Defining Prenatal Care Surveillance Metrics Using Electronic Health Record Data

Area of Science:

• Public Health Surveillance
• Health Informatics
• Maternal Health

Background:

• Current US pregnancy surveillance faces challenges in providing timely and accurate prenatal care use data.
• Electronic health record (EHR) networks offer potential for near real-time, clinically documented data to enhance surveillance systems.

Purpose of the Study:

• To assess the validity and reliability of EHR network data for defining surveillance metrics of prenatal care use.
• To determine if EHR data can be used to monitor early and adequate prenatal care.

Main Methods:

• A longitudinal cohort study analyzed data from US adults receiving prenatal care within the Epic Cosmos EHR network (January 2023 - December 2024).
• Prenatal care use metrics (early initiation, adequacy) were calculated and weighted to match national demographic distributions.
• EHR-based metrics were validated against National Center for Health Statistics (NCHS) data using a two one-sided test of equivalence.

Main Results:

• The study included 1,963,496 patients; the EHR network population had lower Medicaid coverage and higher pregnancy risk factors compared to national data.
• After weighting, EHR-based estimates for early prenatal care initiation were lower than NCHS data.
• However, EHR-based estimates for prenatal care adequacy were equivalent to NCHS estimates and showed stability across demographics, states, and time.

Conclusions:

• Adjusted EHR network data reliably inform surveillance of prenatal care adequacy, despite patient population nonrepresentativeness.
• Near real-time EHR data can enhance the timeliness of population-level pregnancy surveillance.
• This has the potential to better inform policy and clinical efforts to improve prenatal care access and use.