Innovative Strategies to Reduce Disparities in the Quality of Prenatal Care in Underresourced Settings

This study examined what innovative strategies, including the use of health information technology (health IT), have been or can be used to reduce disparities in prenatal care quality in underresourced settings. Based on literature review and key informant interviews, the authors identified 17 strategies that have been or can be used to (a) increase access to timely prenatal care, (b) improve the content of prenatal care, and (c) enhance the organization and delivery of prenatal care. Health IT can be used to (a) increase consumer awareness about the importance of preconception and early prenatal care, facilitate spatial mapping of access gaps, and improve continuity of patient records; (b) support collaborative quality improvement, facilitate performance measurement, enhance health promotion, assist with care coordination, reduce clinical errors, improve delivery of preventive health services, provide decision support, and encourage completeness of documentation; and (c) support data integration and engineer collaborative innovation.

[1]  A. B. Joy,et al.  Low-income women in California may be at risk of inadequate folate intake , 2007 .

[2]  N. Halfon,et al.  Preventing low birth weight: is prenatal care the answer? , 2003, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[3]  W. Ray,et al.  Effects of Medicaid eligibility expansion on prenatal care and pregnancy outcome in Tennessee. , 1990, JAMA.

[4]  Jeffrey D. Klausner,et al.  SEXINFO: a sexual health text messaging service for San Francisco youth. , 2008, American journal of public health.

[5]  M. Chassin,et al.  Achieving and sustaining improved quality: lessons from New York State and cardiac surgery. , 2002, Health affairs.

[6]  C. Hobel,et al.  A Framework for the Development of maternal quality of care indicators. , 2005, Maternal and Child Health Journal.

[7]  J. Haar,et al.  Can text messaging results reduce time to treatment of Chlamydia trachomatis? , 2008, Sexually Transmitted Infections.

[8]  Donald W. Miller,et al.  Prenatal care: a strategic first step toward EMR acceptance. , 2003, Journal of healthcare information management : JHIM.

[9]  Donald W. Miller,et al.  The Transition from Paper to Digital: Lessons for Medical Specialty Societies , 2008, AMIA.

[10]  Janet M. Corrigan,et al.  Leadership by example : coordinating government roles in improving health care quality , 2003 .

[11]  N. Goldenberg,et al.  Metformin during pregnancy reduces insulin, insulin resistance, insulin secretion, weight, testosterone and development of gestational diabetes: prospective longitudinal assessment of women with polycystic ovary syndrome from preconception throughout pregnancy. , 2004, Human reproduction.

[12]  K. Fiscella DOES PRENATAL CARE IMPROVE BIRTH OUTCOMES? A CRITICAL REVIEW , 1995, Obstetrics and gynecology.

[13]  Saskia le Cessie,et al.  The effect of preconception counselling on lifestyle and other behaviour before and during pregnancy. , 2008, Women's health issues : official publication of the Jacobs Institute of Women's Health.

[14]  M. Millenson Pay for performance: the best worst choice , 2004, Quality and Safety in Health Care.

[15]  Sheila Roman,et al.  Public reporting and pay for performance in hospital quality improvement. , 2007, The New England journal of medicine.

[16]  K. Baldwin Comparison of selected outcomes of CenteringPregnancy versus traditional prenatal care. , 2006, Journal of midwifery & women's health.

[17]  [Communication with patients]. , 1997, Pflege.

[18]  Barbara Ann Graves,et al.  Integrative literature review: a review of literature related to geographical information systems, healthcare access, and health outcomes. , 2008, Perspectives in health information management.

[19]  B. Bloom Crossing the Quality Chasm: A New Health System for the 21st Century , 2002 .

[20]  K J Rothman,et al.  Multivitamin/folic acid supplementation in early pregnancy reduces the prevalence of neural tube defects. , 1989, JAMA.

[21]  C M Kilo,et al.  A Framework for Collaborative Improvement: Lessons from the Institute for Healthcare Improvement's Breakthrough Series , 1998, Quality management in health care.

[22]  M. Kogan,et al.  The Influence of Site of Care on the Content of Prenatal Care for Low-Income Women , 1997, Maternal and Child Health Journal.

[23]  Mary Etta Mills,et al.  Linkage of patient records to support continuity of care: Issues and future directions. , 2006, Studies in health technology and informatics.

[24]  E. Patterson Reducing Cesarean Section Rates Safely: Lessons from a "Breakthrough Series" , 1999 .

[25]  J. Hauth,et al.  Impact of interconception antibiotics on the endometrial microbial flora. , 2007, American journal of obstetrics and gynecology.

[26]  N. Cox,et al.  Prevention and Control of Influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). , 2006, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[27]  T. Joyce Impact of Augmented Prenatal Care on Birth Outcomes of Medicaid Recipients in New York City , 1997, Journal of health economics.

[28]  Texting – a revolution in sexual health communication , 2006, International journal of STD & AIDS.

[29]  T. Bennett,et al.  Access to prenatal care following major Medicaid eligibility expansions. , 1993, JAMA.

[30]  M. Kotelchuck,et al.  Assessing the Role and Effectiveness of Prenatal Care: History, Challenges, and Directions for Future Research , 2001, Public health reports.

[31]  B. McEwen Protective and damaging effects of stress mediators. , 1998, The New England journal of medicine.

[32]  K. Godfrey The role of the placenta in fetal programming-a review. , 2002, Placenta.

[33]  P. Bauer,et al.  Recipient and provider perspectives of barriers to rural prenatal care. , 1998, Journal of community health nursing.

[34]  J. Martin,et al.  Births: final data for 2000. , 2002, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[35]  M. Hudes,et al.  Learner-centered nutrition education improves folate intake and food-related behaviors in nonpregnant, low-income women of childbearing age. , 2008, Journal of the American Dietetic Association.

[36]  M. Marquis,et al.  The effects of Florida's Medicaid eligibility expansion for pregnant women. , 1998, American journal of public health.

[37]  Ian M. Bennett,et al.  Improving Maternal Care with a Continuous Quality Improvement Strategy: A Report from the Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) Network , 2009, The Journal of the American Board of Family Medicine.

[38]  D. Lauderdale,et al.  Widening social inequalities in risk for sudden infant death syndrome. , 2005, American journal of public health.

[39]  J. Martin,et al.  Births: final data for 2007. , 2010, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[40]  R H Brook,et al.  The public release of performance data: what do we expect to gain? A review of the evidence. , 2000, JAMA.

[41]  Alain C Enthoven,et al.  Paying for performance: Medicare should lead. , 2003, Health affairs.

[42]  D M Berwick,et al.  Reducing cesarean section rates safely: lessons from a "breakthrough series" collaborative. , 1998, Birth.

[43]  J. Hauth,et al.  Interconceptional antibiotics to prevent spontaneous preterm birth: a randomized clinical trial. , 2006, American journal of obstetrics and gynecology.

[44]  Mark E Feinberg,et al.  Improving women's preconceptional health: findings from a randomized trial of the Strong Healthy Women intervention in the Central Pennsylvania women's health study. , 2008, Women's health issues : official publication of the Jacobs Institute of Women's Health.

[45]  S. McLafferty,et al.  Prenatal Care Need and Access: A GIS Analysis , 2004, Journal of Medical Systems.

[46]  E. Norwitz Defective implantation and placentation: laying the blueprint for pregnancy complications. , 2006, Reproductive biomedicine online.

[47]  S. Newberry,et al.  Preconception Care: A Systematic Review , 2002, Maternal and Child Health Journal.

[48]  J. Ickovics,et al.  Group Prenatal Care and Preterm Birth Weight: Results From a Matched Cohort Study at Public Clinics , 2003, Obstetrics and gynecology.

[49]  G. Chrousos,et al.  The Stress Response and Immune Function: Clinical Implications: The 1999 Novera H. Spector Lecture , 2000, Annals of the New York Academy of Sciences.

[50]  Andrew Curtis,et al.  From Healthy Start to Hurricane Katrina: Using GIS to eliminate disparities in perinatal health , 2008, Statistics in medicine.

[51]  C. Klima Centering pregnancy: a model for pregnant adolescents. , 2003, Journal of midwifery & women's health.

[52]  김욱 Patient Health Questionnaire-9(PHQ-9)을 활용한 대학생의 우울감 및 영향요인 연구 , 2012 .

[53]  Thomas H. Lee,et al.  Paying physicians for high-quality care. , 2004, The New England journal of medicine.

[54]  Tanaka The role of , 2000, Journal of insect physiology.

[55]  Marilyn D Paterno,et al.  Electronic alerts to prevent venous thromboembolism among hospitalized patients. , 2005, The New England journal of medicine.

[56]  Jeanne-Marie Guise,et al.  Examining the value of electronic health records on labor and delivery. , 2008, American journal of obstetrics and gynecology.

[57]  C. Hobel,et al.  Preconception Care Between Pregnancies: The Content of Internatal Care , 2006, Maternal and Child Health Journal.

[58]  B. Gerbert,et al.  Computerized counseling for folate knowledge and use: a randomized controlled trial. , 2008, American journal of preventive medicine.

[59]  A. Dunlop,et al.  Promising Practices in Preconception Care for Women at Risk for Poor Health and Pregnancy Outcomes , 2006, Maternal and Child Health Journal.

[60]  M. Kogan,et al.  Racial disparities in reported prenatal care advice from health care providers. , 1994, American journal of public health.

[61]  C. Hobel,et al.  A Framework for the Development of MaternalQuality of Care Indicators , 2005, Maternal and Child Health Journal.

[62]  C. Hobel,et al.  Gestational Pyelonephritis as an Indicator of the Quality of Ambulatory Maternal Health Care Services , 2006, Obstetrics and gynecology.

[63]  B. Thiers Public Reporting and Pay for Performance in Hospital Quality Improvement , 2008 .

[64]  Peter A. Gloor,et al.  Swarm Creativity: Competitive Advantage Through Collaborative Innovation Networks , 2006 .

[65]  Dawn M. Aycock,et al.  Comparison of Centering Pregnancy to Traditional Care in Hispanic Mothers , 2009, Maternal and Child Health Journal.

[66]  J. S. St. Lawrence,et al.  Receptivity of African American adolescents to an HIV-prevention curriculum enhanced by text messaging. , 2009, Journal for specialists in pediatric nursing : JSPN.

[67]  Robert H. Miller,et al.  The impact of financial incentives on quality of health care. , 1998, The Milbank quarterly.

[68]  Kay A. Johnson,et al.  Healthy start lessons learned on interconception care. , 2008, Women's health issues : official publication of the Jacobs Institute of Women's Health.

[69]  Stephen A. Martin,et al.  A Reengineered Hospital Discharge Program to Decrease Rehospitalization , 2009, Annals of Internal Medicine.

[70]  Bradley Jh,et al.  Electronic medical records for prenatal patients: challenges and solutions. , 1998 .

[71]  C. Morris,et al.  The effect of providing health coverage to poor uninsured pregnant women in Massachusetts. , 1993, JAMA.

[72]  W. Ray,et al.  Presumptive eligibility for pregnant Medicaid enrollees: its effects on prenatal care and perinatal outcome. , 1994, American journal of public health.

[73]  A. Handler,et al.  Introduction of CenteringPregnancy in a public health clinic. , 2009, Journal of midwifery & women's health.

[74]  N. Halfon,et al.  Looking back at pediatrics to move forward in obstetrics , 2008, Current opinion in obstetrics & gynecology.

[75]  Quality,et al.  National Healthcare Disparities Report , 2014 .

[76]  K. Cain,et al.  The effect of expanding Medicaid prenatal services on birth outcomes. , 1998, American journal of public health.

[77]  B. Boushon,et al.  Using a virtual breakthrough series collaborative to improve access in primary care. , 2006, Joint Commission journal on quality and patient safety.

[78]  J. Hibbard,et al.  Hospital performance reports: impact on quality, market share, and reputation. , 2005, Health affairs.

[79]  J. Lumley,et al.  Aiming to increase birth weight: a randomised trial of pre-pregnancy information, advice and counselling in inner-urban Melbourne , 2006, BMC Public Health.

[80]  S. Phelan The prenatal medical record: purpose, organization and the debate of print versus electronic. , 2008, Obstetrics and gynecology clinics of North America.

[81]  H. Atrash,et al.  Recommendations to improve preconception health and health care: strategies for implementation. , 2007, Journal of women's health.

[82]  C. Dolbier,et al.  Barriers to Seeking Help and Treatment Suggestions for Prenatal Depressive Symptoms: Focus Groups with Rural Low-Income Women , 2008, Issues in mental health nursing.

[83]  Donald W. Miller Using an electronic medical record to improve communication within a prenatal care network. , 2005, Obstetrics and gynecology.

[84]  C. Henderson,et al.  Effects of Nurse Home Visiting on Maternal and Child Functioning: Age-9 Follow-up of a Randomized Trial , 2007, Pediatrics.

[85]  A. Sullivan,et al.  Texting decreases the time to treatment for genital Chlamydia trachomatis infection , 2006, Sexually Transmitted Infections.

[86]  J. Hadley MEDICAL CARE RESEARCH AND REVIEW Supplement to Volume 60, Number 2 / June 2003 , 2003 .

[87]  S. Arévalo,et al.  Impact of two scheduling systems on early enrollment in a group prenatal care program. , 2009, Journal of midwifery & women's health.

[88]  S. Rising Centering pregnancy. An interdisciplinary model of empowerment. , 1998, Journal of nurse-midwifery.

[89]  J. Ebersole,et al.  CenteringPregnancySmiles™: Implementation of a Small Group Prenatal Care Model with Oral Health , 2009, Journal of health care for the poor and underserved.

[90]  D. Mak,et al.  . . . Sending out an SMS: an impact and outcome evaluation of the Western Australian Department of Health's 2005 chlamydia campaign. , 2007, Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals.

[91]  Helen Mackenzie A Text Messaging Trial in Family Planning Clinics , 2009, Nursing Informatics.

[92]  K. Bloom,et al.  Pregnancy outcomes of adolescents enrolled in a CenteringPregnancy program. , 2004, Journal of midwifery & women's health.

[93]  H. Kennedy,et al.  "I wasn't alone"--a study of group prenatal care in the military. , 2009, Journal of midwifery & women's health.

[94]  N. Gavin,et al.  Racial Disparities in Medicaid Enrollment and Prenatal Care Initiation Among Pregnant Teens in Florida: Comparisons Between 1995 and 2001 , 2008, Medical care.

[95]  Z. Clayson,et al.  Evaluation of California's statewide implementation of enhanced perinatal services as Medicaid benefits. , 1995, Public health reports.

[96]  M. Narayan The National Standards for Culturally and Linguistically Appropriate Services in Health Care , 2002, Care Management Journals.

[97]  K. Schoendorf,et al.  Differences between black and white women in the use of prenatal care technologies. , 1994, American journal of obstetrics and gynecology.

[98]  M. Lim,et al.  SMS STI: A Review of the Uses of Mobile Phone Text Messaging in Sexual Health , 2008, International journal of STD & AIDS.

[99]  P. Nielsen Group prenatal care and perinatal outcomes: a randomized controlled trial. , 2008, Obstetrics and gynecology.

[100]  3: Is text messaging key to improving adolescent sexual health? , 2007 .

[101]  Fredrick D. Ashbury,et al.  The Impact of Computerized Clinical Reminders on Physician Prescribing Behavior: Evidence From Community Oncology Practice , 2003, American journal of medical quality : the official journal of the American College of Medical Quality.

[102]  Owen Dyer,et al.  Patients will be reminded of appointments by text messages , 2003, BMJ : British Medical Journal.

[103]  T. Joyce,et al.  Changes in prenatal care timing and low birth weight by race and socioeconomic status: implications for the Medicaid expansions for pregnant women. , 2001, Health services research.

[104]  D. Rittenhouse,et al.  Improvements in Prenatal Insurance Coverage and Utilization of Care in California: An Unsung Public Health Victory , 2003, Maternal and Child Health Journal.