Clinician continuity during pregnancy care: A mixed methods study

To measure clinician continuity during pregnancy care and contextualize the findings with patient experiences of clinician continuity and their influence on trust-building.

We conducted a convergent mixed methods study that examined the number of clinicians seen for all patients who gave birth at a large academic medical center between June 2023 and May 2024. Statistical analyses were performed across demographic subgroups with number of clinicians seen during pregnancy care as the primary outcome and the proportion of visits with the most frequently seen clinician as the secondary outcome. Multivariable Poisson regression models were used to control for covariates. Purposive sampling was used to select a subset of English- and Spanish-speaking patients for semi-structured interviews. Participants completed a short sociodemographic survey and interviews exploring perceptions of clinical continuity, factors that build or erode trust, and patients' recommendations for pregnancy care. Interviews were transcribed and analyzed using content analysis. Two researchers met to iteratively refine the codebook, discuss discrepancies, and reach consensus.

We identified 2395 patients with eligible visits for the retrospective cohort. Total visits ranged from two to 38 (median 13, interquartile range [IQR] 10-15) with a median of 4 clinicians seen during pregnancy (IQR 3-5). Participants in the resident practice and hospital-based maternal-fetal medicine practice saw more clinicians (7, IQR 6-9 and 5, IQR 3-7, respectively; p < 0.001). Overall, 21.0% of patients had one or more visit with the obstetrician who was present at delivery. The qualitative phase included 14 participants with a median age of 31 years (IQR 28-35). Most participants valued continuity of care; discontinuity of care was a driving factor of patient-clinician trust erosion. Participants recommended clinical continuity as a strategy to improve pregnancy care.

Clinician continuity during outpatient pregnancy care varied by clinician type, practice, clinical site, and patient factors. Participants highly valued continuity of care, which was associated with greater trust and improved care experiences.