Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access, Access, Provider Training/Education, Telehealth/Virtual Care

Intervention Description: The intervention in the study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City was the adoption and utilization of telehealth for prenatal care visits. The study aimed to evaluate the feasibility and effectiveness of telehealth for prenatal care during the COVID-19 pandemic, which necessitated a shift away from in-person visits to minimize the risk of viral transmission. The telehealth intervention involved the use of video conferencing technology to conduct prenatal care visits remotely. Patients were able to connect with their healthcare providers via video conferencing software, such as Zoom or Skype, to receive prenatal care services. The study analyzed the proportion of prenatal care visits that were conducted via telehealth compared to in-person visits over a 5-week period from March 9 to April 12, 2020, at Columbia University Irving Medical Center (CUIMC)-affiliated prenatal practices in New York City . The study also evaluated the challenges and successes associated with the adoption of telehealth for prenatal care, including provider attitudes towards telehealth, patient barriers to accessing telehealth, and operational considerations for clinics and healthcare systems . Overall, the intervention involved the rapid adoption and utilization of telehealth for prenatal care during the COVID-19 pandemic, with the aim of maintaining access to essential prenatal care services while minimizing the risk of viral transmission.

Intervention Results: The study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City found that telehealth was rapidly adopted and utilized for prenatal care during the study period. The study analyzed 4,248 prenatal care visits over a 5-week period, of which approximately one-third were conducted via telehealth (n=1,352, 31.8%). By the fifth week, 56.1% of generalist visits, 61.5% of maternal-fetal medicine (MFM) visits, and 41.5% of clinic visits were conducted via telehealth . The study also found that providers generally had positive attitudes towards telehealth visits, and accessing technology and performing visits, documentation, and follow-up using the telehealth electronic medical record were all viewed favorably by providers . However, the study identified significant barriers to telehealth and in-person visits, including patient fear of COVID-19 infection, limited access to technology and connectivity, and language barriers . The study also found that the transition to virtual prenatal care was more challenging for patients with Medicaid insurance receiving care at health clinics than for women with commercial insurance in generalist and maternal-fetal medicine faculty practices. Factors related to differential care attendance included operational considerations such as requiring increased staffing in clinics and patient factors related to technological proficiency, language barriers, Wi-Fi and data access, child care, and fear of infection. Additional patient-level and operational supports were required to optimize access for patients with Medicaid . Overall, the study suggests that telehealth was feasible and associated with provider satisfaction for prenatal care during the COVID-19 pandemic. However, significant barriers to telehealth may be present for patients with Medicaid insurance, which may require additional support to resolve .

Conclusion: The conclusions drawn from the study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City are as follows: 1. Rapid Transition Feasibility: The study demonstrated that a rapid transition to telehealth for prenatal care was feasible and associated with provider satisfaction. The adoption and utilization of telehealth for prenatal care were viewed favorably by healthcare providers . 2. Differential Uptake Based on Insurance: The study highlighted that telehealth uptake differed based on insurance, with patients with Medicaid insurance experiencing more challenges and barriers to accessing telehealth compared to those with commercial insurance. This finding underscores the need for additional patient-level and operational supports to optimize access for patients with Medicaid . 3. Operational Challenges: The transition to virtual prenatal care was more challenging for patients with Medicaid insurance receiving care at health clinics than for women with commercial insurance in generalist and maternal-fetal medicine faculty practices. Operational considerations, such as requiring increased staffing in clinics, were identified as significant barriers to the adoption of telehealth for prenatal care . 4. Patient Barriers: The study identified various patient-related barriers to telehealth, including technological proficiency, language barriers, Wi-Fi and data access, child care responsibilities, and fear of infection. These barriers need to be addressed to optimize access to telehealth for prenatal care, particularly for patients with Medicaid insurance . In summary, the study underscores the feasibility of rapid transition to telehealth for prenatal care and the need for additional support to address barriers faced by patients with Medicaid insurance. It emphasizes the importance of addressing operational challenges and patient-related barriers to ensure equitable access to telehealth for prenatal care during public health crises such as the COVID-19 pandemic .

Study Design: The study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City utilized a mixed-methods approach, combining quantitative analysis and qualitative assessment. Quantitative Analysis: The study analyzed trends in whether prenatal care visits were conducted in-person or via telehealth over a 5-week period from March 9 to April 12 at Columbia University Irving Medical Center (CUIMC)-affiliated prenatal practices in New York City during the COVID-19 pandemic. The proportion of visits that were conducted via telehealth was analyzed by visit type by week . This quantitative analysis provided insights into the adoption and utilization of telehealth for prenatal care during the specified period. Qualitative Assessment: In addition to the quantitative analysis, the study conducted a survey and semistructured interviews of healthcare providers to evaluate resources and obstacles in the uptake of telehealth. The survey and interviews aimed to understand provider experiences, satisfaction, and challenges associated with the integration of telehealth into prenatal care. The qualitative assessment provided in-depth insights into the operational challenges and barriers faced by healthcare providers and clinics during the transition to telehealth for prenatal care . By employing both quantitative and qualitative methods, the study aimed to comprehensively assess the transition to telehealth for prenatal care during the COVID-19 pandemic, providing a multifaceted understanding of the challenges, successes, and provider attitudes related to this transition.

Setting: The setting for the study on the transition of prenatal care to telehealth during the COVID-19 pandemic is New York City. Specifically, the study focuses on the prenatal care facilities affiliated with the Columbia University Irving Medical Center (CUIMC) located in midtown Manhattan, Washington Heights in Upper Manhattan, Rockland County, and Westchester . These facilities provide care for patients with both Medicaid and commercial insurance, and the patients accessing prenatal care at these sites primarily deliver at NewYork Presbyterian Morgan Stanley Children’s Hospital of New York and NewYork Presbyterian/The Allen Hospital . The study provides insights into the adoption of telehealth for obstetric patients in a tertiary referral hospital and clinic system in New York City, offering valuable information on the implementation of telehealth in an urban setting during the COVID-19 pandemic.

Population of Focus: The target audience for the study on the transition of prenatal care to telehealth during the COVID-19 pandemic in New York City includes a wide range of stakeholders involved in maternal-fetal medicine, obstetrics and gynecology, public health, healthcare administration, and telehealth implementation. This may encompass: 1. Healthcare Providers: Obstetricians, gynecologists, maternal-fetal medicine specialists, and other healthcare professionals involved in prenatal care. 2. Healthcare Administrators: Hospital administrators, clinic managers, and healthcare system leaders responsible for implementing telehealth services and optimizing prenatal care delivery. 3. Public Health Officials: Professionals involved in public health policy, maternal and child health, and healthcare access initiatives. 4. Telehealth Practitioners: Individuals and organizations involved in the provision of telehealth services, including telemedicine companies and technology developers. 5. Researchers and Academics: Scholars and researchers interested in the impact of telehealth on prenatal care, healthcare delivery during crises, and healthcare disparities. 6. Policymakers: Government officials and policymakers involved in shaping healthcare regulations, reimbursement policies, and telehealth legislation. 7. Patient Advocacy Groups: Organizations advocating for improved access to prenatal care and maternal healthcare services. The study's findings are relevant to these stakeholders as they provide insights into the feasibility, challenges, and benefits of transitioning prenatal care to telehealth, particularly in an urban setting during a public health crisis. Additionally, the study's focus on provider attitudes and patient access issues makes it valuable for those interested in improving maternal healthcare delivery and access to early prenatal care.

Sample Size: Specifically, the study surveyed 36 healthcare providers and conducted interviews with 11 of them 8. While the exact sample size for the patient population is not provided, the study analyzed prenatal visits over a 5-week period from March 9, 2020, to April 12, 2020, during which time telehealth was adopted across clinical sites

Age Range: the study focused on prenatal care for pregnant individuals accessing care at the Columbia University Irving Medical Center (CUIMC)-affiliated obstetric ambulatory prenatal care facilities in New York City. As such, the patient population likely consisted of pregnant individuals of reproductive age, typically ranging from late teens to early 40s. Given the focus on prenatal care, the study's patient population would primarily include pregnant individuals seeking obstetric and gynecological care during the COVID-19 pandemic. The specific age range of these individuals was not explicitly stated in the available information.

Intervention Components (click on component to see a list of all articles that use that intervention): Social Supports, Care Coordination, Prenatal Care Access,

Intervention Description: The study proposed an intervention framework based on the themes and ideas generated from the qualitative analysis of participant perspectives. The proposed intervention design included three overarching thematic domains: (1) social support in the form of accompaniment and reassurance, (2) improved care delivery with greater consistency, communication, and individualization of outpatient prenatal care, and (3) improved access to outpatient prenatal care, convenient appointment availability, and uninterrupted insurance coverage during pregnancy , . The proposed intervention features included integrating CHWs into care teams and existing childbirth education, connecting pregnant individuals with social services resources, group prenatal care support, health information exchange, prenatal passport cards or applications, visit checklists, advanced access scheduling, enhanced care team visibility, drop-in pregnancy support center, insurance screening and enrollment, and CHW support for navigation and continuity . The intervention design aimed to improve trust and impact of prenatal care, advance equitably improved outcomes, and address unmet needs in those at risk for poor pregnancy outcome

Intervention Results: The study identified unique unmet needs and ideas for improving prenatal care among pregnant women with different patterns of unscheduled care utilization. Participants expressed a desire for social support interventions that address unmet psychosocial needs, care coordination, accompaniment, and navigation for at-risk pregnant women, while also addressing broader needs such as insurance eligibility, navigation to community-based resources, and access to timely prenatal care . The proposed intervention framework aimed to address these needs and improve prenatal care delivery for low-SES, Medicaid-insured, predominantly Black, pregnant women . The study also identified limitations, including a small sample size and potential social desirability bias . Overall, the study offers the opportunity to leverage qualitative narratives, tailor and adapt intervention design to meet the specific needs of a hard-to-engage population, and reduce inequitable, preventable maternal morbidity and mortality .

Conclusion: The study concluded that the use of a qualitative study design generated person-centered intervention elements that can improve trust and impact of prenatal care. The findings focused on the differential needs and ideas of pregnant women with unique patterns of utilization of unscheduled care, demonstrating a need for embedding targeted social support alongside clinical care to advance equitably improved outcomes. The study suggested that targeted interventions incorporating user ideas and addressing unique unmet needs of specific subgroups may improve perinatal outcomes. The proposed intervention elements may help maternity care systems improve health care delivery for Black, low-SES pregnant women by specifically focusing on community health worker (CHW) integration to address unmet psychosocial needs, care coordination, accompaniment, and navigation for at-risk pregnant women, while also addressing broader needs such as insurance eligibility, navigation to community-based resources, and access to timely prenatal care , .

Study Design: The study utilized a participatory action, qualitative research design to explore the perspectives and experiences of pregnant women regarding their prenatal care, barriers to care, and unscheduled care utilization in an obstetric triage unit. The qualitative analysis involved conducting in-depth, semi-structured interviews with pregnant women at the point of unscheduled hospital-based obstetric care, prompting participants regarding perspectives on group prenatal care and community health worker (CHW) interventions, and asking open-ended questions regarding ideas for improving care 2, 2. The qualitative data obtained from these interviews were then analyzed using grounded theory to identify major themes and develop an intervention framework aligned with participant perspectives

Setting: The setting for the study was an academic hospital outpatient setting, where pregnant women enrolled in a prenatal clinic were interviewed at the point of unscheduled hospital-based obstetric care in a triage unit . This setting allowed the researchers to gather insights from pregnant women who had experienced unscheduled care and to explore their perspectives on group prenatal care and community health worker (CHW) interventions, as well as their ideas for improving care

Population of Focus: The target audience for the study included pregnant women, particularly those from low socioeconomic status (SES) and Medicaid-insured, predominantly Black, pregnant women. The study aimed to capture the perspectives and experiences of this specific demographic group regarding their prenatal care, unscheduled care utilization, and ideas for improving care delivery

Sample Size: The study enrolled a total of 40 participants, who were categorized into two groups: Group 1 (n = 20) and Group 2 (n = 20) . These groups were defined based on the degree of utilization of unscheduled care during pregnancy, allowing for a comparative qualitative analysis of participant ideas for improving prenatal care. The sample size of 40 participants provided a substantial basis for capturing diverse perspectives and experiences related to prenatal care and unscheduled care utilization.

Age Range: The study did not explicitly mention the age range of the participants. However, it provided the mean age of the participants in Group 1 as 25.5 years and in Group 2 as 25.0 years . This suggests that the participants were generally in their mid-20s, but without specific details on the age range.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient-Centered Medical Home, Prenatal Care Access, Social Supports,

Intervention Description: it focused on examining the factors associated with experiences of person-centered care during pregnancy and birth among Black birthing people in California using the Person-Centered Prenatal Care (PCPC) and the Person-Centered Maternity Care (PCMC-US) scales. These validated measures were used to better understand how Black women and birthing people experience their care in relation to other aspects of their identity, social status, and care-related factors . The study aimed to identify factors associated with lower PCPC and PCMC-US scores, providing insights into the contributors to the experiences of care among Black birthing people in California

Intervention Results: The study identified several factors associated with lower person-centered care scores among Black birthing people in California. Factors associated with lower PCPC scores included having foreign-born parents, having public or no insurance, part-time employment, unstable housing, late start of prenatal care (in the second or third trimester), poorer self-rated health, and lack of continuity of care with prenatal providers. On the other hand, factors associated with lower PCMC-US scores included having public insurance, late start of prenatal care, longer length of stay in the facility following birth, poorer self-rated health, lack of continuity of care between prenatal care and birth providers, and racial discordance with the birth provider . These findings highlight the contributions of intersecting identities as well as health-related and care-related factors to Black birthing people's experiences of care in California. Continuity of care and provider racial concordance were shown to improve pregnancy and birth experiences

Conclusion: The study's conclusions emphasized the significant contributions of intersecting identities, health-related factors, and care-related factors to the experiences of care among Black birthing people in California. The findings underscored the importance of continuity of care and provider racial concordance in improving pregnancy and birth experiences for this population. Additionally, the study highlighted the need to address the intersecting effects of sociodemographic factors on experiences of care and the potential interventions to decrease healthcare disparities. The authors also noted that despite the relatively homogenous sample, the analysis revealed the impact of sociodemographic factors and intersecting identities on care experiences, consistent with the existing literature on factors influencing care experiences

Study Design: The study utilized a cross-sectional design to examine the factors associated with experiences of person-centered care during pregnancy and birth among Black birthing people in California. The cross-sectional design allowed the researchers to collect data at a single point in time, providing a snapshot of the experiences and characteristics of the participants within the specified timeframe. This design is commonly used to assess associations between variables and is suitable for investigating factors related to person-centered care experiences within a specific population

Setting: The setting for the study is California, United States. The research focuses on Black women and birthing people in California and aims to examine factors associated with experiences of person-centered care during pregnancy and birth within this specific demographic and geographic context. By conducting the study in California, the researchers provide insights that are relevant to the local healthcare landscape and can potentially inform targeted interventions and policies to improve the quality of care for Black women and birthing people in the state.

Population of Focus: The target audience for this study includes healthcare providers, policymakers, researchers, and advocates who are interested in improving the quality of care for Black women and birthing people during pregnancy and birth. The study provides valuable insights into factors associated with person-centered care during pregnancy and birth for this population, which can inform the development of targeted interventions and policies aimed at reducing disparities in birth outcomes. The findings of this study can also be of interest to individuals and organizations working to promote health equity and social justice in the United States.

Sample Size: The sample size for the study consisted of 234 Black women and birthing people who were recruited between January and September 2020 as part of a validation study for the Person-Centered Prenatal Care (PCPC) and the Person-Centered Maternity Care (PCMC-US) scales . This sample size was used for the analyses conducted to examine the factors associated with experiences of person-centered care during pregnancy and birth among Black birthing people in Californi

Age Range: The age range of the participants in the study was 15 years or older and less than 1 year postpartum . The study did not provide a specific age range for the participants. However, the study did report that the participants were predominantly aged 29-32 years

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access, Medicaid,

Intervention Description: The study proposed several intervention features based on participant ideas for change. These intervention features were intended to address the unique unmet needs and preferences of pregnant women with varying degrees of unscheduled care utilization. The proposed intervention features included: 1. Social Support: - Integration of community health workers (CHWs) into care teams and existing childbirth education. - Connecting pregnant individuals with social services resources. - Group prenatal care support. 2. Care Delivery: - Health information exchange. - Prenatal passport cards or applications. - Visit checklists. - Integration of technology already in use. 3. Access: - Advanced access scheduling. - Enhanced care team visibility. - Drop-in pregnancy support center. - Insurance screening and enrollment. - Integration of CHW support for navigation and continuity. These intervention features were intended to address the participants' expressed needs for social support, improved care delivery, and enhanced access to outpatient prenatal care. The study aimed to leverage these person-centered intervention elements to improve trust and impact of prenatal care, with the potential to advance equitably improved outcomes

Intervention Results: he study identified three overarching thematic domains from participant ideas for improving prenatal care: social support, improved care delivery, and improved access to outpatient prenatal care. The study found that pregnant women with frequent unscheduled care utilization had unique unmet needs compared to those with no prior unscheduled visits. Participants in Group 1 overwhelmingly wanted to feel heard and centered by providers, while those in Group 2 expressed ambivalence about increased social support. The study proposed several intervention features based on participant ideas for change, including integration of CHWs into care teams, group prenatal care support, and advanced access scheduling. The study concluded that these person-centered intervention elements could improve trust and impact of prenatal care, with the potential to advance equitably improved outcomes

Conclusion: The study concluded that low-income, Medicaid-insured, predominantly Black pregnant women face unique unmet needs in prenatal care delivery, which can be addressed through person-centered intervention elements. The study proposed several intervention features based on participant ideas for change, including integration of CHWs into care teams, group prenatal care support, and advanced access scheduling. These intervention features were intended to address the participants' expressed needs for social support, improved care delivery, and enhanced access to outpatient prenatal care. The study aimed to leverage these person-centered intervention elements to improve trust and impact of prenatal care, with the potential to advance equitably improved outcomes. The study highlights the importance of engaging pregnant women in the design of interventions to improve prenatal care delivery and reduce disparities in maternal and infant health outcomes

Study Design: The study design was a qualitative, participatory action research approach. The researchers conducted in-depth, semi-structured interviews with pregnant women at the point of unscheduled hospital-based obstetric care in a triage unit. The interviews were designed to explore the participants' perspectives on group prenatal care, community health worker (CHW) interventions, and ideas for improving care. The study team then used grounded theory to develop a coding structure and identify major themes that emerged from the data, relating to participant ideas for improving care. The resulting intervention framework was presented to all study team members for validation, adjustment, and finalization.

Setting: The setting for this study was focused on low-SES, Medicaid-insured, predominantly Black pregnant women. The study aimed to understand the experiences and perspectives of pregnant individuals who are frequent and infrequent users of unscheduled care in the emergency room and obstetric triage. The insights and recommendations provided in the study are based on the narratives and experiences of these specific groups of pregnant individuals, highlighting the importance of tailoring prenatal care delivery to meet the unique needs of this population.

Population of Focus: The target audience for this study was low-income, Medicaid-insured, predominantly Black pregnant women with varying degrees of unscheduled care utilization. The study aimed to understand the perspectives and experiences of this specific demographic group in order to identify unmet needs and propose interventions to improve prenatal care delivery tailored to their unique requirements. The findings and recommendations presented in the study are intended to inform healthcare providers, policymakers, and organizations involved in prenatal care for this target audience, with the goal of enhancing access to early prenatal care and improving perinatal outcomes.

Sample Size: he sample size for this study was 40 participants, who were enrolled and categorized as either Group 1 (n = 20) or Group 2 (n = 20). The participants were low-income, Medicaid-insured, predominantly Black pregnant women with varying degrees of unscheduled care utilization. The study team conducted in-depth, semi-structured interviews with these participants to explore their perspectives on barriers and facilitators of health and ideas for improvement in care delivery, with a focus on the potential role of community health workers and social support. The study team then used modified grounded theory to develop general and subset themes by study group and mapped these themes to potential intervention features.

Age Range: The study did not provide a specific age range for the participants. However, it did report that the mean age for Group 1 was 25.5 years and for Group 2 was 25.0 years. The study also reported that all enrolled participants self-identified as cis-gender women and were predominantly Black (95%).

Intervention Components (click on component to see a list of all articles that use that intervention): Health Insurance Coverage, Prenatal Care Access

Intervention Description: Multivariate analysis of Alabama vital statistics records between 1988 and 1990 for infants weighing 500 to 1499 g was conducted, comparing hospital of birth and maternal and infant transfer status, and controlling for infant birthweight and for maternal pregnancy history and demographic characteristics.

Intervention Results: With other factors adjusted for, non-White mothers with early prenatal care were more likely than White mothers to deliver their very low birthweight infants in hospitals with neonatal ICUs without transfer. Among the mothers who presented first at hospitals without such facilities, those who had late prenatal care were less likely than those with early care to be transferred to hospitals with neonatal ICUs before delivery. Medicaid coverage increased the likelihood of antenatal transfer for White women. Likelihood of infant transfer was not associated with these maternal characteristics.

Conclusion: Maternal race, prenatal care use, and insurance status may influence the likelihood that very low birthweight infants will have access to neonatal intensive care. Interventions to improve perinatal regionalization should address individual and system barriers to the timely referral of high-risk mothers.

Study Design: Multivariate analysis

Setting: N/A

Data Source: Vital records for all infants with birthweights between 500 and 1499 g for the years 1988, 1989, and 1990 in the state of Alabama form the database for this study (n = 2596). Infant birthweight; maternal county of residence, zip code of residence, race, age, and education; month in which prenatal care began; parity; previous post-20-week pregnancy termination; previous infant death; hospital of delivery; and transfer either of the mother prior to delivery or of the infant after delivery are reported on the vital record. The state health department links birth certificate and death certificate records, so date of death within 12 months of birth is also included on the vital record. However, the vital records file does not include data on infants born in out-ofstate hospitals to mothers resident in Alabama.

Sample Size: 2596 infant records

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Organizational Changes, Prenatal Care Access, Access, Telehealth/Virtual Care

Intervention Description: The OB Nest intervention involved a reduced-frequency prenatal care model enhanced with remote home monitoring devices and nursing support. Participants in the OB Nest group received 8 scheduled clinic appointments with an obstetrician or a certified nurse midwife, as well as 6 virtual (phone or online) connected care visits with an OB Nest registered nurse. These virtual visits consisted of home blood pressure and fetal heart rate evaluation. Additionally, the OB Nest model included home monitoring devices and an online prenatal community to support the pregnant women .

Intervention Results: The study found that participants in the OB Nest group had significantly higher satisfaction with care and lower prenatal-related stress compared to patients in the usual care group. Perceived quality of care was similar between groups. Adherence to the provision of American College of Obstetricians and Gynecologists prenatal services was similar in both arms. Maternal and fetal clinical outcomes were similar between groups. Total reported nursing time was higher in OB Nest. The study concluded that OB Nest is an innovative, acceptable, and effective reduced-frequency prenatal care model that resulted in higher patient satisfaction and lower prenatal stress while reducing the number of appointments with clinicians and maintaining care standards for pregnant women .

Conclusion: The study concluded that the OB Nest intervention is an innovative, acceptable, and effective reduced-frequency prenatal care model. It resulted in higher patient satisfaction and lower prenatal stress, while reducing the number of appointments with clinicians and maintaining care standards for pregnant women. The findings suggest that OB Nest is a step toward evidence-driven prenatal care that improves patient satisfaction .

Study Design: The study utilized a rigorous randomized controlled trial (RCT) design to compare the OB Nest prenatal care model with usual care. Participants were randomized to either OB Nest or usual care using a dynamic allocation system, with an algorithm minimizing imbalances in a 1:1 ratio across specific factors such as age, body mass index, and parity. The allocation sequence was concealed from the study nurse who enrolled and assessed the eligibility of participants. The study team nurses and clinicians were aware of the assigned arms after randomization occurred, and team members analyzing quantitative data were blinded to which intervention arm mothers were assigned to

Setting: The study was conducted as a single-center randomized controlled trial within the Outpatient Obstetric Division at Mayo Clinic, a tertiary care academic center in Rochester, Minnesota. The Mayo Clinic serves approximately 2400 pregnant women annually, and the trial took place between March 2014 and January 2015

Population of Focus: The target audience for the OB Nest prenatal care model and the study evaluating its effectiveness were low-risk pregnant women who were between 18 and 36 years old, at less than 13 weeks of gestation, and without a concurrent medical or obstetric complication, who had the ability to provide informed consent. The study aimed to evaluate the acceptability and effectiveness of the OB Nest model compared to traditional prenatal care for this specific population .

Sample Size: he study aimed to recruit 300 pregnant women, with 150 participants assigned to the OB Nest group and 150 participants assigned to the usual care group. The sample size was determined based on the power to detect differences in patient satisfaction, which was considered the most important endpoint for pregnant patients and caregiver representatives when creating the OB Nest bundle. The study was powered to detect differences in patient satisfaction with a 98% power to detect a difference of 7 points, based on a standard deviation of 14.4, with 10% attrition

Age Range: The study enrolled English-speaking pregnant women between 18 and 36 years old who were at less than 13 weeks of gestation. This age range was part of the enrollment criteria for the study .

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Prenatal Care Access,

Intervention Description: provides a comprehensive approach to care for women of advanced maternal age. This approach includes preconception care, routine prenatal care, and surveillance for potential complications during pregnancy. The document emphasizes the importance of compassionate care and support for women in this age group as they navigate the journey of motherhood. The recommendations provided in the document are based on existing knowledge and expert consensus in the field of women's health care.

Intervention Results: The document emphasizes the importance of preconception care, routine prenatal care, and surveillance for potential complications during pregnancy. The approach is designed to optimize care for women of advanced maternal age and improve the likelihood of a normal pregnancy outcome. The document also highlights the importance of compassionate care and support for women in this age group as they navigate the journey of motherhood.

Conclusion: he PDF file provides a comprehensive approach to care for women of advanced maternal age, including preconception counseling, antepartum testing, and postpartum care. The authors emphasize the importance of addressing medical comorbidities, performing detailed anatomic surveys, and providing appropriate antepartum testing and growth assessments. They also discuss the risks and benefits of various screening and diagnostic tests for fetal aneuploidy. Overall, the PDF file highlights the need for individualized care and close monitoring of women of advanced maternal age to ensure safe and healthy outcomes for both mother and baby.

Study Design: as it appears to be a review article or clinical guideline rather than a research study with a defined sample size. Therefore, the document synthesizes existing knowledge and recommendations in the field of women's health care for women of advanced maternal age, drawing from relevant literature and expert consensus.

Setting: US The comprehensive approach to care for women of advanced maternal age is being implemented. However, the information and recommendations provided in the document can be applied in various healthcare settings, including hospitals, clinics, and private practices.

Population of Focus: The target audience for the comprehensive approach to care for women of advanced maternal age includes women's health care providers, such as midwives, nurse practitioners, clinical nurse specialists, and perinatal nurses. Additionally, this information may also be relevant to obstetricians, gynecologists, and other healthcare professionals involved in the care of women during preconception, prenatal, and peripartum stages.

Sample Size: na

Age Range: na

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access, Care Coordination, Quality Improvement/Practice-Wide Intervention,

Intervention Description: The intervention involved the implementation of a new model of prenatal care called PodCare. This model required changes to providers' schedules, including the extension of weekly resident physician didactic schedules to include one hour of Pod meetings. At these meetings, providers selected patients for discussion to ensure completeness of care and appropriate delivery planning. The model aimed to decrease the number of prenatal care visits while increasing continuity with providers and maintaining high-quality care .

Intervention Results: The results of the study showed that after the implementation of the PodCare model, the median number of prenatal care visits decreased from 13 to 10 (p < 0.00004) and the median number of providers seen decreased from 7 to 5 (p < 0.0000008). Additionally, more patients chose care with the low-risk physician team (42% compared to 26%). The model also performed well above national averages on measures of timeliness of care and percentage of deliveries receiving a postpartum visit. There were no significant differences in secondary outcomes such as mode of delivery, Group B strep testing, and diabetes screening

Conclusion: The study concluded that the PodCare model increased the value of individual prenatal care by decreasing the number of visits, increasing continuity, and providing care coordination. The model provides a robust experience in interdisciplinary care and may be successful at other academic institutions. The study also suggested that the PodCare model presents savings in opportunity cost given more available clinic visits for other obstetrical or gynecologic patients. The model also allows residents and associate providers to provide the bulk of care under the supervision of an attending physician, making it a cost-effective and resource-wise decision

Study Design: The study utilized a retrospective cohort design to compare the outcomes of prenatal care before and after the implementation of the PodCare model. Data were abstracted retrospectively from the electronic medical record for all patients initiating prenatal care in the one year before and after PodCare, and a washout period of six months on either side of the intervention was applied

Setting: The study was conducted in an academic setting at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, USA .

Population of Focus: The target audience of the study was healthcare providers and clinic staff who provide prenatal care to pregnant women. The study aimed to test the hypothesis that a new model of prenatal care, PodCare, would increase the value of traditional prenatal care by decreasing the number of visits while increasing continuity with providers and maintaining current high-quality care .

Sample Size: The study included 85 women in 2013 and 165 women in 2014 as study subjects . These women were included in the analysis to evaluate the impact of the PodCare model on prenatal care visits and provider interactions.

Age Range: The age range of the participants in the study was 18.8 to 42.6 years .

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access, Policy/Guideline (State), Development/Improvement of Services,

Intervention Description: improving housing stability, access to healthcare, and support services could be beneficial for this vulnerable group

Intervention Results: The majority (81%) of the women identified as African American. Over 95% of the women were single, and 74 women reported a prior pregnancy. Almost half of the women reported being behind on rent at least one time in the last 6 months, and 43% indicated that they had lived in more than three places in the last year.

Conclusion: indicate a significant financial and maternity risk for pregnant women experiencing homelessness. The study emphasizes that addressing the needs of homeless pregnant women requires more than just standard case management and healthcare coordination. It recommends additional financial resources to address utility arrears, long-term rent support, higher security deposits, and intensive prenatal care that integrates prior preterm birth history and other health issues. The study underscores the importance of tailored interventions to support the maternal and child health of homeless pregnant women

Study Design: cross-sectional

Setting: Columbus, OH

Population of Focus: women who report pregnancy/unhoused.

Sample Size: n=100

Age Range: 25.5 years, with a standard deviation of 4.6 years

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access, Family-Based Interventions, Access,

Intervention Description: program facilitation and identified developmental benefits of a two-generation program beginning prenatally.

Intervention Results: Our core category, Engaging From Both Sides, included (a) Mitigating Adversity (focused codes Developing Trust, Letting Go of Fear, and Putting in the Effort); (b) Continual Learning (focused codes Staying Connected, and Taking it to the Community); (c) Fostering Families (focused codes Cultivating Optimism, and Happiness and Love); (d) Unravelling Cycles of Crisis (focused codes Advocating, and Helping Parents’ Parent); and (e) Becoming Mainstream (focused codes Knowing Someone Has Your Back, and Managing Stress, Anxiety, and Anger). We found significant improvements in child Fine Motor, Problem-Solving, and Personal-Social domains between program intake and exit.

Conclusion: Our study adds to existing literature regarding mechanisms of two-generation programs beginning prenatally. Mitigating effects of intergenerational adversity was the primary motivation for interaction and engagement of staff and parents in two-generation programming, which improved child development.

Study Design: convergent, concurrent mixed methods study

Setting: Canada

Population of Focus: public health professionals

Sample Size: 10 agency staff, 14 focus groups of parents, 100 children

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access, Access,

Intervention Description: the Luke Clinic, a free, volunteer-run, faith-based clinic that offers prenatal, postpartum, and infant care to patients in Detroit. The clinic provides patient-centered care and aims to build trusting relationships with patients, with a focus on serving marginalized populations facing poverty, lack of trust in the healthcare system, racial disparities in care, and concrete barriers to accessing care such as limited transportation, childcare, work hour conflicts, and lack of insurance. The clinic offers a range of wrap-around services in addition to medical care, including social workers, insurance navigators, free medication and lab work, ultrasound and antenatal testing services, a diaper bank, maternal/infant clothing, equipment, childcare, doulas, breastfeeding support, contraception, and language interpreters. The clinic is primarily nurse-led with medical oversight by a family medicine physician with expertise in obstetrics, and it operates via a cadre of volunteer physicians, certified nurse midwives, nurses, and administrative staff. The clinic also partners with hospitals and specialists to facilitate patient-centered care

Intervention Results: The PDF reports that in the first 2 years of operation, the demand for services at the Luke Clinic rose rapidly, and there were stellar clinical outcomes, despite the fact that Luke patients are among the medically and socially highest risk populations in the nation. The number of patient appointments increased every quarter over the 2 years, more than doubling by the end of the second year. Patients were predominantly Black, white Hispanic, or white non-Hispanic, and many were immigrants. The clinic had a no-show rate of 23%, which is half that seen at many urban clinics and is unusual for a population of patients in poverty. Additionally, Luke patients were more than twice as likely as women nationally to present in the second or third trimester for their first prenatal care visit. The clinic's model of providing patient-centered care and building trusting relationships contributed to positive patient outcomes for a cohort of women who are at extremely high risk both medically and socially 3, 1. Furthermore, the PDF includes a table comparing the medical conditions and behavioral risk factors during pregnancy for Luke clinic patients with pregnant women in the United States. The table shows higher percentages of certain medical comorbidities and substance use among Luke clinic patients compared to pregnant women nationally. This data provides insights into the specific health challenges faced by the patient population served by the clinic

Conclusion: the Luke Clinic's model of providing free, patient-centered, and wrap-around care has shown the ability to engage and retain patients while providing high-quality care to a population that is at extremely high risk both medically and socially. The clinic's focus on building relationships and offering non-traditional approaches to care has contributed to positive patient outcomes, despite the fact that the patient population served by the clinic faces significant barriers to accessing care. The authors hope that the Luke Clinic's model will inspire more health systems to focus on alternative approaches to care and that academic institutions will consider new ways to engage students with community care. The authors also emphasize the importance of respectful patient relationships and the need to identify barriers to care for women in poverty and promote models of care that are patient-centric, rather than health-institution-centric

Study Design: s it primarily focuses on describing the model and outcomes of the Luke Clinic, a novel approach to providing prenatal and infant care

Setting: The setting for the novel model of a free clinic for prenatal and infant care is in Detroit, Michigan. The clinic operates in a local church in Southwest Detroit, with additional services provided at various sites around the church and in a large sanctuary

Population of Focus: The target audience for the free clinic for prenatal and infant care in Detroit includes pregnant women, postpartum women, and infants in the local community. Specifically, the clinic aims to serve marginalized populations, including those facing poverty, lack of trust in the healthcare system, racial disparities in care, and concrete barriers to accessing care such as limited transportation, childcare, work hour conflicts, and lack of insurance

Sample Size: However, it does state that in the first 2 years of operation, the clinic cared for nearly 200 individual patients, and the number of patient appointments more than doubled by the end of the second year. This information provides some insight into the scale of the patient population served by the clinic

Age Range: The age range of patients who receive care at the Luke Clinic, the free clinic for prenatal and infant care in Detroit, is not explicitly stated in the PDF file. However, the clinic offers prenatal, postpartum, and infant care, so it can be inferred that the age range of patients is likely limited to women who are pregnant or have recently given birth, as well as their infants

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access, Group Education,

Intervention Description: The intervention in the study "Implementing Group Prenatal Care in Southwest Georgia Through Public–Private Partnerships" was the implementation of the CenteringPregnancy program in a public health setting . CenteringPregnancy is a group prenatal care model that integrates health assessment, interactive learning, and community building . The program consists of 10 two-hour sessions at routine prenatal care intervals from early second trimester through delivery, with groups consisting of 8-12 women . Physical assessments occur during the first 30 minutes behind a privacy screen, and the session's final 1.5 hours include facilitated discussions of topics within the CenteringPregnancy curriculum or of the groups' choosing . Patients are grouped by delivery month and are asked to calculate their gestational age, weigh themselves, and take their own blood pressures. These activities, along with education and group support, boost confidence and communication skills within healthcare settings, which is important for women with few patient-provider experiences . The SWHD provided group prenatal care 2 days per week at different Centering Healthcare Institute (CHI) accredited locations, with onsite Medicaid presumptive eligibility, transportation assistance, social service linkages, home visitation, nutrition assessments, and telehealth services . The program was implemented through a public-private partnership between the SWHD, local obstetricians and medical centers, and non-profit grant funders

Intervention Results: The study "Implementing Group Prenatal Care in Southwest Georgia Through Public–Private Partnerships" reported the following results: 1. Six hundred and six low-income women initiated prenatal care, with 55.4% self-identifying as non-Hispanic black and 36.4% as Hispanic. The median age of the women was 23 years, and nearly 69% initiated prenatal care in the first trimester . 2. Perinatal outcomes were examined among 338 singleton live births. The preterm birth rate (percentage of births < 37 weeks gestation at delivery) from 2010 to 2014 was 9.1%, and the low birth weight rate (percentage of births < 2500 g) was 8.9%. Additionally, nearly 77% of women initiated breastfeeding . 3. The study also assessed the attendance and participation in the CenteringPregnancy program, with 452 women enrolling and 369 attending at least three sessions . These results provide insights into the perinatal outcomes and program participation of low-income women in Southwest Georgia who received group prenatal care through the CenteringPregnancy program. The findings suggest that the program may improve access to prenatal care and perinatal outcomes for medically underserved women in low-resource settings .

Conclusion: concluded that the CenteringPregnancy program can be successfully implemented in a public health setting to improve perinatal outcomes for low-income women . The study found that the program was associated with a relatively low preterm birth rate and low birth weight rate, as well as a high rate of breastfeeding initiation . The study also identified several key lessons learned from the implementation of the program, including the importance of steadfast leadership, setting a start date and starting regardless of group size, and being prepared for painful disclosures . The study's findings suggest that group prenatal care may be an effective approach to improving perinatal outcomes for low-income women in low-resource settings, and that public-private partnerships can be an effective way to implement such programs .

Study Design: The study "Implementing Group Prenatal Care in Southwest Georgia Through Public–Private Partnerships" utilized a retrospective observational study design . The researchers reviewed prenatal and hospital medical records of patients who initiated prenatal care between October 2009 and October 2014 to assess the program's first 5-year perinatal outcomes . Descriptive analyses were conducted to examine the demographic and clinical characteristics of women initiating prenatal care and to assess perinatal outcomes among patients with singleton live births who attended at least three CenteringPregnancy sessions or delivered prior to attending the third session . The study design allowed the researchers to evaluate the impact of the CenteringPregnancy program on perinatal outcomes for low-income women in Southwest Georgia. The retrospective observational study design enabled the researchers to analyze existing data to assess the effectiveness of the program in improving access to prenatal care and perinatal outcomes for medically underserved women in a low-resource setting.

Setting: The setting for the study "Implementing Group Prenatal Care in Southwest Georgia Through Public–Private Partnerships" is primarily focused on Southwest Georgia. The program was implemented in Georgia’s Southwest Public Health District (SWHD), which serves approximately 360,000 individuals across 14 counties . The specific locations within this district where the program was implemented include public health clinics, medical centers, and obstetrician practices in the Southwest Georgia region . The study's setting reflects a low-resource, medically underserved area, where the implementation of group prenatal care aimed to improve access to prenatal services and perinatal outcomes for low-income women . This setting is crucial for understanding the context in which the program was implemented and the population it aimed to serve.

Population of Focus: The target audience for the study "Implementing Group Prenatal Care in Southwest Georgia Through Public–Private Partnerships" includes: 1. **Public Health Professionals**: The findings of the study are relevant to public health professionals, including those involved in maternal and child health, community health, and healthcare administration. The study provides insights into the successful implementation of group prenatal care in a public health setting and offers lessons learned that can be valuable for public health practitioners 1. 2. **Healthcare Providers**: Obstetricians, gynecologists, midwives, and other healthcare providers involved in prenatal care may find the study's outcomes and lessons learned relevant to their practice. The study's focus on improving access to prenatal care and perinatal outcomes for medically underserved women can inform healthcare providers working in similar settings 1. 3. **Policy Makers and Funders**: The study's emphasis on public-private partnerships and the successful implementation of group prenatal care in a low-resource setting may be of interest to policy makers and funders involved in maternal and child health initiatives. The findings can inform decision-making related to funding and policy development aimed at improving prenatal care access and perinatal outcomes for underserved populations. 4. **Researchers and Academics**: Researchers and academics in the fields of public health, maternal and child health, and healthcare disparities may find the study's methodology and outcomes relevant to their research interests. The study contributes to the evidence base on the implementation of group prenatal care and its impact on perinatal outcomes in low-resource settings. By targeting these audiences, the study aims to disseminate its findings and lessons learned to professionals and stakeholders involved in improving prenatal care access and perinatal outcomes for medically underserved populations.

Sample Size: The sample size for the study "Implementing Group Prenatal Care in Southwest Georgia Through Public–Private Partnerships" was 606 low-income women who initiated prenatal care between October 2009 and October 2014 . Of these 606 women, 338 had singleton live births and were included in the analysis of perinatal outcomes . Additionally, 452 women enrolled in the CenteringPregnancy program, with 369 of these women attending at least three sessions . The study's sample size reflects the population of low-income women in Southwest Georgia who face limited access to prenatal care and disproportionately higher rates of adverse perinatal outcomes . While the sample size is relatively small, the study's findings provide valuable insights into the implementation of group prenatal care in a public health setting and its impact on perinatal outcomes for low-income women.

Age Range: The age range for the sample population in the study "Implementing Group Prenatal Care in Southwest Georgia Through Public–Private Partnerships" was 13 to 49 years . The median maternal age was 23 years, with an interquartile range (IQR) of 20 to 28 years . The age distribution of the sample population was as follows: - 21.0% of women were between 13 and 19 years old - 38.6% of women were between 20 and 24 years old - 21.6% of women were between 25 and 29 years old - 11.3% of women were between 30 and 34 years old - 7.5% of women were 35 years old or older The age range of the sample population is important to consider because maternal age can be a risk factor for adverse perinatal outcomes, such as preterm birth and low birth weight . The study's findings suggest that group prenatal care may be effective in improving perinatal outcomes for low-income women across a range of ages.

Intervention Components (click on component to see a list of all articles that use that intervention): Mobile Programs, Prenatal Care Access,

Intervention Description: The intervention in the study was the SmartMoms Canada mHealth app, which was developed for both Android and IOS devices . The app was designed to promote healthy lifestyle behaviors such as physical activity, healthy diet, managing anxiety, and practicing adequate sleep hygiene among pregnant and postpartum women . The app was provided to the participants, who were given a minimum of one week to become familiar with the technological accessories, including a Fitbit Charge 2 fitness tracker and a BodyTrace scale . During the focus groups, the participants were asked to provide feedback on their experiences using the app, including its strengths and weaknesses, and suggestions for future improvements

Intervention Results: The study found that pregnant and postpartum women positively viewed the SmartMoms Canada app with respect to its ability to provide pregnancy guidance, pregnancy-specific exercises, and advice on sleep . The participants also expressed a desire for more feedback in the form of notifications, further interactivity to input their own goals, and short workout routines based on time availability and stage of pregnancy . Additionally, the women highlighted the importance of organizing the app based on their personal health preferences and emphasized the inclusion of overall maternal health, including exercise, nutrition, and mindfulness . Furthermore, the study revealed that the participants were critical of certain aspects of the app, such as its design and aesthetic, and expressed a need for more emphasis on physical activity and less focus on weight tracking . The women also shared their experiences with other mHealth services and expressed their technological proficiency and knowledge of pregnancy-specific mHealth services . Overall, the results indicated that the SmartMoms Canada app was well-received by the participants, who provided valuable feedback for its improvement and future development , .

Conclusion: The conclusion of the study highlighted the potential of the SmartMoms Canada app as a promising solution to address the gaps in healthcare provider communication related to weight during pregnancy, along with support on physical activity, diet, and sleep . The authors emphasized the importance of incorporating qualitative feedback to improve the app, including the integration and synchronization of Wi-Fi™ enabled accessories and the provision of greater feedback on weight gain . The study also underscored the significance of embedding evidence-based tools in daily healthcare routines and encouraging healthcare providers to integrate such tools in their practice . Furthermore, the authors suggested that the future of mHealth tools and their role in prenatal care will depend on the successful embedding of these evidence-based tools in daily health care routines and encouraging healthcare providers to integrate such tools in their practice . They also indicated that the findings from this study and future studies will contribute to offering home pregnancy care, patient empowerment, and revolutionizing prenatal care practices, ultimately contributing to improved maternal-fetal health outcomes .

Study Design: The study utilized a qualitative research design, specifically employing focus groups and thematic analysis to gather and analyze data . Two focus groups involving a total of 13 participants, consisting of both currently pregnant and recently postpartum women, were organized for the study . The focus groups were transcribed verbatim, and thematic analysis was undertaken using manual coding and NVivo software . Additionally, Likert-scale surveys were used to collect and analyze responses from the participants .

Setting: The study was conducted in Ottawa, Canada, which is the capital city of Canada . The focus groups and evaluations took place at the University of Ottawa, indicating that the research was carried out in an academic setting. This setting is significant as it reflects the potential for the SmartMoms Canada mHealth app to be integrated into the Canadian healthcare system and academic research environment.

Population of Focus: The target audience of the study on the SmartMoms Canada mHealth app is pregnant and postpartum women in Canada . The study aimed to evaluate the receptiveness, functionality, and future prospects of the app among this population. The participants in the study were women who were pregnant or had given birth to a baby within six months of the first scheduled focus group . The study aimed to assess the utility of the SmartMoms Canada mHealth app in improving weight outcomes during pregnancy and promoting healthful lifestyle behaviors such as physical activity, healthy diet, managing anxiety, and practicing adequate sleep hygiene

Sample Size: The study involved a total of 13 participants in two focus groups, with 11 pregnant women and 7 postpartum women initially expressing interest and eligibility to participate . Of these, 17 women attended the first appointment and were given the SmartMoms Canada app along with the necessary accessories. However, 4 women were lost to follow-up, leaving a total of 13 participants who took part in one of the two focus groups

Age Range: The average age of the participants in the study was 31.5 years, with a standard deviation of 3.28 years . This indicates that the participants were generally in their early thirties. However, the specific age range of the participants was not explicitly provided in the information available from the study.

Intervention Components (click on component to see a list of all articles that use that intervention): Community-Based Group Education, Prenatal Care Access,

Intervention Description: We linked birth certificates and Medicaid claims for women receiving group prenatal care in 18 healthcare practices and applied preferential-within cluster propensity score methods to identify a comparison group, accounting for the nested data structure by practice. We examined five standardized, claims-based outcomes: postpartum visit attendance; contraception within 3 days; and any contraception, long-acting reversible contraception (LARC), and permanent contraception within eight weeks. We assessed outcomes using logistic regression for two treatment levels: (1) any group attendance compared to no group attendance and (2) attendance at five or more group sessions to at least five prenatal care visits, including crossovers attending fewer than five group sessions (minimum threshold analysis).

Intervention Results: Women attending at least five group sessions had higher rates of postpartum visit attendance (71.5% vs. 67.5%, p < .05). Women with any group attendance (N = 2834) were more likely than women with individual care only (N = 13,088) to receive contraception within 3 days (19.8% vs. 16.9%, p < .001) and to receive a LARC within eight weeks' postpartum (18.0% vs. 15.2%, p < .001). At both treatment levels, group participants were less likely to elect permanent contraception (5.9% vs. 7.8%, p < 0.001). Women meeting the five-visit group threshold were not more likely to initiate contraception or LARCs within 8 weeks' postpartum.

Conclusion: Participation in at least five group compared to five individual prenatal care visits is associated with greater rates of postpartum visit attendance. Additional engagement and education in group prenatal care may influence postpartum visit attendance.

Study Design: Retrospective cohort

Setting: 18 healthcare practices serving Medicaid-enrolled women, South Carolina

Sample Size: 15922 Medicaid enrolled women (2834 women received CenteringPregnancy, 13088 received individual prenatal care)

Age Range: 14-44

Intervention Components (click on component to see a list of all articles that use that intervention): Group Education, Prenatal Care Access,

Intervention Description: The South Carolina CenteringPregnancy Expansion Project provides training, technical assistance, and start-up funds to obstetric practices implementing the CenteringPregnancy™ model. Practices joined the initiative in several cohorts over seven years. The CenteringPregnancy model of group prenatal care includes all of the elements of the American College of Obstetrics and Gynecology’s recommended individual care physical assessment and screening visits. Prenatal care is provided in ten, two-hour group sessions with six to twelve women with similar due dates within a 4–6 week range. The first 30 min of each session is dedicated to individual, routine medical assessments by the healthcare provider, and the remaining 90 min are composed of group discussions and interactive activities facilitated by the medical care team using a curriculum focused on pregnancy, childbirth, and parenting-related topics. Women will also attend traditional, individual prenatal care visits early in pregnancy (i.e. before enrolling in the group), late in pregnancy (i.e. after the 10th session and before birth), as replacement for a missed group session, and if they require additional individualized follow-up.

Intervention Results: Women attending at least five group sessions had higher rates of postpartum visit attendance (71.5% vs. 67.5%, p < .05). Women with any group attendance (N = 2834) were more likely than women with individual care only (N = 13,088) to receive contraception within 3 days (19.8% vs. 16.9%, p < .001) and to receive a LARC within eight weeks’ postpartum (18.0% vs. 15.2%, p < .001).

Conclusion: Participation in at least five group compared to five individual prenatal care visits is associated with greater rates of postpartum visit attendance. Additional engagement and education in group prenatal care may influence postpartum visit attendance.

Study Design: Retrospective cohort analysis

Setting: 18 sites implementing the CenteringPregnancy model in South Carolina

Population of Focus: Pregnant women enrolled in Medicaid

Sample Size: 2,834 women with prenatal group attendance; 13,088 with individual care only

Age Range: 14--44

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Prenatal Care Access, Targeting Interventions to Focused Groups

Intervention Description: The intervention in this study was Pennsylvania's criminal sentencing reform policy, which aimed to reduce the state's prison population by implementing revised sentencing guidelines and increasing investments in community-based services. The policy was implemented in 2012 and was expected to reduce the number of people admitted to state prisons in Pennsylvania. The study aimed to evaluate the impact of this policy on early and adequate prenatal care utilization among birthing people in Pennsylvania, with a focus on effect heterogeneity across birthing person race/ethnicity and educational attainment. The study found that the benefits of the policy for prenatal care were largely limited to counties where prison admission rates declined the most after the policy, and improvements were primarily observed among groups that are more likely to be affected by prison admissions, Black birthing people and those with lower levels of education

Intervention Results: The study found that in counties where prison admissions declined the most after the policy, early prenatal care increased from 69.0% to 73.2%, and inadequate prenatal care decreased from 18.1% to 15.9%. By comparison, improvements in early prenatal care were smaller in counties where prison admissions increased the most post-policy (73.5 to 76.4%) and there was no change to prenatal care inadequacy (14.4% pre and post). The study found this pattern of improvements to be particularly strong among Black birthing people and those with lower levels of educational attainment. The study concluded that Pennsylvania's sentencing reforms were associated with small advancements in racial and socioeconomic equity in prenatal care. However, the study also noted that incremental changes to criminal justice policy are unlikely to have broad effects for health equity, and transformative policy changes in the areas of healthcare, social welfare, and criminal justice together will be necessary to see dramatic shifts in preventative healthcare inequities.

Conclusion: The study concluded that Pennsylvania's criminal sentencing reform policy was associated with small advancements in racial and socioeconomic equity in prenatal care utilization. The study found that the benefits of the policy for prenatal care were largely limited to counties where prison admission rates declined the most after the policy, and improvements were primarily observed among groups that are more likely to be affected by prison admissions, Black birthing people and those with lower levels of education. The study also noted that incremental changes to criminal justice policy are unlikely to have broad effects for health equity, and transformative policy changes in the areas of healthcare, social welfare, and criminal justice together will be necessary to see dramatic shifts in preventative healthcare inequities. The study highlights the importance of contextual conditions of incarceration for preventative healthcare access and utilization and sheds light on how criminal justice reforms may have spillover effects for healthcare utilization and health equity.

Study Design: The study design was an interrupted time series analysis using individual-level birth certificate data linked to county-level rates of prison admissions in Pennsylvania from 2009 to 2015. The study aimed to evaluate the impact of Pennsylvania's criminal sentencing reform policy on early and adequate prenatal care utilization, with a focus on effect heterogeneity across birthing person race/ethnicity and educational attainment. The study used Poisson regression models with robust error variance to estimate changes in prenatal care utilization after the policy, stratified by quartiles of county-level pre-post difference in mean monthly prison admission rates. The study design allowed for the assessment of changes in prenatal care utilization over time, before and after the policy, and across different subgroups of the population.

Setting: The setting for this study is Pennsylvania, focusing on the period from 2009 to 2015. The researchers linked individual-level birth certificate data to monthly county-level rates of prison admissions in Pennsylvania during this time frame. By examining the effects of Pennsylvania's criminal sentencing reform on prenatal healthcare access and equity, the study provides valuable insights into the impact of policy changes on healthcare utilization in the context of the criminal justice system

Population of Focus: The target audience for this study is likely researchers, policymakers, and healthcare professionals interested in understanding the impact of criminal justice policies on healthcare access and equity, particularly in the context of prenatal care. The study provides important insights into the potential benefits of reducing incarceration rates for improving early and adequate prenatal care, particularly for marginalized communities. The findings may be of interest to those working in public health, criminal justice reform, and healthcare policy.

Sample Size: Thestudy used individual-level birth certificate microdata on births in Pennsylvania from 2009 to 2015, totaling 999,503 births. This large sample size allowed the researchers to assess the effects of Pennsylvania's criminal sentencing reform on prenatal healthcare access and equity across a significant number of births in the state. The substantial sample size contributes to the robustness of the study's findings.

Age Range: The study did not report a specific age range for the birthing people included in the sample. However, the study did collect data on self-reported age (< 19, 20–29, 30–39, 40 + years) as an individual-level covariate in their statistical analysis. Therefore, the study likely included birthing people across a range of ages, from under 19 to over 40 years old.

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access, Technology-Based Support,

Intervention Description: The intervention in this study involved user engagement with a digital health platform called Maven during pregnancy. The engagement included various activities such as reading articles, watching class recordings, attending live web-based classes, and interacting with dedicated care advocates who are allied health professionals. Additionally, interactions with health care providers, including obstetrician/gynecologists (OB/GYNs), doulas, midwives, mental health providers, nutritionists, and wellness coaches, were also part of the intervention. The study assessed the number of messages sent by users to their care advocates and providers, as well as the number of appointments with providers. The pregnancy trimester of enrollment was used as a proxy for an individual’s time enrolled in the digital platform

Intervention Results: The study found that more users who reported avoiding in-person care also reported that the digital platform helped them understand warning signs and learn medically accurate information. In the adjusted models, all modes of digital service use were associated with avoiding in-person care in a dose-response manner. Users were more likely to avoid in-person care if they reported that Maven helped them recognize warning signs or learn medically accurate information. The study also found that understanding warning signs and learning medically accurate information from the digital platform were independently associated with in-person care avoidance

Conclusion: The study concluded that digital platforms, such as Maven, can be effective in helping pregnant individuals avoid in-person care. The educational pathway suggests that digital platforms can be particularly effective in helping users recognize warning signs and learn medically accurate information, which may help them avoid in-person care by recognizing when it is medically appropriate. The results suggest that digital platforms can provide information and tools that patients need to recognize warning signs, avoid medical misinformation, and decide when in-person care is medically appropriate during pregnancy. This study extends the available literature by assessing the potential influence of access to comprehensive digital health services on emergency room and in-person care avoidance during pregnancy

Study Design: This study is a retrospective cohort analysis that aims to assess the association between user engagement with a digital health platform, Maven, and user reports that the platform helped them avoid in-person care during pregnancy. The study included 5263 users who used the product during pregnancy and reported outcomes after delivery. The study controlled for various factors such as age, race and ethnicity, medical risk score, mental health conditions, pregnancy-related anxiety, parity, pregnancy trimester enrolled, and high Social Vulnerability Index (SVI) . The study found that the use of the digital platform was associated with a better understanding of medically accurate information and warning signs, which in turn was associated with the perceived influence of the digital platform on in-person care avoidance

Setting: The study was conducted as a retrospective cohort analysis, and the setting was not explicitly mentioned in the provided excerpts. However, it focused on assessing the association between user engagement with a digital health platform and user reports that the platform helped them avoid in-person care during pregnancy

Population of Focus: The target audience for this study includes pregnant individuals who were enrolled in the digital platform during their pregnancy between January 2020 and July 2022 and delivered at the time of data analysis in July 2022. These individuals were users of the digital health platform and completed health surveys at both onboarding to the pregnancy program and the postpartum program

Sample Size: The study included a total of 5263 users who used the digital health platform during pregnancy and reported outcomes after delivery

Age Range: The average age of the sample was 32.7 years with a standard deviation of 4.0 years. However, the age range of the sample was not explicitly mentioned in the provided excerpts

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access, Social Supports, Targeting Interventions to Focused Groups

Intervention Description: The augmented care intervention included educationally oriented peer groups, additional appointments, extended time with clinicians, and other supports. The Mother and Family Specialty Center was created to provide augmented care, which sought to minimize risk conditions and improve pregnancy outcomes. The center provided transportation, child care, and a physical environment designed to provide welcoming, positive messages. Discussion groups were held as an integral part of each center visit to increase both social support and knowledge. Information was compiled and distributed to mothers-to-be in both video and easy-to-read print formats. The intervention also included home visits, weekend clinic hours, and direct provision of additional books and equipment

Intervention Results: Women in augmented care rated all aspects of their prenatal care significantly more favorably than did those in usual care. Participating in the Mother and Family Specialty Center was associated with highly positive appraisals of helpfulness, a belief among multiparous women that care was better this time, increased amounts of time spent with their regular nurse, and an almost universal perception that their nurse was “very helpful”. In contrast, those in usual care had more mixed evaluations of their prenatal care, although 80% judged their overall care to be “very helpful”. The number of prenatal visits was significantly greater in augmented care than in usual care. A dramatic difference between the 2 groups was self-report of participation in prenatal or childbirth classes: 79% for augmented care and 17% for usual care. Informing women about their own risk conditions and about pregnancy and delivery was an important feature of augmented care. Significantly more women in augmented care than in usual care reported that they were told they or their baby were “at risk,” although most still reported that they were not informed of their own specific risks. This self-report is at odds with the documented nurse records, which indicated that particular risks were discussed on multiple occasions. However, 69% of those aware of their risk conditions in augmented care reported positive behavior change as a result of prenatal care information, compared with 48% in usual care. Pregnancy outcomes did not differ significantly between the groups; however, among patients in augmented care, rates of preterm births were lower and cesarean deliveries and stays in neonatal intensive care units occurred in smaller proportions. Both groups had lower-than-predicted rates of low birthweight

Conclusion: High-quality prenatal care, emphasizing education, health promotion, and social support, significantly increased women’s satisfaction, knowledge of risk conditions, and perceived mastery in their lives, but it did not reduce low birthweight. The study found that augmented care did not significantly improve pregnancy outcomes, but it did improve women’s perceptions of their care and their knowledge of risk conditions. The study suggests that providing additional support and education to high-risk pregnant women can improve their satisfaction with care and their knowledge of risk conditions, which may lead to positive behavior change. The study also suggests that providing additional support and education to high-risk pregnant women may reduce rates of preterm births, cesarean deliveries, and stays in neonatal intensive care units .

Study Design: The study design was a randomized controlled trial . All pregnant women who sought prenatal care from the Jefferson County (Alabama) Department of Health from March 1994 to June 1996 were screened for eligibility. Women were eligible if they met the following criteria: (1) African American, (2) eligible for Medicaid, (3) less than 26 weeks’ gestation, (4) at least 16 years old, and (5) score of 10 or higher on a risk assessment scale. The scale was based on multiple analyses of a computerized database that included all Medicaid-eligible pregnancies in the area during 1993 and 1994 and a prospective study of high-risk pregnancies . The eligible women were randomly assigned to augmented care or usual care

Setting: The study was conducted in Jefferson County, Alabama, and specifically focused on the Mother and Family Specialty Center, which provided the augmented prenatal care program for high-risk African American women . The center offered a supportive environment with culturally appropriate and individualized care, emphasizing health promotion and education . The setting included features such as transportation assistance, child care, and a welcoming physical environment designed to provide positive messages and cultural appropriateness .

Population of Focus: The target population of the study was high-risk African American women who were eligible for Medicaid, scored 10 or higher on a risk assessment scale, were 16 years or older, and had no major medical complications . The study aimed to improve pregnancy outcomes and patients’ knowledge of risks, satisfaction with care, and behavior for this specific population . The study sample included 656 African American women who enrolled in the trial, with outcome data available for 619 who delivered in area hospitals

Sample Size: The sample size for the study was 656 African American women who enrolled in the trial. Outcome data were available for 619 who delivered in area hospitals, where 318 received augmented care and 301 received usual care . The sample size of 285 women in the experimental group and a similar number of controls were considered adequate to detect a reduction in the rate of low birthweight from 20%–25% to 10%–12%

Age Range: The sample size for the study was 656 African American women who enrolled in the trial. Outcome data were available for 619 who delivered in area hospitals, where 318 received augmented care and 301 received usual care . The sample size of 285 women in the experimental group and a similar number of controls were considered adequate to detect a reduction in the rate of low birthweight from 20%–25% to 10%–12%

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Home Visits, Prenatal Care Access,

Intervention Description: The intervention was a telephonic perinatal care coordination program that included risk assessment, patient education, coordination of care for home services and clinic appointments, coordination of interventions requested by care providers, and patient advocacy. The program was based on best management practices and agreed-upon methods of patient care delivery developed by a panel of experts organized by the Case Management Society of America (CMSA). The program was designed to improve both clinical and financial outcomes for low-income, high-risk pregnant women, particularly those from minority cultural and racial backgrounds

Intervention Results: The intervention was a telephonic perinatal care coordination program that included risk assessment, patient education, coordination of care for home services and clinic appointments, coordination of interventions requested by care providers, and patient advocacy. The program was based on best management practices and agreed-upon methods of patient care delivery developed by a panel of experts organized by the Case Management Society of America (CMSA). The program was designed to improve both clinical and financial outcomes for low-income, high-risk pregnant women, particularly those from minority cultural and racial backgrounds

Conclusion: The study concluded that the telephonic perinatal care coordination program led to increased mean birth weights for the treatment group when intervening variables were controlled. However, the mean gestational age at delivery was not significantly different between the treatment and control groups. Additionally, the program resulted in cost savings, with an average of $501.31 saved per patient in inpatient and outpatient costs combined. The study suggested that the telephonic case management model could be used with other populations to obtain similar results, indicating its potential for broader application

Study Design: The study utilized a quasi-experimental design, with a treatment group and a control group. The treatment group received the telephonic perinatal care coordination program, while the control group received standard care. The study aimed to evaluate the impact of the intervention on pregnancy outcomes for low-income, high-risk pregnant women

Setting: The study was conducted in two large obstetric clinics and a level-3 tertiary care center in Minneapolis, Minnesota, USA .

Population of Focus: The target audience for the study was low-income, high-risk pregnant women, particularly those from minority cultural and racial backgrounds , . The program aimed to demonstrate the value of telephonic perinatal case management for this specific population by improving both clinical and financial outcome

Sample Size: The initial number of participants in the treatment group was 64, and the number of participants in the control group was 59. However, due to the exclusion of twin gestations, the total of singleton pregnancies included in the analysis was 111, with 50 in the control group and 61 in the treatment group

Age Range: The age range of the participants was not explicitly stated in the study. However, the study did report that almost one in ten participants were age 19 or younger, and nearly one in ten were age 35 or older

Intervention Components (click on component to see a list of all articles that use that intervention): Transportation Assistance, Prenatal Care Access, Access,

Intervention Description: It was a retrospective cohort study that aimed to investigate the association between travel time and prenatal care attendance among women who received prenatal care and delivered at North Carolina Women’s Hospital between July 1, 2014, and June 30, 2016. The study utilized electronic medical record (EMR) data from the Carolina Data Warehouse for Health (CDW-H) and the UNC Hospital Perinatal Database (PNDB) to identify a subset of women from the Care4Moms study with singleton pregnancies who received prenatal care from UNC OB/GYN physicians in the NC Women’s Hospital Clinic and were at least 18 years of age. The study used multinomial logistic regression models to estimate the association between travel time and appointment attendance, adjusted for sociodemographic covariates

Intervention Results: The study found that for every 10 minutes of additional travel time, women were 1.05 times as likely to arrive late and 1.03 times as likely to cancel appointments than arrive on time. However, travel time did not significantly affect a patient’s likelihood of not showing for appointments. Additionally, the study identified disparities in appointment attendance based on sociodemographic factors. Non-Hispanic black patients were 71% more likely to arrive late and 51% more likely to not show for appointments than non-Hispanic white patients. Publicly insured women were 28% more likely to arrive late to appointments and 82% more likely to not show for appointments than privately insured women

Conclusion: The study concluded that changes to transportation availability alone may only modestly affect outcomes compared with strategically improving access for sociodemographically marginalized women. The findings suggested that marginalized socioeconomic groups may have a higher risk of poor attendance, widening existing health disparities. The study recommended that providers consider re-evaluating punitive late-arrival policies and informed strategies to better address the needs of patients with longer travel times, particularly those belonging to marginalized sociodemographic groups

Study Design: The study design was a retrospective cohort study of women who received prenatal care and delivered at North Carolina Women’s Hospital between July 1, 2014, and June 30, 2016. The study utilized electronic medical record (EMR) data from the Carolina Data Warehouse for Health (CDW-H) and the UNC Hospital Perinatal Database (PNDB) to identify a subset of women from the Care4Moms study with singleton pregnancies who received prenatal care from UNC OB/GYN physicians in the NC Women’s Hospital Clinic and were at least 18 years of age. The study used multinomial logistic regression models to estimate the association between travel time and appointment attendance, adjusted for sociodemographic covariates

Setting: The setting of the study is based on a U.S.-based population of pregnant women older than 18 years. The research aims to provide insights into the impact of travel time on appointment attendance outcomes within this demographic

Population of Focus: e target audience for this study includes healthcare professionals, policymakers, and researchers involved in maternal and child health, particularly those interested in understanding the impact of travel time on prenatal care attendance and its implications for marginalized socio-demographic groups. Additionally, public health officials and organizations focused on improving access to prenatal care for underserved populations would also find this research relevant and valuable

Sample Size: The study included a sample size of 2,808 women who received prenatal care and delivered at North Carolina Women’s Hospital between July 1, 2014, and June 30, 2016. This sample size encompassed a total of 24,021 appointments, providing a robust dataset for analyzing the association between travel time and prenatal care attendance

Age Range: The study included women who were at least 18 years of age. The age range was categorized into five levels: 18–24, 25–28, 29–32, 33–35, and 36 years and older. This age restriction was implemented to mitigate potential differences in this population’s access to transit, as North Carolina law restricts access to a regular driver’s license to those older than 18 years

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Social Supports, Prenatal Care Access,

Intervention Description: The Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) recommendations focused on the appropriateness of key aspects of prenatal care delivery for average-risk pregnant individuals. The interventions and components of prenatal care delivery addressed in the recommendations included: 1. Prenatal Visit Schedules: This involved determining the appropriate timing and frequency of prenatal visits, including care initiation, visit timing and frequency, and routine pregnancy assessments. 2. Integration of Telemedicine: The recommendations provided guidance on the integration of telemedicine, including virtual visits and home devices, into prenatal care delivery for average-risk pregnant individuals.

Intervention Results: The results of the Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) recommendations included the development of more flexible prenatal care delivery for average-risk individuals. The expert panel, consisting of 19 clinicians and researchers, provided recommendations for key aspects of prenatal care delivery, including prenatal visit schedules, integration of telemedicine, and care individualization. The panelists agreed that a risk assessment for medical, social, and structural determinants of health should be completed as soon as individuals present for care. Additionally, the panel provided recommendations for prenatal visit schedules, integration of telemedicine, and care individualization. The recommendations aimed to ensure that individuals are connected to needed services as early as possible and to match individuals' needs to services delivered.

Conclusion: The conclusions of the Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) recommendations highlighted the need for more flexible and individualized prenatal care delivery for average-risk pregnant individuals. The study emphasized the importance of individualizing care, incorporating telemedicine, and considering both medical conditions and social and structural determinants of health in routine care delivery. The MiPATH recommendations were developed to address the limitations of the existing prenatal care guidelines, which have remained largely unchanged since 1930. By providing more flexible prenatal care choices, including options for visit frequency, monitoring plans, and the inclusion of telemedicine, the recommendations aimed to tailor care based on patient preference and needs in consultation with practitioner recommendations. The study also acknowledged the limitations of the recommendations, including the reliance on expert consensus due to the lack of robust evidence in certain areas. Additionally, the panel considered prenatal care delivery in an ideal setting, and the real-world considerations, such as late presentation to care and lack of supporting resources, were recognized as important areas for future research and policy recommendations. The MiPATH recommendations were described as the initial step in an ongoing process, with plans to obtain input from various stakeholders, including patients, professional societies, public health representatives, and payers, to garner diverse perspectives on the new recommendations. Furthermore, ongoing efforts, such as a systematic review by the Agency for Healthcare Research and Quality, were planned to capture additional supporting evidence for key aspects of prenatal care delivery. In conclusion, the MiPATH recommendations aimed to redesign prenatal care to be more effective, efficient, and equitable for pregnant individuals nationwide, taking into account the evolving landscape of prenatal care delivery and the individualized needs of pregnant individuals. ,

Study Design: The Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) recommendations were developed using an appropriateness study design, specifically the RAND Corporation and University of California Los Angeles Appropriateness Method (RAM), which is a modified Delphi process. The appropriateness study involved six phases: 1. Definition and scope of key terms 2. Literature review and data synthesis 3. Case scenario development 4. Expert panel selection, engagement, and scenario revision 5. Expert panel introduction and appropriateness rating (round 1) 6. Expert panel meeting and appropriateness rating (round 2) 7. Expert panel review of findings The goal of the study was to generate recommendations for components of prenatal care delivery across common average-risk pregnancy conditions. The RAM method was selected for this panel because of its rigor, evidence-based methodology, and ability to incorporate existing evidence and expert opinion to arrive at clinical recommendations. The study received institutional review board exemption from the University of Michigan (HUM00188505). The MiPATH recommendations offer more flexible prenatal care delivery for average-risk individuals.

Setting: The Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) recommendations were developed through a panel process using the RAND Corporation and University of California Los Angeles Appropriateness Method. The panel consisted of 19 clinicians and researchers who represented expertise across maternity care, pediatrics, telemedicine, and social and structural determinants of health. The panelists were selected based on their expertise and were not limited to a specific setting. The recommendations were developed for average-risk pregnant individuals (i.e., individuals not requiring care by maternal-fetal medicine specialists) and were not limited to a specific geographic or healthcare setting. The recommendations were developed to be applicable to a wide range of settings and circumstances.

Population of Focus: The target audience for the Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) recommendations includes a diverse group of stakeholders involved in prenatal care delivery, such as: 1. Maternity Care Clinicians: The recommendations provide important guidance for maternity care clinicians, including obstetricians, midwives, and other healthcare professionals involved in prenatal care delivery. 2. Patients: MiPATH plans to obtain input from patients to ensure that their perspectives are considered in the development and implementation of the recommendations. 3. Professional Societies: Input from professional societies is sought to ensure that the recommendations align with established standards and best practices in prenatal care. 4. Public Health Representatives: Involvement of public health representatives is important to ensure that the recommendations address broader public health goals and priorities related to prenatal care. 5. Payers: Input from payers, such as insurance companies and healthcare payers, is sought to ensure that the recommendations align with payment models and reimbursement structures. The goal is to garner diverse perspectives on the new recommendations from a wide range of stakeholders, including patients, professional societies, public health representatives, and payers, to ensure that the recommendations are well-informed and aligned with the needs of various stakeholders involved in prenatal care delivery.

Sample Size: The Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) panel consisted of 19 clinicians and researchers who participated in the development of the recommendations. This panel was selected based on their expertise in maternity care, pediatrics, telemedicine, and social and structural determinants of health. The panelists were involved in a rigorous process using the RAND Corporation and University of California Los Angeles Appropriateness Method to develop the recommendations for prenatal care delivery. The sample size of 19 panelists reflects the expertise and diversity of perspectives involved in the development of the MiPATH recommendations.

Age Range: The panelists involved in the development of the recommendations were clinicians and researchers with expertise in maternity care, pediatrics, telemedicine, and social and structural determinants of health, and their age range is not specified in the published literature.

Intervention Components (click on component to see a list of all articles that use that intervention): Other (Provider Practice), Prenatal Care Access, Non-Traditional Providers

Intervention Description: The intervention in this study was the provision of obstetric care, specifically prenatal care and delivery services, by family physicians (FPs) in a rural county in Alabama. The FPs provided full-time prenatal care and delivery services at a local hospital, with high-risk pregnancies and infants referred to a regional medical center located 38 miles away. The FPs were trained through an obstetrics fellowship and had experience in managing high-risk deliveries. The study examined the impact of the availability of local obstetric services, particularly prenatal care provided by FPs, on infant mortality rates in the county

Intervention Results: The results of the study indicated that the availability of obstetric care, particularly prenatal care and delivery services provided by family physicians (FPs), was associated with lower infant mortality rates in the rural county of Pickens, Alabama. The study found that during the period when both prenatal care and delivery services were provided locally by FPs, the county achieved an infant mortality rate (IMR) that was lower than both the state and national IMRs during the same period. The closure of the local maternity unit coincided with a 50% increase in IMR, while the provision of full-time prenatal care by an FP trained through an obstetrics fellowship, even in the absence of local delivery services, contributed to an 11% decline in IMR compared to a period with no obstetric care available locally . Furthermore, the study observed a significant decrease in IMR in Pickens County between periods when no obstetric services were available and when full prenatal care and delivery services were provided locally by FPs. The results also highlighted the potential impact of FPs providing obstetric care, including lower rates of cesarean deliveries, forceps deliveries, and labor inductions in low-risk pregnancies compared to obstetricians/gynecologists (OB/GYNs), as well as higher rates of spontaneous vaginal deliveries and vaginal deliveries after cesarean. Despite the loss of local delivery services, the provision of full-time prenatal care by an FP trained through an obstetrics fellowship resulted in a decline in IMR, indicating the potential benefit of prenatal care alone in reducing infant mortality . Additionally, the study compared IMR trends in other rural counties with and without obstetric services and observed variations in IMR changes based on the availability of obstetric care. These findings supported the association between the provision of obstetric care, particularly by FPs, and changes in IMR in rural communities .

Conclusion: The study concluded that the availability of obstetric care, particularly prenatal care and delivery services provided by family physicians (FPs), can have a significant impact on infant mortality rates in rural areas. The study found that the provision of full-time prenatal care and delivery services by FPs was associated with lower infant mortality rates in a rural county in Alabama. The study also highlighted the potential impact of FPs providing obstetric care, including lower rates of cesarean deliveries, forceps deliveries, and labor inductions in low-risk pregnancies compared to obstetricians/gynecologists (OB/GYNs), as well as higher rates of spontaneous vaginal deliveries and vaginal deliveries after cesarean. The study suggested that properly trained FPs can have a profound impact on infant mortality in rural areas and that efforts should be made to maintain their competencies in managing high-risk deliveries. The study also emphasized the importance of access to prenatal care in reducing infant mortality rates, even in the absence of local delivery services

Study Design: The study utilized a natural experiment design to investigate the impact of the availability of obstetric services, particularly prenatal care provided by family physicians, on infant mortality in a rural county. The natural experiment involved variations in the availability of obstetric services in Pickens County, Alabama, over different time periods, allowing the researchers to assess the association between the closure and reopening of local obstetric units and changes in infant mortality rates . This design enabled the researchers to examine the potential impact of the availability of local obstetric services on infant mortality in a real-world setting.

Setting: The setting of the study was Pickens County, Alabama, a rural area where obstetric services, including prenatal care, were unavailable for a period of time . This rural setting allowed the researchers to examine the impact of the availability of obstetric care provided by family physicians on infant mortality in a specific geographic area.

Population of Focus: The target audience for this study includes healthcare professionals, policymakers, and researchers interested in maternal and child health, particularly in rural areas. The findings of the study are relevant to family physicians, obstetricians, public health officials, and policymakers involved in improving access to prenatal care and reducing infant mortality in rural communities

Sample Size: The study focused on a specific rural county, Pickens County in Alabama, and did not explicitly mention a sample size. The researchers likely used available data on infant mortality, prenatal care, and obstetric services within the county to conduct their analysis. Therefore, the "sample size" in this context would refer to the population of the county and the available data on births, infant deaths, and prenatal care services within that population.

Age Range: The study focused on infant mortality, which is defined as the number of deaths among infants less than one year of age . Therefore, the age range of interest in this study was from birth to one year of age.

Intervention Components (click on component to see a list of all articles that use that intervention): Assistance in Making Dental Appointment, Prenatal Care Access,

Intervention Description: The intervention described in the study involved routinely asking pregnant women about dental problems and whether they had seen a dental provider in the previous six months. Additionally, the study utilized a dental referral form from the New York State Department of Health to facilitate referrals for dental care by prenatal providers. The findings indicated that this intervention resulted in a high rate of dental care referrals, and women who reported receiving a dental referral were more than four times more likely to report visiting a dentist during pregnancy compared to those without a referral

Intervention Results: The study found that 95.3% of the surveyed women were eligible for a dental referral, and almost three-quarters of these eligible women reported being referred for dental care by their prenatal provider. Among those who reported a referral, 67.3% reported visiting a dentist during their pregnancy, while only 35.1% of those who reported no referral or were unsure about receiving a referral reported a dental visit. Furthermore, when controlling for minority racial–ethnic status, women who reported receiving a referral for dental care by their prenatal provider were 4.6 times more likely to report a dental visit during pregnancy compared to those who reported no such referral . The study also highlighted that the dental referral program may serve as a model for improving access to and utilization of dental care by low-income pregnant women, as it demonstrated that low-income pregnant women who are referred for dental care by their prenatal provider will seek and utilize dental care when offered

Conclusion: The study concluded that integrating dental screening questions into prenatal care and routinely referring pregnant women for dental care can improve access to and utilization of dental care by low-income pregnant women. The findings showed that low-income pregnant women who reported receiving a dental referral were more likely to report visiting a dentist during pregnancy compared to those who did not receive a referral. The study suggested that the dental referral program may serve as a model for improving access to and utilization of dental care by low-income pregnant women

Study Design: The study was a cross-sectional analytic study conducted over a two-month period in 2010. It involved recruiting Medicaid-eligible pregnant women from targeted prenatal clinics and asking them to complete a written questionnaire in English or Spanish. The survey questions covered demographics, pregnancy characteristics, perceived oral health and oral health behaviors, dental symptoms during pregnancy, dental care history, dental care referral during pregnancy, and having a dental visit during pregnancy. The data were then analyzed using SPSS v.20, and means and proportions were reported. The study also compared groups regarding dental care utilization during pregnancy using Chi-Square tests and controlled for identified confounding variables using logistic regression

Setting: he setting of the study is prenatal clinics in New York, specifically in Long Island, Queens, and Brooklyn. The study evaluated data from an ongoing program that adopted the use of oral health screening within the prenatal setting to increase dental care utilization among low-income women at high risk of disease

Population of Focus: The target audience for the dental care referral program and the study's findings includes healthcare professionals, policymakers, public health practitioners, and researchers interested in improving access to dental care for low-income pregnant women. Additionally, the findings may be relevant to organizations and individuals involved in maternal and child health, oral health promotion, and healthcare access for underserved populations.

Sample Size: The sample size was not explicitly mentioned in the provided excerpts. However, the study collected data from a convenience sample of women who volunteered to complete surveys, which may have influenced the sample size and introduced selection bias

Age Range: The study targeted Medicaid-eligible pregnant women aged 18 and above

Intervention Components (click on component to see a list of all articles that use that intervention): Community Health Workers (CHWs), Prenatal Care Access, Care Coordination,

Intervention Description: The intervention being evaluated in the study is the Health Start Program (HSP) in Arizona. The HSP is a community health worker (CHW) home visiting perinatal support program. CHWs are required to complete 12 hours of continuing education per year . The HSP aims to provide support to at-risk, racially and ethnically diverse, rural, and urban mothers and children in Arizona. The program focuses on improving maternal and child health outcomes by providing various forms of support, including prenatal care, newborn health, and child health up to 5 years of age. The program involves home visits and aims to address the significant challenges and barriers to obtaining healthcare services faced by under-resourced women in Arizona. The specific details of the intervention activities and content are not explicitly outlined in the study protocol

Intervention Results: It primarily focuses on the evaluation protocol, data sources, outcome measures, and the methodology used for assessing maternal and child health outcomes using administrative data.

Conclusion: The study aims to meet the federal Home Visiting Evidence of Effectiveness (HomVEE) standard for evidence-based effectiveness. The study will use a matched comparison group design that meets the published standard for HomVEE's moderate rating. The study will evaluate the impact of the HSP on multiple maternal, infant, and child health outcomes using a combination of four data source

Study Design: The study design is a retrospective, propensity score-matched observational study. The study uses a matched comparison group design that meets the published standard for Home Visiting Evidence of Effectiveness (HomVEE) moderate rating. The study aims to evaluate the impact of the Health Start Program (HSP) on multiple maternal, infant, and child health outcomes. The study uses a combination of four data sources: the HSP database, Vital Records Birth Data, Hospital Discharge Data, and Arizona State Immunization Information System. The study employs propensity score matching (PSM) to create a synthetic comparison group to observe the "counterfactual" to HSP participation, that is, what would have happened in the absence of the program. The study will compare outcomes between HSP mothers and those matched to them by the propensity score

Setting: The setting for this study is the state of Arizona in the United States. Arizona is the sixth largest state in the US, with a population of 6.8 million people. The state is unique in its racial and ethnic diversity, with a higher proportion of Latino and American Indian residents compared to the national average. Additionally, nearly a quarter of the population lives in rural areas, where poverty rates are almost double that of the national poverty rate. The Health Start Program (HSP) is a statewide program that employs community health workers (CHWs) in 14 distinct Arizona counties to engage at-risk, low-income mothers and improve maternal and child outcomes .

Population of Focus: The target audience for the Health Start Program (HSP) in Arizona includes at-risk, low-income, and racially and ethnically diverse pregnant women and their families. The program aims to engage this specific demographic to improve maternal and child outcomes by providing support, education, and advocacy through the use of community health workers (CHWs) who reflect the ethnic, cultural, and socioeconomic characteristics of the communities they serve. The HSP is designed to address the needs of under-resourced women and families who may face significant challenges and barriers to obtaining healthcare services, particularly prenatal care

Sample Size: However, the protocol does mention that the analytic population is of sufficient size to detect meaningful program effects from low-frequency events, including preterm births, low and very low birth weights, maternal morbidity, and differences in immunization and hospitalization rates over a relatively long period. The study also notes that lack of statistical power is not a significant issue for this project, despite the respective sizes of the intervention and comparison populations

Age Range: The study focuses on maternal and child health outcomes within the context of the Health Start Program (HSP) in Arizona. While the specific age range of the children included in the study is not explicitly mentioned, the outcomes evaluated are related to prenatal care, newborn health, and child health up to 5 years of age. Therefore, the study likely encompasses maternal and child health outcomes from prenatal care initiation through early childhood, covering a broad age range from prenatal to early childhood stages

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), NATIONAL, Policy/Guideline (National), STATE, Prenatal Care Access

Intervention Description: Prenatal care is an important component of preventive health care with multigenerational consequences for women and their families. For low-income immigrant women, Emergency Medicaid, a federal safety net program for those poor enough to qualify for Medicaid but who cannot meet the citizenship requirements, covers the cost of a birth but not prenatal care or postpartum contraception. An “unborn child” option enacted in CHIP and CHIPRA gave states new options to provide prenatal care coverage with federal matching funds for extending coverage to immigrant children and pregnant women, regardless of their legal status or date of entry to the U.S. The study leveraged a natural experiment where unauthorized immigrant women eligible for Emergency Medicaid gained access to prenatal care coverage by the expansion of the Emergency Medicaid Plus program in Oregon.

Intervention Results: Expanding access to prenatal care coverage increased both utilization and quality of prenatal care, and women were more likely to receive adequate care and recommended preventive health services. After expansion of access to prenatal care, there was an increase in prenatal visits (7.2 more visits, 95% CI 6.46 to 7.98), receipt of adequate prenatal care (28% increased rate, CI 26 to 31), rates of diabetes screening (61% increased rate, CI 56 to 65) and fetal ultrasounds (74% increased rate, CI 72 to 77). Maternal access to prenatal care was also associated with an increased number of well-child visits (0.24 more visits, CI 0.07 to 0.41), increased rates of recommended screenings and vaccines, and reduced infant mortality (-1.04 per 1000, CI -1.45 to -0.62) and rates of extremely low birth weight (<1000g) (-1.5 per 1000, CI -2.58 to -0.53).

Conclusion: Our results provide evidence of increased utilization and improved health outcomes for unauthorized immigrants and their children who are United States citizens after introduction of prenatal care expansion in Oregon. This study contributes to the debate around reauthorization of the Children's Health Insurance Program in 2017.

Study Design: Quasi-experimental difference-in-difference

Setting: Policy (Oregon Health Authority)

Population of Focus: Pregnant low-income immigrant women and their infants

Data Source: Medical claims data from January 1, 2003 through October 1, 2015

Sample Size: 210,200 mothers and infants

Age Range: Pregnant women: 12-51 years; Infants: 0-1 years

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access, Access, Community Health Centers

Intervention Description: The study did not involve an intervention. Instead, it focused on analyzing the operational efficiency, patient composition, and regional context of U.S. health centers and their associations with access to early prenatal care and low birth weight. The study utilized data from multiple sources to examine the quality of prenatal care and birth outcomes of patients served at Community Health Centers (CHCs) operating in the United States in 2015. The research involved analyzing existing data to understand the relationships between sociodemographic composition of CHCs and the efficiency of health centers, as well as how CHC demographics and efficiency are associated with the numbers of patients served and patient health outcomes relating to pregnancy and childbirth

Intervention Results: The study found that there were significant differences in the association between latent classes and access to prenatal care in the first trimester. CHCs in Class 2, characterized by patients who are Older Rural Whites, had the highest rate of access to prenatal care in the first trimester. Compared to other classes, CHCs in Class 2 had more prenatal patients who received early prenatal care. The study also found that greater efficiency at health centers was associated with lower rates of low birth weight (LBW), even controlling for the sociodemographic composition of CHC patients and regional context. However, greater efficiency was not associated with improved access to early prenatal healthcare. The study noted several limitations, including that their measure of prenatal care only captured the timing of initiation of care and did not capture other dimensions of prenatal care quality. Additionally, the study was unable to identify and separate what share of the labor and financial inputs to their DEA model were being used specifically for pregnancy-related services.

Conclusion: The study concluded that Community Health Centers (CHCs) play a crucial role in providing prenatal care, particularly in rural areas where access to obstetric services is declining. The findings highlighted the importance of CHCs in addressing the unique challenges of providing prenatal and perinatal health care in rural communities. The study also emphasized the persistent racial inequalities in prenatal care and birth outcomes, with CHCs serving predominantly white patients having the highest rates of early access to prenatal care and the lowest rates of low birth weight (LBW) births. Conversely, CHCs serving a larger share of Black and Hispanic patients had significantly lower rates of early access to prenatal care and higher rates of LBW births. The study suggested that patient and regional sociodemographic factors had a stronger association with lower or higher rates of LBW at health centers than either patient access to early prenatal care or the relative efficiency of the centers. Additionally, the study highlighted the need for future research to examine how patient characteristics within particular regional settings of healthcare are associated with patient engagement in care and health outcomes.

Study Design: The study design was a cross-sectional analysis of data from the Uniform Data System (UDS) of the Health Resources and Services Administration (HRSA) for the year 2015. The study used a combination of latent class analysis (LCA), data envelopment analysis (DEA), and generalized linear models with a fractional response to analyze the associations between operational efficiency, patient composition, regional context of U.S. health centers, and access to early prenatal care and low birth weight. The study aimed to identify and classify diversity among health centers in terms of their patient populations and regional contexts and to understand how these factors are associated with the degree of access to early prenatal care for patients and the health outcomes of prenatal patients and their babies.

Setting: The setting of this study is the United States, specifically community health centers (CHCs) that provide primary care services to underserved populations. The study used data from the Uniform Data System (UDS) of the Health Resources and Services Administration (HRSA) to analyze the associations between operational efficiency, patient composition, regional context of U.S. health centers, and access to early prenatal care and low birth weight.

Population of Focus: The target audience for this study includes researchers, policymakers, and practitioners interested in improving maternal and child health through the community health center (CHC) system in the United States. Additionally, stakeholders involved in healthcare delivery, public health, and health disparities may also find the findings of this study relevant to their work.

Sample Size: The initial sample size for this study was 1,331 community health centers (CHCs) funded by the Community Health Center (CHC) Program. However, 79 health centers were excluded, resulting in a final sample of 1,252 CHCs for the latent class analysis (LCA). For the data envelopment analysis (DEA) model, an additional 187 CHCs were excluded, reducing the sample to 1,065. Finally, 24 CHCs were excluded from the sample for analyses predicting the proportion of births born at low birth weight (LBW), resulting in a final sample of 1,041 CHCs for LBW analyses.

Age Range: The study did not have a specific target age group. Instead, the study focused on perinatal health outcomes, which includes health outcomes related to pregnancy and childbirth. The study analyzed data on patient demographics, health outcomes, quality of care indicators, costs, and revenues for all 1,375 federally-qualified health centers (FQHCs) in the United States. The study also used regional zip code tabulation area (ZCTA)-level data from the US Census American Community Survey (ACS; 2010–2014) and Behavioral Risk Factor Surveillance System (BRFSS; 2009–2012) to obtain regional data associated with each CHC's service area.