Adapting COVID-19 Prenatal Care Innovations for Patients At Risk of Adverse Pregnancy Outcomes: a Mixed Methods Study of the Plan for Appropriate Tailored Healthcare in Pregnancy

针对有不良妊娠结局风险的患者采用 COVID-19 产前护理创新：针对妊娠期适当定制医疗保健计划的混合方法研究

• 批准号: 10666730
• 负责人: Alex Peahl
• 金额: $ 26.47万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-14 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10666730
• 关键词: Accident and Emergency department; Admission activity; Adopted; Adoption; Affect; American College of Obstetricians and Gynecologists; Birth; Birth Rate; Black race; COVID-19; COVID-19 pandemic; Caring; Cesarean section; Clinical; Consensus; Data; Disparity; Electronic Health Record; Emergency department visit; Ensure; Equity; Evaluation; Expert Opinion; Gestational Diabetes; Goals; Guidelines; Gynecologist; Health; Health Services Accessibility; Hybrids; Incidence; Indiana; Institution; Interview; Investigation; Knowledge; Low income; Medical; Medical Liabilities; Medical center; Medicine; Methods; Michigan; Modeling; Neonatal; Neonatal Intensive Care Units; Outcome; Outpatients; Patients; Pattern; Persons; Population; Postpartum Depression; Postpartum Period; Pre-Eclampsia; Pregnancy; Premature Birth; Prenatal care; Provider; Recommendation; Research; Research Design; Risk; Risk Factors; Sampling; Schedule; Services; Site; Small for Gestational Age Infant; Strategic Planning; Subgroup; Telemedicine; Telephone; Time; Transportation; United States; United States National Institutes of Health; Universities; Visit; Woman; Work; adverse outcome; adverse pregnancy outcome; barrier to care; black patient; care delivery; care outcomes; design; econometrics; experience; high risk; improved; innovation; intervention effect; marginalization; marginalized population; maternal outcome; neonatal outcome; overtreatment; pandemic disease; patient population; pregnant; prenatal; provider factors; rural patients; service utilization; tailored health care; traditional care

PROJECT SUMMARY/ABSTRACT BACKGROUND: Prenatal care is a critical lever for improving maternity outcomes for the 4 million women who give birth annually. Yet, the traditional model of care—a uniform 14 in-person visits—overtreats and unduly burdens many patients. The COVID-19 pandemic rapidly transformed prenatal care delivery, prompting adoption of hybrid prenatal care models (reduced visit schedules with telemedicine). These changes are the basis for new national prenatal care consensus recommendations: the Plan for Appropriate Tailored Healthcare in pregnancy (PATH). Reduced visit schedules and telemedicine are supported by evidence and expert opinion, but it is unclear how hybrid prenatal care models will affect care utilization, health outcomes, and patient and provider experience, particularly for marginalized patient groups with the worst baseline outcomes. While PATH is promising for removing access barriers, changes could have unintended consequences (e.g. more unscheduled or delayed care). Thus, there is a critical need to evaluate the effects of hybrid prenatal care models to inform adaptations for widespread implementation for medically average-risk and marginalized patient populations. OVERALL STRATEGY: This research aims to understand how hybrid prenatal care models affect service utilization and health outcomes for average-risk patients, especially those from marginalized groups (low- income, Black, and rural patients). To achieve these goals, we will conduct econometric analyses to compare prenatal care utilization and outcomes from two institutions that have initiated and maintained hybrid prenatal care models to the present (Michigan Medicine, University of Pittsburgh Medical Center) with a control site (Indiana University) that adopted the hybrid prenatal care model only from March-May 2020 before returning to traditional care. We will used mixed methods to integrate EHR data with in-depth qualitative interviews to explain differences in utilization and critical adaptations needed to improve prenatal care delivery for average- risk and key marginalized groups. RESEARCH AIMS: Our study’s aims are: 1) Evaluate the effects of hybrid prenatal care models on care utilization and health outcomes for average-risk patients. 2) Explore how patient and provider factors affect utilization of hybrid prenatal care models to inform critical adaptations for optimizing prenatal care. IMPACT: This timely investigation is highly likely to exert a sustained, powerful impact on prenatal care delivery, maternal and neonatal outcomes, and equity, with potential for particular benefit among marginalized pregnant patients.

项目概要/摘要 背景：对于 400 万妇女来说，产前护理是改善孕产结局的关键杠杆。 然而，传统的护理模式——统一 14 次亲自就诊——过度治疗和不当。 COVID-19 大流行迅速改变了产前护理的提供方式，促使其成为许多患者的负担。 采用混合产前护理模式（通过远程医疗减少就诊时间）。 新的全国产前保健共识建议的基础：适当定制计划 怀孕期间的医疗保健 (PATH) 已得到证据和支持。 专家意见，但尚不清楚混合产前护理模式将如何影响护理利用、健康结果、 患者和提供者的经验，特别是对于基线最差的边缘化患者群体 虽然 PATH 有望消除准入障碍，但变化可能会带来意想不到的结果。 后果（例如更多计划外或延迟的护理）因此，迫切需要评估其影响。 混合产前护理模式为适应医学平均风险的广泛实施提供信息 以及患者人数的减少。 总体策略：本研究旨在了解混合产前护理模式如何影响服务 平均风险患者的利用率和健康结果，特别是那些来自边缘化群体（低风险）的患者 收入、黑人和农村患者）为了实现这些目标，我们将进行计量经济学分析来进行比较。 两个已启动并维持混合产前护理的机构的产前护理利用情况和结果 迄今为止的护理模式（密歇根医学、匹兹堡大学医学中心），带有控制站点 （印第安纳大学）从 2020 年 3 月至 5 月才采用混合产前护理模式，然后又返回 我们将使用混合方法将 EHR 数据与深入的定性访谈相结合，以 解释改善平均产前护理服务所需的利用率和关键适应性的差异 风险和关键边缘群体。 研究目的：我们的研究目的是：1) 评估混合产前护理模式对护理的影响 2) 探索患者和提供者因素如何影响 利用混合产前护理模型为优化产前护理的关键调整提供信息。 影响：这项及时的调查很可能对产前护理产生持续、强大的影响 分娩、孕产妇和新生儿结局以及公平性，有可能为边缘化人群带来特别好处 怀孕患者。