Comparative Effect of Two Enhanced Prenatal Care Models on Care Experiences: A Randomized Controlled Trial

Area of Science:

• Maternal Health
• Healthcare Delivery Models
• Health Services Research

Background:

• The EMBRACE trial evaluated enhanced group prenatal care (eGPC) versus enhanced individual prenatal care (eIPC) in a population eligible for Medicaid in California's San Joaquin Valley.
• This study specifically focuses on the secondary aim of comparing prenatal and intrapartum care experiences between the two models.

Purpose of the Study:

• To compare the effects of eGPC and eIPC on prenatal and intrapartum care experiences.
• To assess care experiences using validated scales such as PCPC, MORi, PCSS, and PCMC-US.

Main Methods:

• A pragmatic randomized trial (EMBRACE) involving 674 participants (294 eGPC, 380 eIPC).
• Care experiences were measured using standardized scores (0-100) from multiple validated scales.
• Restricted maximum likelihood mixed linear regression models were used to analyze adjusted mean differences (aMDs) in scores, with subgroup analyses conducted for attendance and race/ethnicity.

Main Results:

• Mean adjusted prenatal care experience scores were generally good but suboptimal for both eGPC and eIPC groups (e.g., PCPC scores 90.5 and 88.7, respectively).
• No significant differences in prenatal or intrapartum care experience scores were found between the eGPC and eIPC groups.
• Subgroup analyses did not reveal significant differences in care experiences.

Conclusions:

• Both enhanced prenatal care models resulted in favorable prenatal care experiences.
• The study highlights that while care experiences were good, there is still room for improvement to reach optimal levels in this population.
• Findings were consistent across different subgroups, including race/ethnicity and attendance levels.