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BMC Pregnancy and Childbirth

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Open Access 01-12-2017 | Study protocol

Expect With Me: development and evaluation design for an innovative model of group prenatal care to improve perinatal outcomes

Authors: Shayna D. Cunningham, Jessica B. Lewis, Jordan L. Thomas, Stephanie A. Grilo, Jeannette R. Ickovics

Published in: BMC Pregnancy and Childbirth | Issue 1/2017

Abstract

Background

Despite biomedical advances and intervention efforts, rates of preterm birth and other adverse outcomes in the United States have remained relatively intransigent. Evidence suggests that group prenatal care can reduce these risks, with implications for maternal and child health as well as substantial cost savings. However, widespread dissemination presents challenges, in part because training and health systems have not been designed to deliver care in a group setting. This manuscript describes the design and evaluation of Expect With Me, an innovative model of group prenatal care with a strong integrated information technology (IT) platform designed to be scalable nationally.

Methods/Design

Expect With Me follows clinical guidelines from the American Congress of Obstetricians and Gynecologists. Expect With Me incorporates the best evidence-based features of existing models of group care with a novel integrated IT platform designed to improve patient engagement and support, enhance health behaviors and decision making, connect providers and patients, and improve health service delivery. A multisite prospective longitudinal cohort study is being conducted to examine the impact of Expect With Me on perinatal and postpartum outcomes, and to identify and address barriers to national scalability. Process and outcome evaluation will include quantitative and qualitative data collection at patient, provider, and organizational levels. Mixed-method data collection includes patient surveys, medical record reviews, patient focus groups; provider surveys, session evaluations, provider focus groups and in-depth interviews; an online tracking system; and clinical site visits. A two-to-one matched cohort of women receiving individual care from each site will provide a comparison group (n = 1,000 Expect With Me patients; n = 2,000 individual care patients) for outcome and cost analyses.

Discussion

By bundling prevention and care services into a high-touch, high-tech group prenatal care model, Expect With Me has the potential to result in fundamental changes to the health care system to meet the “triple aim:” better healthcare quality, improved outcomes, and lower costs. Findings from this study will be used to optimize the dissemination and effectiveness of this model.

Trial registration

ClinicalTrials.gov, NCT02169024. Retrospectively registered on June 18, 2014.

Office of Disease Prevention and Health Promotion. Maternal, infant and child health. Washington, DC: Department of Health and Human Services; 2014.

Centers for Disease Control and Prevention. Births and natality 2014. 2016. http://www.cdc.gov/nchs/fastats/births.htm. Accessed 22 Dec 2016.

United States Census Bureau. Completed fertility for women 40 to 50 years old by selected characteristics: June 2014. 2014.

Hamilton B, Martin J, Osterman M. Births: preliminary data from 2015. Natl Vital Stat Rep. 2016;65:1–14.PubMed

Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ. 2010;88:31–8.CrossRefPubMed

Mathews T, MacDorman M, Thoma M. Infant mortality statistics from the 2013 period linked birth/infant death data set. Natl Vital Stat Rep. 2015;64:1–29.

Centers for Disease Control and Prevention. Preterm births. 2016. http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PretermBirth.htm. Accessed 22 Dec 2016.

Saigal S, Doyle L. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet. 2008;371:261–9.CrossRefPubMed

Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller AB, et al. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health. 2013;10 Suppl 1:S2.CrossRefPubMedCentralPubMed

10.

Barker D, Eriksson J, Forsen T, Osmond C. Fetal origins of adult disease: Strength of effects and biological basis. Int J Epidemiol. 2002;31:1235–9.CrossRefPubMed

11.

Kajantie E, Osmond C, Barker D, Forsen T, Phillips D, Eriksson J. Size at birth as a predictor of mortality in adulthood: A follow-up of 350,000 person years. Int J Epidemiol. 2005;34:655–63.CrossRefPubMed

12.

Behrman R, Butler A. Preterm birth: causes, consequences, and prevention. Washington, DC: Institute of Medicine; 2007.

13.

Patton M. US Health Care Costs Rise Faster Than Inflation. Forbes; 2015.

14.

Truven Health Analytics Inc. Costs of Preterm Birth. Prepared for March of Dimes; 2013.

15.

Hodek JM, von der Schulenburg JM, Mittendorf T. Measuring economic consequences of preterm birth - Methodological recommendations for the evaluation of personal burden on children and their caregivers. Health Econ Rev. 2011;1:6.CrossRefPubMedCentralPubMed

16.

Chang HH, Larson J, Blencowe H, Spong CY, Howson CP, Cairns-Smith S, et al. Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very high human development index. Lancet. 2013;381:223–34.CrossRefPubMed

17.

Ferrero DM, Larson J, Jacobsson B, Di Renzo GC, Norman JE, Martin Jr JN, et al. Cross-country individual participant analysis of 4.1 million singleton births in 5 countries with very high human development index confirms known associations but provides no biologic explanation for 2/3 of all preterm births. PLoS One. 2016;11:e0162506.CrossRefPubMedCentralPubMed

18.

Ickovics JR, Kershaw TS, Westdahl C, Magriples U, Massey Z, Reynolds H, et al. Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstet Gynecol. 2007;110(2 Pt 1):330–9.CrossRefPubMedCentralPubMed

19.

Picklesimer AH, Billings D, Hale N, Blackhurst D, Covington-Kolb S. The effect of centering pregnancy group prenatal care on preterm birth in a low-income population. Am J Obstet Gynecol. 2012;206:415.e411–7.

20.

Edward McCabe. Prematurity Prevention Conference 2015: Quality Improvement, Evidence and Practice. Arlington: March of Dimes; 2015.

21.

Ickovics J, Earnshaw V, Lewis J, Kershaw T, Magriples U, Stasko E, et al. Cluster randomized controlled trial of group prenatal care: perinatal outcomes among adolescents in New York City health centers. Am J Public Health. 2016;106:359–65.CrossRefPubMedCentralPubMed

22.

Carter EB, Temming LA, Akin J, Fowler S, Macones GA, Colditz GA, et al. Group prenatal care compared with traditional prenatal care: a systematic review and meta-analysis. Obstet Gynecol. 2016;128:551–61.CrossRefPubMed

23.

Kershaw TS, Magriples U, Westdahl C, Rising SS, Ickovics J. Pregnancy as a window of opportunity for HIV prevention: Effects of an HIV intervention delivered within prenatal care. Am J Public Health. 2009;99:2079–86.CrossRefPubMedCentralPubMed

24.

Magriples U, Boynton MH, Kershaw T, Lewis J, Rising SS, Tobin JN, et al. The impact of group prenatal care on pregnancy and postpartum weight trajectories. Am J Obstet Gynecol. 2015;213:688.e681–9.CrossRef

25.

Felder J, Epel E, Lewis JB, Cunningham S, Tobin JN, Rising SS, et al. Effect of group prenatal care on depressive symptoms and associations with preterm birth: A cluster randomized control trial. J Consult Clin Psychol. (revise and resubmit December 2016).

26.

Heberlein E, Picklesimer AH, Billings DL, Covington-Kolb S, Farber N, Frongillo EA. Qualitative comparison of women’s perspectives on the functions and benefits of group and individual prenatal care. J Midwifery Womens Health. 2016;61:224–34.CrossRefPubMed

27.

Picklesimer AH. The SC Centering Story, Northeastern Centering Symposium. Waltham: Centering Healthcare Institute and March of Dimes; 2015.

28.

UnitedHealth Center for Health Reform & Modernization. 100 Percent of Our Future: Improving the Health of America’s Children. Minneapolis: UnitedHealth Group; 2013.

29.

Gareau S, Lòpez-De Fede A, Loudermilk BL, Cummings TH, Hardin JW, Picklesimer AH, et al. Group prenatal care results in medicaid savings with better outcomes: A propensity score analysis of Centering Pregnancy participation in South Carolina. Matern Child Health J. 2016;20:1384–93.

30.

Declercq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Listening to mothers III: pregnancy and birth. New York: Childbirth Connection; 2013.

31.

McDonald SD, Sword W, Eryuzlu LN, Neupane B, Beyene J, Biringer AB. Why are half of women interested in participating in group prenatal care? Matern Child Health J. 2016;20:97–105.CrossRefPubMed

32.

Paina L, Peters DH. Understanding pathways for scaling up health services through the lens of complex adaptive systems. Health Policy Plan. 2011;27:365–73.CrossRefPubMed

33.

Novick G, Sadler LS, Knafl KA, Groce NE, Kennedy HP. In a hard spot: providing group prenatal care in two urban clinics. Midwifery. 2013;29:690–7.CrossRefPubMed

34.

Novick G, Womack JA, Lewis JB, Stasko EC, Rising SS, Sadler LS, et al. Perceptions of barriers and facilitators during implementation of a complex model of group prenatal care in six urban sites. Res Nurs Health. 2015;38:462–74.CrossRefPubMedCentralPubMed

35.

Noffsinger EB. Running group visits in your practice. London, New York: Springer Science & Business Media; 2009.CrossRef

36.

American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care. Elk Grove Village (IL) and Washington, DC: AAP and ACOG; 2012.

37.

Antheunis ML, Tates K, Nieboer TE. Patients’ and health professionals’ use of social media in health care: motives, barriers and expectations. Patient Educ Couns. 2013;92:426–31.CrossRefPubMed

38.

Greaves F, Ramirez-Cano D, Millett C, Darzi A, Donaldson L. Harnessing the cloud of patient experience: Using social media to detect poor quality healthcare. BMJ Qual Saf. 2013;22:183–6.CrossRef

39.

Cheston CC, Flickinger TE, Chisolm MS. Social media use in medical education: a systematic review. Acad Med. 2013;88:893–901.CrossRefPubMed

40.

Deakin T, McShane CE, Cade JE, Williams RD. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2005;2:CD003417.

41.

Housden L, Wong ST, Dawes M. Effectiveness of group medical visits for improving diabetes care: a systematic review and meta-analysis. CMAJ. 2013;185:E635–44.CrossRefPubMedCentralPubMed

42.

Catling CJ, Medley N, Foureur M, Ryan C, Leap N, Teate A, et al. Group versus conventional antenatal care for women. Cochrane Database Syst Rev. 2015;2:CD007622.

43.

Ashman A, Gillies R. Cooperative learning: The social and intellectual outcomes of learning in groups. Abingdon: Routledge; 2003.

44.

Feldman M. Cluster visits. Am J Nurs. 1974;74:1485–8.PubMed

45.

Massey Z, Rising SS, Ickovics JR. CenteringPregnancy group prenatal care: promoting relationship-centered care. J Obstet Gynecol Neonatal Nurs. 2006;35:286–94.CrossRefPubMed

46.

Hyde J, Appleby PR, Weiss G, Bailey J, Morgan X. Group-level interventions for persons living with HIV: A catalyst for individual change. AIDS Educ Prev. 2005;17(1 Suppl A):53–65.CrossRefPubMed

47.

International Organization for Standardization. Ergonomics of human-system interaction — Part 210: Human-centred design for interactive systems. Available at: http://www.iso.org/iso/catalogue_detail.htm?csnumber=52075. Accessed 10 Mar 2016.

48.

Hartzler A, Izard J, Dalkin B, Mikles S, Gore J. Design and feasibility of integrating personalized PRO dashboards into prostate cancer care. J Am Med Inform Assoc. 2016;23:38–47.CrossRefPubMed

49.

Hartzler A, Chaudhuri S, Fey B, Flum D, Lavallee D. Integrating patient-reported outcomes into spine surgical care through visual dashboards: Lessons learned from human-centered design. EGEMS. 2015;3:1133.PubMedCentralPubMed

50.

Salmon M, Salmon C, Bissinger A, Muller MM, Gebreyesus A, Geremew H, et al. Alternative ultrasound gel for a sustainable ultrasound program: application of human centered design. PLoS One. 2015;10:e0134332.CrossRefPubMedCentralPubMed

51.

Brennan P, Downs S, Casper G. Project HealthDesign: Rethinking the power and potential of personal health records. J Biomed Inform. 2010;43:S3–5.CrossRefPubMed

52.

Wandersman A, Duffy J, Flaspohler P, Noonan R, Lubell K, Stillman L, et al. Bridging the gap between prevention research and practice: The interactive systems framework for dissemination and implementation. Am J Community Psychol. 2008;41:171–81.CrossRefPubMed

53.

Steckler A, Linnan L. Process evaluation for public health interventions and research. San Francisco: Jossey-Bass; 2002.

54.

Chaudoir S, Dugan A, Barr C. Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures. Implement Sci. 2013;8:22.CrossRefPubMedCentralPubMed

55.

Huijg J, Crone M, Verheijden M, van der Zouwe N, Middelkoop B, Gebhardt W. Factors influencing the adoption, implementation, and continuation of physical activity interventions in primary health care: a Delphi study. BMC Fam Pract. 2013;14:142.CrossRefPubMedCentralPubMed

56.

Sudman S, Bradburn N. Response effects in surveys. Chicago: Aldine; 1974.

57.

Babor T, Brown J, del Boca F. Validity of self-reports in applied research on addictive behaviors: fact or fiction? Addict Behav. 1990;12:5–31.

58.

Latkin C, Vlahov D, Anthony J. Socially desirable responding and self-reported HIV infection risk behaviors among intravenous drug users. Addiction. 1993;88:517–26.CrossRefPubMed

59.

Meichenbaum D. Cognitive-behavior modification. Boston: Springer Science & Business Media; 2013.

60.

Austin PC. A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003. Stat Med. 2008;27:2037–49.CrossRefPubMed

61.

Cunningham SD, Grilo S, Lewis JB, Novick G, Rising SS, Tobin JN, et al. Group prenatal care attendance: Determinants and relationship with care satisfaction. Matern Child Health J. 2016 Aug;2. ePub ahead of print.

62.

Burnham KP, Anderson DR. Model selection and multimodel inference: a practical information-theoretic approach. New York: Springer; 2002.

63.

Patton MQ. Qualitative research and evaluation methods. Thousand Oaks: SAGE Publications; 2002.

64.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2008;3:77–101.CrossRef

65.

Drummond M, Sculpher M, Torrance G, O’Brien B, Stoddart G. Methods for the economic evaluation of health care programmes. Oxford: University Press; 2005.

66.

Boardman A, Greenberg D, Vining A, Weimer D. Cost-Benefit Analysis: Concepts and Practice. Pearson Series in Economics; 2014.

67.

Basu A, Manning WG. Issues for the next generation of health care cost analyses. Med Care. 2009;47(7 Suppl 1):S109–14.CrossRefPubMed

68.

Buntin MB, Zaslavsky AM. Too much ado about two-part models and transformation? comparing methods of modeling medicare expenditures. J Health Econ. 2004;23:525–42.CrossRefPubMed

69.

Wier LM, Andrews RM. The national hospital bill: the most expensive conditions by payer, 2008. Rockville: Agency for Healthcare Research and Quality; 2011.

70.

Eichelberger KY, Doll K, Ekpo GE, Zerden ML. Black lives matter: claiming a space for evidence-based outrage in obstetrics and gynecology. Am J Public Health. 2016;106:1771–2.CrossRefPubMed

71.

Creanga A, Berg C, Ko J, Farr SL, Tong VT, Bruce FC, et al. Maternal mortality and morbidity in the United States: Where are we now? J Womens Health. 2014;23:3–9.CrossRef

72.

Creanga A, Berg C, Syverson C, Seed K, Bruce C, Callaghan W. Pregnancy-related mortality in the United States, 2006–2010. Obstet Gynecol. 2015;125(1):5–12.CrossRefPubMed

73.

Creanga AA, Bateman BT, Kuklina EV, Callaghan WM. Racial and ethnic disparities in severe maternal morbidity: a multisite analysis, 2008–2010. Am J Obstet Gynecol. 2014;210:435.e1–8.CrossRef

74.

Handler A, Johnson K. A call to revisit the prenatal period as a focus for action within the reproductive and perinatal care continuum. Matern Child Health J. 2016;20:2217–27.CrossRefPubMed

Title: Expect With Me: development and evaluation design for an innovative model of group prenatal care to improve perinatal outcomes
Authors: Shayna D. Cunningham
Jessica B. Lewis
Jordan L. Thomas
Stephanie A. Grilo
Jeannette R. Ickovics
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Pregnancy and Childbirth / Issue 1/2017
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-017-1327-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Expect With Me: development and evaluation design for an innovative model of group prenatal care to improve perinatal outcomes

Abstract

Background

Methods/Design

Discussion

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods/Design

Discussion

Trial registration

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