Background

Despite the importance of prenatal care, quality measurement efforts have focused on the number of prenatal visits, or prenatal care adequacy, rather than the services received. It is unknown whether attending more prenatal visits is associated with receiving more guideline-based prenatal care services. The relationship between guideline-based prenatal care and patients’ clinical and sociodemographic characteristics has also not been studied.

Objective

This study aimed to measure the receipt of guideline-based prenatal care among pregnant patients and to describe the association between guideline-based prenatal care and the number of prenatal visits and other patient characteristics.

Study Design

This was a retrospective descriptive cohort study of 176,092 pregnancy episodes between 2016 and 2019. We used de-identified administrative claims data on commercial enrollees across the United States from the OptumLabs Data Warehouse. We identified the following 8 components of prenatal care that are universally recommended by the American College of Obstetricians and Gynecologists and other guideline-issuing organizations: testing for sexually transmitted infections, obstetric laboratory test panel, urine culture, urinalysis, anatomy scan ultrasound, oral glucose tolerance test, tetanus, diphtheria, and pertussis vaccine, and group B Streptococcus test. We measured the proportion of pregnant patients who received each of these guideline-based services at the appropriate gestational age. We measured the association between guideline-based services and the number of prenatal visits and prenatal care adequacy. We described variation of guideline-based care according to patient age, comorbidities, high deductible health plan enrollment, and their county’s rurality, health professional shortage area status, racial composition, median income, and educational attainment.

Results

The 176,092 pregnancy episodes were mostly among patients aged 25 to 34 years (63%) with few pregnancy comorbidities (81%) and living in urban areas (92%). Guideline-based care varied by service, from 51% receiving a timely urinalysis to 90% receiving an anatomy scan and 91% completing testing for sexually transmitted infections. Patients with at least 4 prenatal visits received, on average, 6 of the 8 guideline-based services. Guideline-based care did not increase with additional prenatal visits and varied by patient characteristics. Rates of tetanus, diphtheria, and pertussis vaccination were lower in counties with high proportions of minoritized populations, lower education, and lower income.

Conclusion

In this commercially insured population, receipt of guideline-based care was not universal, did not increase with the number of prenatal visits, and varied by patient- and area-level characteristics. Measuring guideline-based care is feasible and may capture quality of prenatal care better than visit count or adequacy alone.

中文翻译：

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商业保险人群中基于指南的产前护理的变化

背景

尽管产前保健很重要，但质量测量工作的重点是产前检查次数或产前保健充分性，而不是接受的服务。目前尚不清楚参加更多的产前检查是否与接受更多基于指南的产前保健服务有关。基于指南的产前护理与患者的临床和社会人口学特征之间的关系也没有被研究过。

客观的

本研究旨在衡量怀孕患者接受基于指南的产前保健的情况，并描述基于指南的产前保健与产前检查次数和其他患者特征之间的关联。

学习规划

这是一项对 2016 年至 2019 年间 176,092 次妊娠事件的回顾性描述性队列研究。我们使用了来自 OptumLabs 数据仓库的美国各地商业登记者的去识别行政索赔数据。我们确定了美国妇产科学院和其他指南发布组织普遍推荐的以下 8 个产前保健组成部分：性传播感染检测、产科实验室检测板、尿培养、尿液分析、解剖学扫描超声、口服葡萄糖耐受试验、破伤风、白喉和百日咳疫苗和 B 组链球菌测试。我们测量了在适当胎龄接受这些基于指南的服务的怀孕患者的比例。我们测量了基于指南的服务与产前检查次数和产前保健充分性之间的关联。我们描述了根据患者年龄、合并症、高免赔额健康计划登记及其所在县的农村、卫生专业人员短缺地区状况、种族构成、收入中位数和教育程度的变化。

结果

176,092 次妊娠事件主要发生在 25 至 34 岁（63%）、很少有妊娠合并症（81%）和居住在城市地区（92%）的患者中。基于指南的护理因服务而异，从 51% 接受及时尿液分析到 90% 接受解剖扫描和 91% 完成性传播感染检测。至少进行 4 次产前检查的患者平均接受了 8 项基于指南的服务中的 6 项。基于指南的护理并未随着额外的产前检查而增加，并且因患者特征而异。在少数民族人口比例高、教育程度低和收入低的县，破伤风、白喉和百日咳疫苗接种率较低。

结论

在这个商业保险人群中，接受基于指南的护理并不普遍，没有随着产前检查次数的增加而增加，并且因患者和地区水平的特征而异。衡量基于指南的护理是可行的，并且可以比单独的访问次数或充分性更好地捕捉产前护理的质量。