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

项目摘要/摘要 背景：产前护理是改善400万妇女产后结局的关键杠杆 每年生一胎。然而，传统的护理模式--统一的14次面对面探视--过度和过度 加重了许多病人的负担。新冠肺炎大流行迅速改变了产前护理交付，促使 采用混合产前护理模式(通过远程医疗减少探视时间表)。这些变化是 新的国家产前护理共识建议的基础：适当量身定制的计划 孕期保健(路径)。减少的探视计划和远程医疗得到了证据和 专家意见，但尚不清楚混合型产前护理模式将如何影响护理利用率、健康结局、 以及患者和提供者的体验，特别是对于基线最差的边缘化患者群体 结果。尽管Path有望消除访问障碍，但变化可能是意想不到的 后果(例如，更多计划外或延迟的护理)。因此，迫切需要评估以下措施的效果 混合产前护理模式，为医学平均风险的广泛实施提供信息 以及被边缘化的患者群体。 总体策略：本研究旨在了解混合型产前护理模式如何影响服务 中等风险患者的利用和健康结果，特别是来自边缘群体(低风险患者)的患者 收入、黑人和农村患者)。为了实现这些目标，我们将进行计量分析，以比较 发起和维持杂交产前的两家机构的产前护理利用和结局 到目前为止的护理模式(密歇根医学，匹兹堡大学医学中心)和控制点 (印第安纳大学)仅在2020年3-5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，以 解释平均而言，改善产前护理交付所需的利用率和关键适应方面的差异- 风险和关键的边缘化群体。 研究目的：我们的研究目的是：1)评估混合型产前护理模式对护理的影响 中等风险患者的利用和健康结果。2)探讨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的关键适应提供信息。 影响：这一及时的调查极有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，有可能使边缘化群体特别受益 怀孕的病人。

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.