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Principal Investigator: Alex Peahl
Organization: UNIVERSITY OF MICHIGAN AT ANN ARBOR
Fiscal Year: 2024
Award: $188,565
Funding agency: Eunice Kennedy Shriver National Institute of Child Health and Human Development
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.
Terms: <ACOG><Abdominal Delivery><Access to Care><Accident and Emergency department><Admission><Admission activity><Adopted><Adoption><Affect><American College of Obstetricians and Gynecologists><Birth><Birth Rate><Black><Black race><C section><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><CV-19><Caring><Cesarean><Cesarean section><Clinical><Consensus><Coronavirus Infectious Disease 2019><Data><Disparities><Disparity><ED visit><EPH Gestosis><ER visit><Electronic Health Record><Emergency Department><Emergency care visit><Emergency department visit><Emergency hospital visit><Emergency room><Emergency room visit><Ensure><Equity><Evaluation><Expert Opinion><Gestation><Gestational Diabetes><Gestational Diabetes Mellitus><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><NIH><National Institutes of Health><Neonatal><Neonatal Intensive Care Units><Newborn Intensive Care Units><Out-patients><Outcome><Outpatients><Parturition><Patients><Pattern><Persons><Phone><Population><Post-Natal Depression><Post-Partum Depression><Postnatal Depression><Postpartum Depression><Postpartum Period><Pre-Eclampsia><Preeclampsia><Pregnancy><Pregnancy Toxemias><Pregnancy-Induced Diabetes><Premature Birth><Prematurely delivering><Prenatal care><Preterm Birth><Proteinuria-Edema-Hypertension Gestosis><Provider><Recommendation><Research><Research Design><Risk><Risk Factors><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Sampling><Schedule><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Site><Small for Gestational Age Infant><Strategic Planning><Study Type><Subgroup><Telemedicine><Telephone><Time><Transportation><United States><United States National Institutes of Health><Universities><Visit><Woman><Work><access to health services><access to services><access to treatment><accessibility to health services><adverse consequence><adverse outcome><adverse pregnancy outcome><availability of services><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><black patient><care access><care delivery><care outcomes><clinician factors><clinician-level factors><coronavirus disease 2019><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><coronavirus infectious disease-19><design><designing><econometrics><electronic health care record><electronic health medical record><electronic health plan record><electronic health registry><electronic medical health record><experience><health care outcomes><health service access><health services availability><healthcare outcomes><high risk><improved><innovate><innovation><innovative><intervention effect><marginalization><marginalized group><marginalized individual><marginalized people><marginalized population><maternal outcome><mother outcome><neonatal ICU><neonatal outcome><obstacle to care><obstacle to healthcare><over-treatment><overtreatment><pandemic><pandemic disease><patient population><physician factors><physician-level factors><post-partum><pre-eclamptic><pregnancy care><pregnancy diabetes><pregnancy toxemia/hypertension><pregnant><premature childbirth><premature delivery><prenatal><prenatal appointment><prenatal checkup><prenatal visit><preterm delivery><provider factors><provider-level factors><rural patients><service availability><service utilization><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><small for gestational age><study design><tailored health care><tailored healthcare><traditional care><treatment access><unborn>