From the 2019 HVPAA National Conference
Ms. Taylor Jones (University of South Carolina School of Medicine – Greenville), Mr. Dhruvkumar Patel (University of South Carolina School of Medicine – Greenville), Dr. Lauren Demosthenes (University of South Carolina School of Medicine – Greenville)
The current, widely accepted model of prenatal care for uncomplicated pregnancies is 12-14 visits. Studies have concluded that fewer visits is safe. A systematic review of 7 randomized control trials compared a reduced prenatal care model of 4-9 visits to the standard of care. There was no difference in maternal or perinatal morbidity or mortality particularly when there were at least 5 visits.(1) (2) Alternative methods of prenatal care delivery offer a reduced number of visits at various sites in the United States. For example, OB Nest is a standard practice at Mayo Clinic OB that uses remote blood pressure monitoring, fetal heart detection, and text-based communication with 8 prenatal visits.(3) Similarly, the University of Utah combined 5 scheduled in-clinic visits with 7 virtual visits. They reported no changes in maternal or fetal outcomes with high levels of patient satisfaction at a lower cost than traditional visits.(4) Similarly, Babyscriptsä is a tech-enabled toolkit for prenatal and postpartum care that allows obstetric care providers to remotely monitor patient progress and provide reputable health information.
Methods
An IRB-approved pilot study of low risk pregnant women (N=100) were recruited from August 2017 to April 2018 to participate in a nine visit schedule of maternity care using an educational application with remote blood pressure monitoring from Babyscripts. We collected baseline data from this cohort including blood pressure, diabetes screening, maternal complications, fetal APGAR scores, appointment adherence, and additional appointments requested. We also assessed patient and provider satisfaction with the Babyscripts application.
Results
The Babyscripts application was well received by patients: 95% of patients were satisfied with the mobile application, 94% reported positivity around pregnancy readiness, 90% were satisfied with their healthcare team, and 89% were happy with remote monitoring. Babyscripts was able to appropriately identify 8% of women with elevated blood pressures who would later be diagnosed with gestational hypertension. There were no maternal complications in 91% of the women. Three percent of women experienced postpartum hemorrhage and 3% had preeclampsia at delivery. APGAR scores were greater than 7 after 5 minutes in 98% of babies. With the reduced appointment schedule, only 7 patients requested one additional appointment for subjective complaints while 30% of patients missed at least one appointment (18% missed one, 12% missed two or more).
Discussion
Evidence supports satisfaction and safety with reduced prenatal visits using the Babyscripts application and remote monitoring. The remote monitoring successfully identified patients at risk for gestational hypertension. By reducing the number of low risk prenatal visits, physicians can theoretically increase access for more patients and improve provider efficiency. Utilization of remote monitoring may allow women to miss less work or avoid the time and expense of unnecessary in-person prenatal visits. Next steps will include analyzing outcomes data for a similarly matched group who did not use Babyscripts. This data will be ready to present as comparison during the November HVPAA meeting.
(1)Rosen MG et al. Caring for our future: a report by the expert panel on the content of prenatal care. Obstet Gynecol 1991;77(5):782-787.
(2)Carroli et al. WHO systematic review of randomized controlled trials of routine antenatal care. Lancet 2001;357:1565-70.
(3)Meylor de Mooij MJ et al. OB Nest: Reimagining Low-Risk Prenatal Care. Mayo Clinic Proceedings, 2018;93(4): 458-466.
(4)Personalized Prenatal Care: How Far Have We Come & Where Are We Going? (Lecture.Retrieved 4/29/2019, from https://medicine.utah.edu/obgyn/postgraduate-course/docs/clark3.pdf)
