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

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.