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.

项目总结/摘要 背景：产前护理是改善400万妇女生育结果的关键杠杆， 每年生一次。然而，传统的护理模式--统一的14次亲自探视--过度治疗和不适当地 给许多患者带来负担。COVID-19大流行迅速改变了产前护理服务， 采用混合产前护理模式（利用远程医疗减少就诊时间）。这些变化是 新的全国产前护理共识建议的基础： 妊娠期保健（PATH）。有证据支持缩短就诊时间和远程医疗， 专家意见，但目前还不清楚混合产前护理模式将如何影响护理利用，健康结果， 以及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 结果。虽然PATH有望消除准入障碍，但变化可能会产生意想不到的影响。 后果（例如，更多的计划外或延迟护理）。因此，迫切需要评估 混合产前护理模式，为广泛实施医疗平均风险提供信息 和边缘化的患者群体。 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 平均风险患者的使用和健康结果，特别是那些来自边缘化群体的患者（低- 收入，黑人和农村患者）。为了实现这些目标，我们将进行经济计量分析， 两个机构启动和维持混合产前护理的产前护理利用率和结果 护理模式到目前为止（密歇根医学，匹兹堡大学医学中心）与控制网站 （印第安纳州大学），仅从2020年3月至5月采用混合产前护理模式，然后返回 传统护理我们将使用混合方法将EHR数据与深入的定性访谈相结合， 解释利用率的差异和改善产前护理提供所需的关键调整，平均- 风险和主要边缘化群体。 研究目的：本研究的目的是：1）评价混合式产前护理模式对产前护理的影响 平均风险患者的利用率和健康结果。2)了解患者和提供者因素如何影响 利用混合产前护理模式，为优化产前护理提供重要的适应信息。 影响：这一及时的调查很可能对产前护理产生持续、有力的影响。 分娩、孕产妇和新生儿结果以及公平，有可能使边缘化群体特别受益 怀孕的病人