Variation in guideline-based prenatal care in a commercially insured population

Area of Science:

• Obstetrics and Gynecology
• Health Services Research
• Public Health

Background:

• Current prenatal care quality metrics often focus on visit frequency rather than services rendered.
• The association between the number of prenatal visits and the receipt of guideline-based care is not well understood.
• Limited research exists on how patient and area characteristics influence guideline-based prenatal care delivery.

Purpose of the Study:

• To assess the uptake of recommended guideline-based prenatal care services.
• To examine the relationship between the number of prenatal visits and the receipt of these services.
• To describe variations in guideline-based care based on patient and geographic factors.

Main Methods:

• Retrospective descriptive cohort study of 176,092 pregnancy episodes (2016-2019).
• Utilized administrative claims data from commercial enrollees in the US.
• Assessed 8 key guideline-recommended prenatal services, including STI testing, lab work, vaccines, and ultrasounds.

Main Results:

• Receipt of guideline-based care varied by service, with anatomy scans (90%) and STI testing (91%) being high, while urinalysis (51%) was lower.
• Patients with ≥4 visits received an average of 6 out of 8 services; additional visits did not increase service receipt.
• Tetanus, diphtheria, and pertussis vaccination rates were lower in areas with higher proportions of minority populations, lower income, and lower education.

Conclusions:

• Guideline-based prenatal care is not universally provided to commercially insured individuals.
• The number of prenatal visits does not correlate with receiving more guideline-based services.
• Measuring specific guideline-based services offers a more nuanced view of prenatal care quality than visit counts alone.