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Chen D, Cai Q, Yang R, Xu W, Lu H, Yu J, Chen P, Xu X. Women's experiences with Centering-Based Group Care in Zhejiang China: A pilot study. Women Birth 2024; 37:101618. [PMID: 38703517 DOI: 10.1016/j.wombi.2024.101618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The group prenatal care model, which caters to women with low medical needs but high support needs, has become a highly prevalent and innovative approach implemented globally. For Centering-Based Group Care (CBGC) to remain effective, women's evaluations of the quality of care and perspectives about the model are crucial. AIM This study aimed to describe women's appraisal of CBGC quality and explore the experiences of women in the mixed-methods pilot study conducted in Zhejiang, China. METHODS From August 2021 to December 2022, 20 women provided complete quantitative data using the Quality of Prenatal Care Questionnaire before hospital discharge. Semi-structured interviews were conducted at 6 months postpartum. Qualitative data were analysed using Colaizzi's method. FINDINGS The mean (standard deviation) total score (of the 5) of the questionnaire was 4.43 (0.1) with a good quality of CBGC. Qualitative research identified five themes: motivations and concerns for participation, the appeal of interactive learning, the development of community ties and social support, healing from psychological trauma with CBGC, and suggestions for CBGC enhancement. DISCUSSION Women rated CBGC quality as good and benefited significantly from it in the study. As a new alternative option, the women's accounts suggested that CBGC performed excellently in enhancing knowledge, strengthening social bonds, and providing psychological support. CONCLUSION CBGC quality cannot be determined based on limited the sample size. This pilot study provides evidence regarding the beneficial effects of knowledge, socialization, and psychological healing on CBGC. Further research is suggested to measure CBGC effectiveness and quality.
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Affiliation(s)
- Danqi Chen
- Nursing Department, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Qian Cai
- Nursing Department, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Rui Yang
- School of Nursing, Capital Medical University, Beijing, China
| | - Wenli Xu
- Obstetrics Department, Haining Maternal and Child Health Hospital, Branch of Women's Hospital School of Medicine Zhejiang University, Haining, Zhejiang, China
| | - HongMei Lu
- Nursing Department, Haining Maternal and Child Health Hospital, Branch of Women's Hospital School of Medicine Zhejiang University, Haining, Zhejiang, China
| | - Jinghua Yu
- Obstetrics Department, Haining Maternal and Child Health Hospital, Branch of Women's Hospital School of Medicine Zhejiang University, Haining, Zhejiang, China
| | - Peihua Chen
- Nursing Department, Haining Maternal and Child Health Hospital, Branch of Women's Hospital School of Medicine Zhejiang University, Haining, Zhejiang, China
| | - Xinfen Xu
- Nursing Department, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China.
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Maghalian M, Abbasalizadeh F, Mohammad-Alizadeh-Charandabi S, Ghanbari-Homaie S, Mirghafourvand M. Implementation and evaluation of the centering pregnancy group prenatal care model in pregnant women with diabetes: a convergent parallel mixed methods study protocol. Reprod Health 2024; 21:54. [PMID: 38637855 PMCID: PMC11025169 DOI: 10.1186/s12978-024-01792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Diabetes during pregnancy has negative effects on both mothers and their fetuses. To improve perinatal outcomes and women's experience of care, the World Health Organization (WHO) suggests implementing health system interventions to enhance the use and quality of antenatal care. The main goal of this study is to implement and evaluate the outcomes of the Centering Pregnancy group care model for pregnant women with diabetes. METHODS/DESIGN The study will consist of three phases: a quantitative phase, a qualitative phase, and a mixed phase. In the quantitative phase, a randomized controlled trial will be conducted on 100 pregnant women with diabetes receiving prenatal care in Tabriz City, Iran. The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire will also be validated in this phase. The qualitative phase will use qualitative content analysis with in-depth and semi-structured individual interviews to explore pregnant women's understanding of the impact of the Centering Pregnancy group care model on their care process. The mixed phase will focus on the degree and extent of convergence between quantitative and qualitative data. DISCUSSION The implementation of the Centering Pregnancy group care approach is anticipated to empower women in effectively managing their diabetes during pregnancy, resulting in improved outcomes for both mothers and newborns. Furthermore, adopting this approach has the potential to alleviate the financial burden of diabetes on healthcare system. TRIAL REGISTRATION Iranian Registry of Clinical Trials (IRCT): (IRCT20120718010324N80/ Date of registration: 2024-01-03). URL: https://irct.behdasht.gov.ir/trial/74206 .
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Affiliation(s)
- Mahsa Maghalian
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Abbasalizadeh
- Women's Reproductive Health Research Center, Department of Perinatology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Solmaz Ghanbari-Homaie
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
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Wagijo MA, Crone M, Bruinsma-van Zwicht B, van Lith J, Billings D, Rijnders M. The Effect of CenteringPregnancy Group Antenatal Care on Maternal, Birth, and Neonatal Outcomes Among Low-Risk Women in the Netherlands: A Stepped-Wedge Cluster Randomized Trial. J Midwifery Womens Health 2024; 69:191-201. [PMID: 38339816 DOI: 10.1111/jmwh.13582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/10/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION This study was carried out to assess the effects of participating in CenteringPregnancy (CP) on maternal, birth, and neonatal outcomes among low-risk pregnant women in the Netherlands. METHODS A total of 2124 pregnant women in primary care were included in the study. Data were derived from the Dutch national database, Perined, complemented with data from questionnaires completed by pregnant women. A stepwise-wedge design was employed; multilevel intention-to-treat analyses and propensity score matching were the main analytic approaches. Propensity score matching resulted in sample sizes of 305 nulliparous women in both the individual care (IC) and the matched control group (control-IC) and 267 in the CP and control-CP groups. For multiparous women, 354 matches were found for IC and control-IC groups and 152 for CP and control-CP groups. Main outcome measures were maternal, birth, and neonatal outcomes. RESULTS Compared with the control-CP group receiving standard antenatal care, nulliparous women participating in CP had a lower risk of maternal hypertensive disorders (odds ratio [OR], 0.53; 95% CI, 0.30-0.93) and for the composite adverse maternal outcome (OR, 0.52; 95% CI, 0.33-0.82). Breastfeeding initiation rates were higher amongst nulliparous (OR, 2.23; 95% CI, 134-3.69) and multiparous women (OR, 1.62; 95% CI, 1.00-2.62) participating in CP compared with women in the control-CP group. CONCLUSION Nulliparous women in CP were at lower risk of developing hypertensive disorders during pregnancy and, consequently, at lower risk of having adverse maternal outcomes. The results confirmed our hypothesis that both nulliparous and multiparous women who participated in CP would have higher breastfeeding rates compared with women receiving standard antenatal care.
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Affiliation(s)
- Mary-Ann Wagijo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Health Promotion, Prevention and Care, Maastricht University, Maastricht, The Netherlands
| | - Mathilde Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Health Promotion, Prevention and Care, Maastricht University, Maastricht, The Netherlands
| | | | - Jan van Lith
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Deborah Billings
- Group Care Global, Philadelphia, Pennsylvania
- University of South Carolina, Columbia, South Carolina
| | - Marlies Rijnders
- Department of Child Health, Dutch Organization of Applied Scientific Research, Leiden, The Netherlands
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Place JM, Van De Griend K, Zhang M, Schreiner M, Munroe T, Crockett A, Ji W, Hanlon AL. National assessment of obstetrics and gynecology and family medicine residents' experiences with CenteringPregnancy group prenatal care. BMC Pregnancy Childbirth 2023; 23:805. [PMID: 37990297 PMCID: PMC10664296 DOI: 10.1186/s12884-023-06124-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 11/13/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE To examine family medicine (FM) and obstetrician-gynecologist (OB/GYN) residents' experiences with CenteringPregnancy (CP) group prenatal care (GPNC) as a correlate to perceived likelihood of implementing CP in future practice, as well as knowledge, level of support, and perceived barriers to implementation. METHODS We conducted a repeated cross-sectional study annually from 2017 to 2019 with FM and OB/GYN residents from residency programs in the United States licensed to operate CP. We applied adjusted logistic regression models to identify predictors of intentions to engage with CP in future practice. RESULTS Of 212 FM and 176 OB/GYN residents included in analysis, 67.01% of respondents intended to participate as a facilitator in CP in future practice and 51.80% of respondents were willing to talk to decision makers about establishing CP. Both FM and OB/GYN residents who spent more than 15 h engaged with CP and who expressed support towards CP were more likely to participate as a facilitator. FM residents who received residency-based training on CP and who were more familiar with CP reported higher intention to participate as a facilitator, while OB/GYN residents who had higher levels of engagement with CP were more likely to report an intention to participate as a facilitator. CONCLUSION Engagement with and support towards CP during residency are key factors in residents' intention to practice CP in the future. To encourage future adoption of CP among residents, consider maximizing resident engagement with the model in hours of exposure and level of engagement, including hosting residency-based trainings on CP for FM residents.
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Affiliation(s)
- Jean Marie Place
- Department of Nutrition and Health Science, Public Health, Ball State University, Office 546, 1613 W. Riverside Ave, Muncie, IN, USA.
| | - Kristin Van De Griend
- Department of Health Sciences, Community and Public Health, Idaho State University, Pocatello, ID, USA
| | - Mengxi Zhang
- Health Systems and Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | | | - Tanya Munroe
- Quality and Special Initiatives, Centering Healthcare Institute, Boston, MA, USA
| | - Amy Crockett
- Department of Obstetrics and Gynecology, Prisma Health, Greenville, SC, USA
| | - Wenyan Ji
- Department of Statistics, Center for Biostatistics and Health Data Science, Virginia Tech, Roanoke, VA, USA
| | - Alexandra L Hanlon
- Department of Statistics, Biostatistics and Health Data Science, Virginia Tech, Roanoke, VA, USA
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Wagijo MA, Crone M, Zwicht BBV, van Lith J, Billings DL, Rijnders M. Contributions of CenteringPregnancy to women's health behaviours, health literacy, and health care use in the Netherlands. Prev Med Rep 2023; 35:102244. [PMID: 37415970 PMCID: PMC10320596 DOI: 10.1016/j.pmedr.2023.102244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 07/08/2023] Open
Abstract
The objective of this study was to assess the effects of CenteringPregnancy (CP) in the Netherlands on different health outcomes. A stepped wedged cluster randomized trial was used, including 2132 women of approximately 12 weeks of gestation, from thirteen primary care midwifery centres in and around Leiden, Netherlands. Data collection was done through self-administered questionnaires. Multilevel intention-to-treat analysis and propensity score matching for the entire group and separately for nulliparous- and multiparous women were employed. The main outcomes were: health behaviour, health literacy, psychological outcomes, health care use, and satisfaction with care. Women's participation in CP is associated with lower alcohol consumption after birth (OR = 0.59, 95 %CI 0.42-0.84), greater consistency with norms for healthy eating and physical activity (β = 0.19, 95 %CI 0.02-0.37), and higher knowledge about pregnancy (β = 0.05, 95 %CI 0.01-0.08). Compared to the control group, nulliparous women who participating in CP reported better compliance to the norm for healthy eating and physical activity (β = 0.28, 95 %CI0.06-0.51)) and multiparous CP participants consumed less alcohol after giving birth (OR = 0.42, 95 %CI 0.23-0.78). Health care use and satisfaction rates were significantly higher among CP participants. A non-significant trend toward lower smoking rates was documented among CP participants. Overall, the results of this study reveal a positive (postpartum) impact on fostering healthy behaviours among participants.
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Affiliation(s)
- Mary-ann Wagijo
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Mathilde Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Birgit Bruinsma-van Zwicht
- Department of Obstetrics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Jan van Lith
- Department of Obstetrics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Deborah L. Billings
- Group Care Global, 6520 Wissahickon Ave., Philadelphia, PA 19119, USA
- University of South Carolina (Columbia, SC) / University of North Carolina, Chapel Hill, NC, USA
| | - Marlies Rijnders
- Department of Child Health, TNO, PO Box 22152301 CE, Leiden, The Netherlands
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Chen Y, Crockett AH, Britt JL, Zhang L, Nianogo RA, Qian T, Nan B, Chen L. Group vs Individual Prenatal Care and Gestational Diabetes Outcomes: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2330763. [PMID: 37642966 PMCID: PMC10466168 DOI: 10.1001/jamanetworkopen.2023.30763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023] Open
Abstract
Importance The impact of group-based prenatal care (GPNC) model in the US on the risk of gestational diabetes (GD) and related adverse obstetric outcomes is unknown. Objective To determine the effects of the GPNC model on risk of GD, its progression, and related adverse obstetric outcomes. Design, Setting, and Participants This is a single-site, parallel-group, randomized clinical trial conducted between February 2016 and March 2020 at a large health care system in Greenville, South Carolina. Participants were individuals aged 14 to 45 years with pregnancies earlier than 21 weeks' gestational age; follow-up continued to 8 weeks post partum. This study used an intention-to-treat analysis, and data were analyzed from March 2021 to July 2022. Interventions Eligible participants were randomized to receive either CenteringPregnancy, a widely used GPNC model, with 10 group-based sessions or traditional individual prenatal care (IPNC). Main Outcomes and Measures The primary outcome was the incidence of GD diagnosed between 24 and 30 weeks of gestation. The secondary outcomes included progression to A2 GD (ie, GD treated with medications) and GD-related adverse obstetric outcomes (ie, preeclampsia, cesarean delivery, and large for gestational age). Log binomial models were performed to estimate risk differences (RDs), 95% CIs, and P values between GPNC and IPNC groups, adjusting for all baseline covariates. Results Of all 2348 participants (mean [SD] age, 25.1 [5.4] years; 952 Black participants [40.5%]; 502 Hispanic participants [21.4%]; 863 White participants [36.8%]), 1176 participants were randomized to the GPNC group and 1174 were randomized to the IPNC group. Among all participants, 2144 (91.3%) completed a GD screening (1072 participants [91.3%] in GPNC vs 1071 [91.2%] in IPNC). Overall, 157 participants (6.7%) developed GD, and there was no difference in GD incidence between the GPNC (83 participants [7.1%]) and IPNC (74 participants [6.3%]) groups, with an adjusted RD of 0.7% (95% CI, -1.2% to 2.7%). Among participants with GD, GPNC did not reduce the risk of progression to A2 GD (adjusted RD, -6.1%; 95% CI, -21.3% to 9.1%), preeclampsia (adjusted RD, -7.9%; 95% CI, -17.8% to 1.9%), cesarean delivery (adjusted RD, -8.2%; 95% CI, -12.2% to 13.9%), and large for gestational age (adjusted RD, -1.2%; 95% CI, -6.1% to 3.8%) compared with IPNC. Conclusions and Relevance In this secondary analysis of a randomized clinical trial among medically low-risk pregnant individuals, the risk of GD was similar between participants who received GPNC intervention and traditional IPNC, indicating that GPNC may be a feasible treatment option for some patients. Trial Registration ClinicalTrials.gov Identifier: NCT02640638.
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Affiliation(s)
- Yixin Chen
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Amy H. Crockett
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Prisma Health, Greenville, South Carolina
- University of South Carolina School of Medicine, Greenville
| | - Jessica L. Britt
- Department of Obstetrics and Gynecology, Prisma Health, Greenville, South Carolina
| | - Lu Zhang
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina
| | - Roch A. Nianogo
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
- California Center for Population Research, Los Angeles
| | - Tianchen Qian
- Department of Statistics, University of California, Irvine
| | - Bin Nan
- Department of Statistics, University of California, Irvine
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
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Moyett JM, Ramey-Collier K, Zambrano Guevara LM, MacDonald A, Kuller JA, Wheeler SM, Dotters-Katz SK. CenteringPregnancy: A Review of Implementation and Outcomes. Obstet Gynecol Surv 2023; 78:490-499. [PMID: 37594439 DOI: 10.1097/ogx.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Importance CenteringPregnancy (CP) is a model for group prenatal care associated with improved perinatal outcomes for preterm birth and low birthweight, increased rates of breastfeeding, and higher rates of patient and clinician satisfaction. Objective The study aims to review the literature related to perinatal outcomes associated with CP, benefits and barriers to implementation, and utility of the model. Evidence An electronic-based search was performed in PubMed using the search terms "CenteringPregnancy" OR "Centering Pregnancy," revealing 221 articles. Results The CP model improves patient centeredness, efficiency, and equality in prenatal care. Challenges include administrative buy-in, limited resources, and financial support. Multisite retrospective studies of CP demonstrate improved maternal, neonatal, postpartum, and well-being outcomes, especially for participants from minority backgrounds; however, prospective studies had mixed results. CenteringPregnancy is feasibly implemented with high tenet fidelity in several low- and middle-income settings with improved perinatal outcomes compared with traditional care. Conclusions CenteringPregnancy is feasible to implement, largely accepted by communities, and shows positive qualitative and quantitative health outcomes. This body of literature supports CP as a potential tool for decreasing racial inequalities in prenatal access, quality of care, and maternal mortality. Further investigation is necessary to inform obstetric clinicians about the potential outcome differences that exist between group and traditional prenatal care.
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Affiliation(s)
- Julia M Moyett
- Medical Student, Duke University School of Medicine, Durham, NC
| | | | | | - Amy MacDonald
- Director, Group Care, Pomelo Care Affiliation, Bethesda, MD
| | | | | | - Sarah K Dotters-Katz
- Associate Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, NC
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Davis KM, Jones KA, Yee LM, Feinglass J. Modeling the Likelihood of Low Birth Weight: Findings from a Chicago-Area Health System. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01360-0. [PMID: 35799041 PMCID: PMC9823150 DOI: 10.1007/s40615-022-01360-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study presents a statistical model of the incidence of low birth weight (LBW) births in a large, Chicago-area hospital system. The study was undertaken to provide a strategic framework for future health system interventions. METHODS Administrative and electronic health records were matched to census Zip Code Tabulation Area (ZCTA) household poverty data for 42,681 births in 2016-2019 at seven system hospitals, serving a diverse patient population. A logistic regression model of LBW incidence was estimated to test the independent significance of maternal sociodemographic characteristics after controlling for clinical risk factors. RESULTS The incidence of LBW was 6.3% overall but 11.3% among non-Hispanic Black patients as compared to 5.1% among non-Hispanic White patients. LBW incidence ranged from 9.2% for patients from the poorest ZCTA (20% + poor households) compared to 5.6% of patients from the most affluent (< 5% poor) ZCTA. Nulliparous patients, patients with pre-existing chronic conditions, and patients with hypertensive disorders of pregnancy were significantly more likely to have LBW births. After controlling for clinical risk factors and poverty level, non-Hispanic Black patients were still over 80% more likely and to have a LBW birth. DISCUSSION Study findings reveal the joint effects of social and clinical risk factors. Findings profile our highest-risk populations for targeted interventions. Promising prenatal care redesign programs include pregnancy patient navigators, home and group visits, eHealth telemonitoring, improved mental health screening, and diversification of the maternity care workforce. Decreasing LBW births should be a national public health policy priority and will require major investments in the most impacted communities.
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Affiliation(s)
- Ka’Derricka M. Davis
- Division of Maternal and Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Lynn M. Yee
- Division of Maternal and Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Northwestern Feinberg School of Medicine, Chicago, IL
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Understanding and Reducing Persistent Racial Disparities in Preterm Birth: a Model of Stress-Induced Developmental Plasticity. Reprod Sci 2022; 29:2051-2059. [PMID: 35298790 DOI: 10.1007/s43032-022-00903-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/27/2022] [Indexed: 10/18/2022]
Abstract
Preterm birth is a leading cause of neonatal mortality and is characterized by substantial racial disparities in the US. Despite efforts to reduce preterm birth, rates have risen and racial disparities persist. Maternal stress is a risk factor for preterm birth; however, often, it is treated as a secondary variable rather than a primary target for intervention. Stress is known to affect several biological processes leading to downstream sequelae. Here, we present a model of stress-induced developmental plasticity where maternal stress is a key environmental cue impacting the length of gestation and therefore a primary target for intervention. Black women experience disproportionate and unique maternal stressors related to perceived racism and discrimination. It is therefore not surprising that Black women have disproportionate rates of preterm birth. The downstream effects of racism on preterm birth pathophysiology may reflect an appropriate response to stressors through the highly conserved maternal-fetal-placental neuroendocrine stress axis. This environmentally sensitive system mediates both maternal stress and the timing of birth and is a mechanism by which developmental plasticity occurs. Fortunately, stress does not appear to be an all-or-none variable. Evidence suggests that developmental plasticity is dynamic, functioning on a continuum. Therefore, simple, stress-reducing interventions that support pregnant women may tangibly reduce rates of preterm birth and improve birth outcomes for all women, particularly Black women.
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Lewis JB, Cunningham SD, Shabanova V, Hassan SS, Magriples U, Rodriguez MG, Ickovics JR. Group prenatal care and improved birth outcomes: Results from a type 1 hybrid effectiveness-implementation study. Prev Med 2021; 153:106853. [PMID: 34678329 DOI: 10.1016/j.ypmed.2021.106853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022]
Abstract
To compare birth outcomes for patients receiving Expect With Me (EWM) group prenatal care or individual care only, we conducted a type 1 hybrid effectiveness-implementation trial (Detroit and Nashville, 2014-2016). Participants entered care <24 weeks gestation, had singleton pregnancy, and no prior preterm birth (N = 2402). Mean participant age was 27.1 (SD = 5.77); 49.5% were Black; 15.3% were Latina; 59.7% publicly insured. Average treatment effect of EWM compared to individual care only was estimated using augmented inverse probability weighting (AIPW). This doubly-robust analytic method produces estimates of causal association between treatment and outcome in the absence of randomization. AIPW was effective at creating equivalent groups for potential confounders. Compared to those receiving individual care only, EWM patients did significantly better on three of four primary outcomes: lower risk of infants born preterm (<37 weeks gestation; 6.4% vs. 15.1%, risk ratio (RR) 0.42, 95% Confidence Interval (CI) 0.29, 0.54), low birthweight (<2500 g; 4.3% vs. 11.6%, RR 0.37, 95% CI 0.24, 0.49), and admission to NICU (9.4% vs. 14.6%, RR 0.64, 95% CI 0.49, 0.78). There was no difference in small for gestational age (<10% percentile of weight for gestational age). EWM patients attended a mean of 5.9 group visits (SD = 2.7); 70% attended ≥5 group visits. Post-hoc analyses indicated EWM patients utilizing the integrated information technology platform had lower risk for low birthweight infants (RR 0.47, 95% CI 0.24, 0.86) than non-users. Future research is needed to understand mechanisms by which group prenatal care improves outcomes, best practices for implementation, and health systems savings. Trial registration: ClinicalTrials.govNCT02169024.
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Affiliation(s)
- Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America.
| | - Shayna D Cunningham
- Department of Public Health Sciences, UConn Health, Farmington, CT, United States of America
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States of America
| | - Sonia S Hassan
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, United States of America; Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI, United States of America
| | - Urania Magriples
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States of America
| | - Marisa G Rodriguez
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, United States of America
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
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11
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Tucker CM, Felder TM, Dail RB, Lyndon A, Allen KC. Group Prenatal Care and Maternal Outcomes: A Scoping Review. MCN Am J Matern Child Nurs 2021; 46:314-322. [PMID: 34347633 DOI: 10.1097/nmc.0000000000000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to examine the current state of literature on group prenatal care and its impact on maternal outcomes and racial disparities in adverse maternal outcomes. DESIGN We conducted a scoping review of literature published between January 2010 and December 2020 using the PRISMA-ScR reporting checklist. METHODS Eligible studies were identified using key words and MeSH terms in PubMed, CINAHL, and Web of Science. Inclusion criteria were studies that were (a) conducted in the United States; (b) published between January 2010 and December 2020; (c) in English; (d) focused on the primary investigation of group prenatal care and reporting on maternal comorbidity outcomes; and (e) an observational study or clinical trial. RESULTS Nine studies met inclusion criteria. They reported on outcomes of preeclampsia, gestational hypertension, gestational diabetes mellitus, final A1C among patients with gestational diabetes mellitus, and postpartum hemorrhage. None reported on racial disparities for minoritized populations. Among all reported maternal outcomes, results were mixed, providing inconclusive evidence. CLINICAL IMPLICATIONS Outcomes from group prenatal care focus more on neonatal outcomes than maternal outcomes. More studies are needed with stronger designs. Given pervasive racial disparities in U.S. maternal mortality, future studies should assess how group prenatal care participation may contribute to fewer experiences of racial discrimination and implicit bias for Black women in maternity care.
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Bruxvoort C. Emotional and Birth Outcomes Associated With Different Types of Prenatal Care for Women With Low Income. Nurs Womens Health 2021; 25:450-460. [PMID: 34756838 DOI: 10.1016/j.nwh.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/10/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
This article summarizes findings from the literature on the emotional and birth outcomes of women with low income receiving different types of prenatal care. This literature review included studies published between 2015 and 2020. The results indicated that women with low income have challenging experiences in traditional models of prenatal care. Evidence of improved birth outcomes with nontraditional prenatal care is mixed, but qualitative findings indicate that it is associated with better emotional outcomes for women with low income when compared to traditional prenatal care. Future research should investigate ways to improve the negative interpersonal and structural dimensions that can characterize prenatal care for women with low income.
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Riggs E, Yelland J, Mensah FK, Gold L, Szwarc J, Kaplan I, Small R, Middleton P, Krastev A, McDonald E, East C, Homer C, Nesvadba N, Biggs L, Braithwaite J, Brown SJ. Group Pregnancy Care for refugee background women: a codesigned, multimethod evaluation protocol applying a community engagement framework and an interrupted time series design. BMJ Open 2021; 11:e048271. [PMID: 34281928 PMCID: PMC8291298 DOI: 10.1136/bmjopen-2020-048271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Pregnancy and early parenthood are key opportunities for interaction with health services and connecting to other families at the same life stage. Public antenatal care should be accessible to all, however barriers persist for families from refugee communities to access, navigate and optimise healthcare during pregnancy. Group Pregnancy Care is an innovative model of care codesigned with a community from a refugee background and other key stakeholders in Melbourne, Australia. Group Pregnancy Care aims to provide a culturally safe and supportive environment for women to participate in antenatal care in a language they understand, to improve health literacy and promote social connections and inclusion. This paper outlines Froup Pregnancy Care and provides details of the evaluation framework. METHODS AND ANALYSIS The evaluation uses community-based participatory research methods to engage stakeholders in codesign of evaluation methods. The study is being conducted across multiple sites and involves multiple phases, use of quantitative and qualitative methods, and an interrupted time series design. Process and cost-effectiveness measures will be incorporated into quality improvement cycles. Evaluation measures will be developed using codesign and participatory principles informed by community and stakeholder engagement and will be piloted prior to implementation. ETHICS AND DISSEMINATION Ethics approvals have been provided by all six relevant authorities. Study findings will be shared with communities and stakeholders via agreed pathways including community forums, partnership meetings, conferences, policy and practice briefs and journal articles. Dissemination activities will be developed using codesign and participatory principles.
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Affiliation(s)
- Elisha Riggs
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Yelland
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona K Mensah
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Gold
- Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
- Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, Melbourne, Victoria, Australia
| | - Ida Kaplan
- Victorian Foundation for Survivors of Torture, Melbourne, Victoria, Australia
| | - Rhonda Small
- Judith Lumely Centre, La Trobe University, Melbourne, Victoria, Australia
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institute, Stockholm, Sweden
| | - Philippa Middleton
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Faculty of Medical and Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ann Krastev
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Ellie McDonald
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Christine East
- School of Nursing and Midwifery/Mercy Hospital for Women, La Trobe University, Melbourne, Victoria, Australia
| | - Caroline Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Natalija Nesvadba
- Multicultural Services, Mercy Hospitals Victoria Ltd, Melbourne, Victoria, Australia
| | - Laura Biggs
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Stephanie J Brown
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Resilience-promoting policies and contexts for children of color in the United States: Existing research and future priorities. Dev Psychopathol 2021; 33:614-624. [PMID: 33955340 DOI: 10.1017/s095457942000173x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The health status of children in the United States varies by racial and ethnic, shaped by an interrelated set of systems that disadvantage children of color in the United States. In this article, we argue for a broad view of resilience, in both research and policy, that views resilience not just as a property of individuals but also as a characteristic of social contexts and policies. Accordingly, we describe the empirical evidence for policies and contexts as factors that can improve health among children and families that are deprived of equal opportunities and resources due to structural racism. We discuss the evidence and opportunities for policies and interventions across a variety of societal systems, including programs to promote economic and food security, early education, health care, and the neighborhood and community context. Based on this evidence and other research on racism and resilience, we conclude by outlining some directions for future research.
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McCloskey L, Bernstein J, The Bridging The Chasm Collaborative, Amutah-Onukagha N, Anthony J, Barger M, Belanoff C, Bennett T, Bird CE, Bolds D, Brenna BW, Carter R, Celi A, Chachere B, Crear-Perry J, Crossno C, Cruz-Davis A, Damus K, Dangel A, Depina Z, Deroze P, Dieujuste C, Dude A, Edmonds J, Enquobahrie D, Eromosele E, Ferranti E, Fitzmaurice M, Gebel C, Blount LG, Greiner A, Gullo S, Haddad A, Hall N, Handler A, Headen I, Heelan-Fancher L, Hernandez T, Johnson K, Jones E, Jones N, Klaman S, Lund B, Mallampalli M, Marcelin L, Marshall C, Maynard B, McCage S, Mitchell S, Molina R, Montasir S, Nicklas J, Northrup A, Norton A, Oparaeke E, Ramos A, Rericha S, Rios E, Bloch JR, Ryan C, Sarfaty S, Seely E, Souter V, Spain M, Spires R, Theberge S, Thompson T, Wachman M, Yarrington T, Yee LM, Zera C, Clayton J, Lachance C. Bridging the Chasm between Pregnancy and Health over the Life Course: A National Agenda for Research and Action. Womens Health Issues 2021; 31:204-218. [PMID: 33707142 PMCID: PMC8154664 DOI: 10.1016/j.whi.2021.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Many pregnant people find no bridge to ongoing specialty or primary care after giving birth, even when clinical and social complications of pregnancy signal need. Black, indigenous, and all other women of color are especially harmed by fragmented care and access disparities, coupled with impacts of racism over the life course and in health care. METHODS We launched the initiative "Bridging the Chasm between Pregnancy and Health across the Life Course" in 2018, bringing together patients, advocates, providers, researchers, policymakers, and systems innovators to create a National Agenda for Research and Action. We held a 2-day conference that blended storytelling, evidence analysis, and consensus building to identify key themes related to gaps in care and root causes of inequities. In 2019, more than 70 stakeholders joined six working groups to reach consensus on strategic priorities based on equity, innovation, effectiveness, and feasibility. FINDINGS Working groups identified six key strategic areas for bridging the chasm. These include: 1) progress toward eliminating institutional and interpersonal racism and bias as a requirement for accreditation of health care institutions, 2) infrastructure support for community-based organizations, 3) extension of holistic team-based care to the postpartum year and beyond, with integration of doulas and community health workers on the team, 4) extension of Medicaid coverage and new quality and pay-for-performance metrics to link maternity care and primary care, 5) systems to preserve maternal narratives and data across providers, and 6) alignment of research with women's lived experiences. CONCLUSIONS The resulting agenda presents a path forward to remedy the structural chasms in women's health care, with key roles for advocates, policymakers, researchers, health care leaders, educators, and the media.
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Affiliation(s)
- Lois McCloskey
- Community Health Sciences Department, Boston University School of Public Health, Boston, Massachusetts(b) The names and affiliations of all authors in the Bridging the Chasm Collaborative are listed in Table 1..
| | - Judith Bernstein
- Community Health Sciences Department, Boston University School of Public Health, Boston, Massachusetts(b) The names and affiliations of all authors in the Bridging the Chasm Collaborative are listed in Table 1
| | | | | | | | - Mary Barger
- University of San Diego, Hahn School of Nursing
| | | | - Trude Bennett
- University of North Carolina Gillings School of Global Public Health
| | | | | | | | | | - Ann Celi
- Brigham and Women's Hospital, Harvard Medical School
| | | | | | - Chase Crossno
- University of North Texas Health Sciences Center/Texas Christian University School of Medicine
| | | | - Karla Damus
- Boston University Medical Campus, Office of Human Research Affairs
| | | | | | | | | | - Annie Dude
- University of Chicago School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | - Arden Handler
- University of Illinois at Chicago School of Public Health
| | - Irene Headen
- Drexel University Dornsife School of Public Health
| | | | | | | | - Emily Jones
- University of Oklahoma Health Sciences Center, Ziegler College of Nursing
| | | | - Stacey Klaman
- University of North Carolina Gillings School of Global Public Health
| | | | | | | | | | | | | | | | - Rose Molina
- Beth Israel Deaconess Medical Center / The Dimock Center
| | | | | | | | | | | | | | | | | | | | | | | | - Ellen Seely
- Brigham and Women's Hospital, Harvard Medical School
| | | | | | | | | | | | - Madi Wachman
- Boston University Center for Innovation in Social Work and Health
| | | | - Lynn M Yee
- Northwestern University, Feinberg School of Medicine
| | - Chloe Zera
- Beth Israel Deaconess Medical Center, Harvard Medical School
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Novick G, Womack JA, Sadler LS. Beyond Implementation: Sustaining Group Prenatal Care and Group Well-Child Care. J Midwifery Womens Health 2020; 65:512-519. [PMID: 32519425 DOI: 10.1111/jmwh.13114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/01/2020] [Accepted: 03/09/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Group prenatal care and group well-child care (collectively called group care) provide health care in groups. Group care is being introduced in many settings, and the model's benefits are increasingly recognized. Yet, little attention has been paid to understanding model sustainability. This study examined barriers to sustainability and offers suggestions for sustaining group care programs. METHODS This qualitative research was guided by interpretive description. Semistructured interviews with 17 professionals were conducted in 4 sites in one community to explore barriers to sustaining group care and key ingredients for sustainability. Sites were 2 clinics that had provided group prenatal care, a clinic currently providing group prenatal care, and a clinic currently providing group well-child care. Two clinics have continued providing group care and 2 have discontinued it. Participants included midwives, physicians, nurses, and nurse practitioners. Interviews were audio recorded, transcribed, and entered in ATLAS.ti. A priori and inductive coding schemes were developed; code content was compared across individuals, participant types, and settings. RESULTS Five themes were identified: administrative buy-in, robust recruitment, clinician and staff buy-in, owning it, and sustainability mindset. Group care needs to be sold to many different constituencies: administrators, staff and clinicians, and patients. Furthermore, sustainability requires having a conscious awareness of the importance of sustainability from the outset, taking ownership by adapting group care to needs of settings, creating venues for expressing divergent viewpoints and problem-solving, and recognizing that these processes are ongoing with change occurring incrementally. It also includes addressing the need for long-term financing. DISCUSSION Those implementing group care must be prepared to go beyond managing the logistics of introducing a complex new program; they must also be prepared to develop sustainability mindsets, sell the model to everyone on all levels within their institutions, and advocate for enhanced reimbursement for group care and value-driven payment systems.
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Affiliation(s)
- Gina Novick
- Yale University School of Nursing, West Haven, Connecticut
| | - Julie A Womack
- Yale University School of Nursing, West Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Lois S Sadler
- Yale University School of Nursing, West Haven, Connecticut.,Yale Child Study Center, New Haven, Connecticut
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Dubay L, Hill I, Garrett B, Blavin F, Johnston E, Howell E, Morgan J, Courtot B, Benatar S, Cross-Barnet C. Improving Birth Outcomes And Lowering Costs For Women On Medicaid: Impacts Of ‘Strong Start For Mothers And Newborns’. Health Aff (Millwood) 2020; 39:1042-1050. [DOI: 10.1377/hlthaff.2019.01042] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lisa Dubay
- Lisa Dubay is a senior fellow in the Health Policy Center, Urban Institute, in Washington, D.C
| | - Ian Hill
- Ian Hill is a senior fellow in the Health Policy Center, Urban Institute
| | - Bowen Garrett
- Bowen Garrett is a senior fellow in the Health Policy Center, Urban Institute
| | - Fredric Blavin
- Fredric Blavin is a principal research associate in the Health Policy Center, Urban Institute
| | - Emily Johnston
- Emily Johnston is a research associate in the Health Policy Center, Urban Institute
| | - Embry Howell
- Embry Howell is a nonresident fellow in the Health Policy Center, Urban Institute
| | - Justin Morgan
- Justin Morgan is a PhD student at the Harvard T. H. Chan School of Public Health. At the time this research was conducted, he was a research analyst at the Urban Institute
| | - Brigette Courtot
- Brigette Courtot is a principal research associate in the Health Policy Center, Urban Institute
| | - Sarah Benatar
- Sarah Benatar is a principal research associate in the Health Policy Center, Urban Institute
| | - Caitlin Cross-Barnet
- Caitlin Cross-Barnet is a social science research analyst at the Center for Medicare and Medicaid Innovation, in Baltimore, Maryland
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Fowler TT, Aiyelawo KM, Frazier C, Holden C, Dorris J. Health Care Experience Among Women Who Completed Group Prenatal Care (CenteringPregnancy) Compared to Individual Prenatal Care Within Military Treatment Facilities. J Patient Exp 2020; 7:1234-1240. [PMID: 33457570 PMCID: PMC7786673 DOI: 10.1177/2374373520925275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This study compared TRICARE, the health care program of the United States Department of Defense Military Health System, beneficiaries in CenteringPregnancy, an enhanced prenatal care model, to women in individual prenatal care within the same military treatment facility. Maternity patient experience ratings from May 2014 to February 2016 were compiled from the TRICARE Outpatient Satisfaction Survey. Centering patients had 1.91 higher odds of being satisfied with access to care (p < .01, 95% CI = 1.2-3.1) than women in individual care. Specifically, the saw provider within 15 minutes of appointment measure found Centering patients to have 2.00 higher odds of being satisfied than women in individual care (p < .01, 95% CI = 1.2-3.3). There were no other statistically significant differences between cohorts. Qualitative responses indicate most Centering patients surveyed had good experiences, appreciated the structure and communication with others, and would recommend the program. Providers identified command/leadership support, dedicated space, and buy-in from all staff as important factors for successful implementation. Enhanced prenatal care models may improve access to and experiences with care. Program evaluation will be important as the military health system continues to implement such programs.
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