A Community-Centered Approach to Strengthening Perinatal Care Connections

Racial disparities in maternal health outcomes are a public health crisis in the U.S. Adequate connection to pregnancy-related resources is a strategy for improving maternal outcomes (Trost et al., in Pregnancy-related deaths: Data from maternal mortality review committees in 36 States, 2017-2019. Centers for disease control and prevention. https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html , 2022), yet patients receive little support navigating complex systems. We tested the feasibility of a transition-of-care program that identifies individuals in early pregnancy who visit the emergency department (ED) and facilitates connections to needed healthcare and supportive resources.

This pilot used a regional Health Information Exchange (HIE) to identify people from EDs across four counties in South Jersey with evidence of a current or recent pregnancy and limited connection to care. Eligible patients were assigned to a partner site who contacted them to offer scheduling support for pregnancy-related care and connection to supportive resources. The pilot initially focused on prenatal care but expanded to include other supports based on patient needs.

Of the 2073 eligible patients, 896 were contacted, and 379 accepted one or more types of support. Support was accepted across racial, ethnic, age, and insurance groups.

This pilot illustrated that a perinatal transition of care program from the ED to appropriate pregnancy-related services and resources is feasible. The ED provides a unique opportunity to identify and engage people early in pregnancy who might face barriers to accessing timely care. The model reduced reliance on self-navigation and addressed common access challenges.