Stakeholder Perspectives of New Tailored Prenatal Care Delivery

To evaluate obstetric stakeholders' attitudes and implementation considerations regarding the adoption of key components of a newly tailored prenatal care recommendation-PATH (Plan for Appropriate Tailored Healthcare in Pregnancy).

We conducted a national listening tour that used qualitative focus groups from March 2022 to June 2023. We recruited a national sample of obstetric care clinicians, patients, advocates, policymakers, and payers using maximum variation sampling. We explored core PATH domains, including 1) addressing social needs, 2) telemedicine and remote monitoring, and 3) targeted visit schedules. Participants were queried about their perceived barriers to adopting new recommendations and needed supports. We performed a qualitative content analysis to identify positive attitudes, concerns, and multilevel implementation considerations for each recommendation.

In total, 102 obstetric stakeholders participated in nine focus groups from 10 obstetric care organizations, seven patient advocacy and equity organizations, nine policy and public health organizations, and four payer groups. Participants broadly supported the idea of care tailoring and raised important concerns about unintended inequities and negative health outcomes that could arise with inappropriate application of the model. Participants affirmed that addressing social needs is crucial to improving prenatal care access and pregnancy outcomes but identified barriers including insufficient resources and support for interprofessional collaboration. Telemedicine and remote monitoring were widely accepted to improve care access and efficiency, but participants worried that limited access to digital infrastructure could exacerbate existing health disparities. Although participants recognized that targeted visit schedules could enhance visit attendance, care flexibility, and resource equity, some worried about the potential for missed services and worse health outcomes. Across all recommendations, participants identified patient-, clinic-, and policy-level considerations to improve the implementation of new prenatal care models.

PATH is an acceptable and feasible care model with the potential to improve the quality, equity, and efficacy of prenatal care. Multilevel implementation considerations must be integrated with routine use of PATH to promote sustainability across patient populations and settings.