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Assessing Preconception Wellness in the Clinical Setting Using Electronic Health Data.

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Optimizing prepregnancy health is crucial for reducing maternal mortality. However, measuring preconception wellness (PCW) indicators like folic acid use and depression screening remains challenging across different healthcare systems.

Keywords:
electronic health datapreconception healthpreconception health indicatorsprenatal carewomen's health

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Area of Science:

  • Public Health
  • Reproductive Health
  • Healthcare Management

Background:

  • Optimizing prepregnancy health is a key strategy to reduce maternal morbidity and mortality.
  • Nine core indicators of preconception wellness (PCW) have been proposed, but population-level assessment using these indicators is limited.
  • Assessing preconception health status is vital for improving maternal and infant outcomes.

Purpose of the Study:

  • To determine the feasibility of measuring proposed preconception wellness indicators through retrospective review of electronic health records.
  • To assess the documentation rates of key preconception health indicators across two diverse healthcare systems.
  • To identify barriers in measuring and documenting preconception wellness for population health management.

Main Methods:

  • Retrospective chart review of patients receiving prenatal or primary care with pregnancy-related ICD-10 codes.
  • Inclusion of data from two health systems in North Carolina between October 1, 2015, and September 30, 2018.
  • Analysis of documentation rates for nine proposed preconception wellness indicators.

Main Results:

  • Avoidance of teratogenic medications and first-trimester entry to care were highly documented (over 64%).
  • Folic acid use, depression screening, and family planning discussions were documented in less than 20% of cases at both sites.
  • Significant differences in the measurement and documentation of PCW indicators were observed between the two health systems.

Conclusions:

  • Measuring preconception wellness indicators retrospectively presents feasibility challenges due to inconsistent documentation.
  • Variability in documenting PCW indicators across health systems hinders effective population health monitoring.
  • Standardization and promotion of consistently measurable PCW indicators are necessary for health systems and payers to improve prepregnancy health.