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The Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Prenatal Care Recommendations
Alex Friedman Peahl1, Christopher M Zahn, Mark Turrentine
1Department of Obstetrics and Gynecology, the Institute for Healthcare Policy and Innovation, the Program on Women's Healthcare Effectiveness Research, the Department of Internal Medicine, and the Department of Hospital Medicine, University of Michigan, Ann Arbor, Michigan; the American College of Obstetricians and Gynecologists, Washington, DC; the Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas; the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; and the Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School-UTHealth, Houston, Texas; and the University of Michigan Medical School and the Safety Enhancement Program and Center for Clinical Management Research, U.S. Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
Objective:
To describe MiPATH (the Michigan Plan for Appropriate Tailored Healthcare in pregnancy) panel process and key recommendations for prenatal care delivery.
Methods:
We conducted an appropriateness study using the RAND Corporation and University of California Los Angeles Appropriateness Method, a modified e-Delphi process, to develop MiPATH recommendations using sequential steps: 1) definition and scope of key terms, 2) literature review and data synthesis, 3) case scenario development, 4) panel selection and scenario revisions, and 5) two rounds of panel appropriateness ratings with deliberation. Recommendations were developed for average-risk pregnant individuals (eg, individuals not requiring care by maternal-fetal medicine specialists). Because prenatal services (eg, laboratory tests, vaccinations) have robust evidence, panelists considered only how services are delivered (eg, visit frequency, telemedicine).
Results:
The appropriateness of key aspects of prenatal care delivery across individuals with and without common medical and pregnancy complications, as well as social and structural determinants of health, was determined by the panel. Panelists agreed that a risk assessment for medical, social, and structural determinants of health should be completed as soon as individuals present for care. Additionally, the panel provided recommendations for: 1) prenatal visit schedules (care initiation, visit timing and frequency, routine pregnancy assessments), 2) integration of telemedicine (virtual visits and home devices), and 3) care individualization. Panelists recognized significant gaps in existing evidence and the need for policy changes to support equitable care with changing practices.
Conclusion:
The MiPATH recommendations offer more flexible prenatal care delivery for average-risk individuals.
Insights
The Michigan Plan for Appropriate Tailored Healthcare in pregnancy (MiPATH) panel developed new recommendations for prenatal care delivery. These guidelines promote flexible and individualized care for average-risk pregnancies.
Area of Science:
- Maternal Health
- Healthcare Delivery Innovation
- Evidence-Based Practice
Background:
- Current prenatal care models may not fully address individual needs.
- There is a need for updated guidelines on how prenatal services are delivered.
- Social and structural determinants of health impact pregnancy outcomes.
Purpose of the Study:
- To describe the development process of the Michigan Plan for Appropriate Tailored Healthcare in pregnancy (MiPATH) recommendations.
- To outline key recommendations for optimizing prenatal care delivery for average-risk individuals.
Main Methods:
- Utilized the RAND/UCLA Appropriateness Method, a modified e-Delphi process.
- Included literature review, case scenario development, and expert panel ratings.
- Focused on the delivery of prenatal services, not the services themselves.
Main Results:
- Developed recommendations for prenatal visit schedules, telemedicine integration, and care individualization.
- Emphasized the importance of early risk assessment for medical, social, and structural determinants of health.
- Identified evidence gaps and the need for policy changes to support equitable care.
Conclusions:
- The MiPATH recommendations provide a framework for more flexible and tailored prenatal care.
- These guidelines aim to improve the delivery of care for average-risk pregnancies.
- Addressing evidence gaps and policy is crucial for equitable implementation.
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