Association between use of a digital health platform during pregnancy and helping users avoid emergency and in-person care: A retrospective observational study (Preprint)

BACKGROUND Almost one-third of pregnant people visit the Emergency Room (ER) during pregnancy. While some emergency care is necessary, gaps in patient education and inaccessibility of preventive services have been identified as key reasons for high-cost, low-value care in pregnancy. Digital platforms present a promising solution for providing resources that can supplement routine prenatal care, thereby reducing the use of low-value in-person services. OBJECTIVE We describe the relationship between use of Maven and in-person care avoidance (ER or office visit) during pregnancy. Maven is a digital prenatal health platform that provides supplemental services and does not replace routine prenatal visits. Rather, Maven offers educational content (articles, videos, and classes), care coordination (through a care advocate), and provider services (virtual appointments and communication with providers) designed to complement prenatal care. Specifically, the aims of this study are to examine: 1) if utilization of Maven is associated with in-person care avoidance overall, and 2) if improvements in pregnancy-related knowledge facilitate in-person care avoidance. To assess aim 2, we test a) if utilization of Maven is associated with improvements in self-reported understanding of warning signs and medically accurate information, and b) if self-reported understanding of medically accurate information and warning signs is associated with in-person care avoidance in a population of Maven users. METHODS In this retrospective study, we used adjusted logistic regression to examine the relationship between digital platform use, avoidance of in-person care, and the platform’s influence on users’ pregnancy-related knowledge (learning medically accurate information and recognizing warning signs). Demographics, medical history, and in-person care avoidance were self-reported. RESULTS Of 5263 users, 280 (5.3%) reported that Maven helped them avoid in-person care during pregnancy. More users who reported avoiding in-person care also reported that the digital platform helped them understand warning signs (231/280 - 82.5%) and learn medically accurate information (185/280 - 66.1%). In adjusted models, all modes of digital service utilization (assessed as quartiles) were associated with avoiding in-person care in a dose-response manner (e.g., virtual provider appointments: Q2 aOR 1.57; 95% CI: 1.00-2.41; Q3 aOR 2.53; 95% CI: 1.72-3.72; Q4 aOR 5.26; 95% CI: 3.76-7.42). Users were more likely to avoid in-person care if they reported that Maven helped them recognize warning signs (aOR 3.55; 95% CI: 2.60-4.94) or learn medically accurate information (aOR 2.05; 95% CI 1.59-2.67). CONCLUSIONS These results suggest that digital platforms can be effective in helping patients avoid in-person care. The educational pathway suggests that digital platforms can be particularly effective in helping patients recognize warning signs and learn medically accurate information, which may help them avoid in-person care by recognizing when in-person care is medically appropriate. Future work is needed to assess other pathways through which digital resources can support pregnant people and improve perinatal care utilization. CLINICALTRIAL