeks post discharge (mother) Brief encounter form with each office visit (pediatrician) 4 weeks after nursery discharge (mother, pediatrician)

9. LANDmarks (1) Practice Recruitment Study Coordinator Institutional Review Board at Hospital Mother Recruitment Hospital Obstetricians

10. Practice Recruitment Demographic Questionnaire (1 per practice) and Practitioner Surveys (each clinician) Maximum participation = 12 weeks  Enrollment = 8 weeks  Follow-up = 1 month 8 weeks enrollment or 40 - 60 dyads (whichever is first) Key questions for covering clinicians to minimize workload

11. Study Coordinator Organize study materials at hospital(s) and office Implement study  Mobile and Permanent Enrollment Logs  Maintenance List Establish recruitment Monitor ALL study details

12. Institutional Review Board (IRB) at Hospital Need local IRB approval letter prior to study start Local Principal Investigator (PI) required Local application necessary for expedited or full review AAP IRB materials available to "cut and paste” into application

13. Mother Recruitment Approach mothers during postpartum stay Record mother/infant dyads on Mobile Enrollment Log Have mother sign consent form Discuss mother's enrollment packet

14. Hospital Obstetricians Engage OBs  Personal contact  Attend OB Dept. Meeting Complete Obstetrical Questionnaire (OBQ) on mother's day of discharge  Endorsed by ACOG  Quick to complete

15. LANDmarks (2) Data Collection on Day of Nursery Discharge Hospital Nursery + OB Floor Mothers at Home At the Practice/Health Center Incentives/Reimbursement

16. Data Collection on Day of Nursery Discharge Mother completes enrollment questionnaire (MEQ) Discharging pediatrician completes initial questionnaire (PracIQ) Obstetrician completes obstetrical questionnaire (OBQ)

17. Hospital Nursery + OB Floor Mobile Enrollment Log - all eligible mothers Mother/infant dyad enrollment (LAND onesie) To be completed on day of discharge:  Obstetrical Questionnaire (OBQ)  Practitioner Initial Questionnaire (PracIQ; key questions for covering clinicians)  Mother’s Enrollment Questionnaire (MEQ)

18. Mothers at Home Mother’s Daily Diary (MDD) for 14 days post nursery discharge Mother’s Follow-Up Questionnaire (MFQ) OB Postpartum Follow-Up Visit Postcard Mothers receive AAP parenting book upon completion

19. At the Practice/Health Center Permanent Enrollment Log Maintenance List  One reminder phone call to mother on day 1 - 2  MFQ Reminder postcard at 3 weeks post-discharge Practitioner Encounter Questionnaire (PracEQ) to capture all visits Practitioner Follow-Up Questionnaire (PracFQ) at 4 weeks post nursery discharge Reimbursement to defray expenses

20. Incentives/Reimbursement Family incentives  Newborn one-piece undergarment upon enrollment  AAP parenting book upon completion of the Mother’s Daily Diary Practice reimbursement  $30 for each mother/infant pair enrolled with complete practitioner study materials (initial, encounter, & follow-up questionnaires)

21. LAND Study Funding Health Resources and Services Administration Maternal and Child Health Bureau (HRSA MCHB) AAP Friends of Children Corporate Fund AAP Friends of Children Research in Pediatric Practice Fund

22. Visit LAND on the PROS Web Page For more information about the LAND Study, visit the PROS Web page. The PROS page is located on the American Academy of Pediatrics Web page at http://www.aap.org Click on Research, then click on PROS, then click on Life Around Newborn Discharge (LAND)

23. For More Information About LAND... Please contact the PROS Central Office Phone: 800/433-9016, ext 7626 E-mail: pros@aap.org