Patient and Provider Perspectives of a New Prenatal Care Model Introduced in Response to the COVID-19 Pandemic

Objective Randomized controlled trials document the safety and efficacy of reduced frequency prenatal visit schedules and virtual visits, but real-world data are lacking Our institution created a prenatal care delivery model incorporating these alternative approaches to continue safely providing prenatal care during the COVID-19 pandemic Our objective was to evaluate institutional-level adoption and patient and provider experiences with the COVID-19 prenatal care model Study Design We conducted a single-site evaluation of a COVID-19 prenatal care model incorporating a reduced frequency visit schedule and virtual visits deployed at a suburban academic institution on March 20, 2020 We used Electronic Health Record data to evaluate institution-level model adoption, defined as changes in overall visit frequency and proportion of virtual visits in the three months before and after implementation To evaluate the patient and provider experience with the COVID-19 model, we conducted an online survey of all pregnant patients (>20 weeks gestation) and providers in May 2020 Three domains of care experience were evaluated: 1) access, 2) quality and safety, and 3) satisfaction Quantitative data were analyzed with basic descriptive statistics Free-text responses coded by the three survey domains elucidated drivers of positive and negative care experiences Results Following COVID-19 model adoption, average weekly prenatal visit volume fell by 16 1%, from 898 to 761 weekly visits, the average weekly proportion of prenatal visits conducted virtually increased from 10 8% (97/898) to 43 3% (330/761), and the average visit no-show rate remained stable (4 3% pre-implementation;4 2%, post-implementation) Of those eligible, 74 8% (77/103) of providers and 15 0% (253/1690) of patients participated in the surveys Patient respondents were largely white (180/253, 71 1%) and privately insured (199/253, 78 7%), reflecting the study site population Rates of chronic conditions and pregnancy complications also differed from national prevalence Provider respondents were predominantly white (44/66, 66 7%) and female (50/66, 75 8%) Most patients and almost all providers reported that virtual visits improved access to care (patients: 68 8%, 174/253;providers: 74/77, 96 1%) Over half of respondents (patients: 124/253, 53 3%;providers: 41/77, 62 1%) believed virtual visits were safe Nearly all believed home blood pressure cuffs were important for virtual visits (patients: 213/231, 92 2%;providers: 63/66, 95 5%) Most reported satisfaction with the COVID-19 model (patients: 196/253, 77 5%;providers: 64/77, 83 1%) In free-text responses, drivers of positive care experiences were similar for patients and providers, and included perceived improved access to care through decreased barriers (e g transportation, childcare);perceived high quality of virtual visits for low-risk patients and increased safety during the pandemic;and improved satisfaction through better patient counseling Perceived drivers of negative care experience were also similar for patients and providers, but less common These included concerns that unequal access to virtual visits could deepen existing maternity care inequities, concerns that the lack of home devices (e g blood pressure cuffs) would impact care quality and safety, and dissatisfaction with poor patient-provider continuity and inadequate expectation-setting for the virtual visit experience Conclusion Reduced visit schedules and virtual visits were rapidly integrated into real-world care, with positive experiences for many patients and providers Future research is needed to understand the health outcomes and care experience associated with alternative approaches to prenatal care delivery across more diverse patient populations outside of the COVID-19 pandemic, to inform broader health policy decisions