Evaluating the Implementation of the Liaison and Support System (LEA) at André Grégoire CHI: A Model for Integrating Obstetric Care in Vulnerable Populations

Introduction:The maternal mortality rate is a key health status indicator. Maternal health is largely impacted by social inequalities in health. Seine-Saint-Denis is the most unequal department in the Ilede-France region. The André Grégoire Intercommunal Hospital Center (CHI) is a reference point in the field of obstetric care as well as in the identification and support of vulnerable pregnant women who live in this department. Within this context, the Maternity Unit created the midwife career representative system or Liaison and Support project (LEA) financed by the Regional Health Agency. The goal of this research paper is to assess the implementation of this LEA project in the André Grégoire CHI. Methodology:We chose to use a qualitative study to assess the LEA project. We turned to an inductive qualitative approach using a constructivist paradigm. We used semi-structured interviews with open-ended questions. The patients who were selected had given birth in the André Grégoire CHI. We also plan to follow up with the patients after their hospitalization. We also conducted interviews with professionals in the Maternity Unit.Results: A total of 36 interviews was conducted with 16 patients and 20 health care professionals. The age of the mothers ranged from 19 to 38. All the patients had health insurance. The patients who were interviewed acknowledged the quality of care they received in the Maternity Department. Social support is a positive condition in the treatment system of women. However, the COVID 19 crisis led to difficulties for the patients during the post-partum period. The Hospital Center is also recognized for its obstetric care by the midwives. The main challenges to implementing the LEA project were the lack of communication and the competition that we observed. The lack of human and financial resources also has a negative impact on the quality of work life. The LEA project has the potential to reduce the workload -including administrative-of the midwives. Finally, the cityhospital link still needs to be created.Discussion: A managerial role is key if the LEA project is to succeed. The implementation of communication strategies in the Maternity Department is required. The merging of the LEA project and the Unit of Personalized support (UAP) is considered as a viable cooperation strategy. This merging would prevent redundancy. A communication campaign with independent midwives will also be necessary. A quantitative study is proposed in a second analysis. However, the financial situation of the CHI might prevent it from implementing this project. Conclusion:The implementation of the midwife career representative system could improve the treatment system of patients, provided: the relay to the hospital is guaranteed and the communication with the city is effective. The proposed LEA project should ensure the managerial and the coordination of care aspects so that patients can enjoy a continuity of care after leaving the hospital.