Pregnancy-related complaints are a significant driver of emergency room (ER) utilization among women. Because of additional time for patient education and provider relationships, group prenatal care may reduce ER visits among pregnant women by helping them identify appropriate care settings, improving understanding of common pregnancy discomforts, and reducing risky health behaviors. We conducted a retrospective cohort study, utilizing Medicaid claims and birth certificate data from a statewide expansion of group care, to compare ER utilization between pregnant women participating in group prenatal care and individual prenatal care. Using propensity score matching methods, we found that group care was associated with a significant reduction in the likelihood of having any ER utilization (–5.9% among women receiving any group care and –6.0% among women attending at least five group care sessions). These findings suggest that group care may reduce ER utilization among pregnant women and encourage appropriate health care utilization during pregnancy.
AgarwalP.BiasT. K.SambamoorthiU. (2017). Longitudinal patterns of emergency department visits: A multistate analysis of Medicaid beneficiaries. Health Services Research, 52(6), 2121–2136.
2.
Agency for Healthcare Research and Quality. (2010). Healthcare cost and utilization project.
3.
Agency for Healthcare Research and Quality. (2020). Mean expenditure per person with expense by event type, United States, 1996-2017. Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality.
4.
ArpinoB.CannasM. (2016). Propensity score matching with clustered data. An application to the estimation of the impact of caesarean section on the Apgar score. Statistics in Medicine, 35(12), 2074–2091.
5.
BillingsJ.ParikhN.MijanovichT. (2000). Emergency department use in New York City: A substitute for primary care?Issue Brief (Commonwealth Fund). https://pubmed.ncbi.nlm.nih.gov/11665698/
BodenheimerT.SinskyC. (2014.). From triple to quadruple aim: Care of the patient requires care of the provider. The Annals of Family Medicine, 12(6), 573–576.
8.
BrysonA.DorsettR.PurdonS. (2002). The use of propensity score matching in the evaluation of active labour market policies (No. 4993). London School of Economics and Political Science, LSE Library.
9.
CrockettA. H.HeberleinE. C.GlasscockL.Covington-KolbS.SheaK.KhanI. A. (2017). Investing in CenteringPregnancy™ group prenatal care reduces newborn hospitalization costs. Women’s Health Issues, 27(1), 60–66.
10.
CrockettA. H.HeberleinE. C.SmithJ. C.OzlukP.Covington-KolbS.WillisC. (2019.). Effects of a multi-site expansion of group prenatal care on birth outcomes. Maternal and Child Health Journal, 23(10), 1424–1433.
11.
CunninghamS. D.GriloS.LewisJ. B.NovickG.RisingS. S.TobinJ. N.IckovicsJ. R. (2017). Group prenatal care attendance: Determinants and relationship with care satisfaction. Maternal and Child Health Journal, 21(4), 770–776.
12.
CunninghamS. D.MagriplesU.ThomasJ. L.KozhimannilK. B.HerreraC.BarretteE.SheblF. M.IckovicsJ. R. (2017). Association between maternal comorbidities and emergency department use among a national sample of commercially insured pregnant women. Academic Emergency Medicine, 24(8), 940–947.
13.
DeCesareJ. Z.HannahD.AminR. (2017). Postpartum contraception use rates of patients participating in the centering pregnancy model of care versus traditional obstetrical care. The Journal of Reproductive Medicine, 62(1–2), 45–49.
14.
DeVriesA.LiC.-H.OzaM. (2013). Strategies to reduce nonurgent emergency department use: Experience of a Northern Virginia Employer Group. Medical Care, 5, 1224–1230.
GareauS.Lopez-De FedeA.LoudermilkB. L.CummingsT. H.HardinJ. W.PicklesimerA. H.CrouchE.Covington-KolbS. (2016). Group prenatal care results in Medicaid savings with better outcomes: A propensity score analysis of CenteringPregnancy participation in South Carolina. Maternal and Child Health Journal, 20(7), 1384–1393.
17.
GradyM. A.BloomK. C. (2004). Pregnancy outcomes of adolescents enrolled in a CenteringPregnancy program. The Journal of Midwifery & Women’s Health, 49(5), 412–420.
18.
HaleN.PicklesimerA. H.BillingsD. L.Covington-KolbS. (2014). The impact of CenteringPregnancy group prenatal care on postpartum family planning. American Journal of Obstetrics and Gynecology, 210(1), 50e1–50e7.
19.
HeberleinE. C., et al (2020). The effects of Centering Pregnancy group prenatal care on postpartum visit attendance and contraception use. Contraception, 102(1), 46–51.
20.
HousdenL. M.WongS. T. (2016). Using group medical visits with those who have diabetes: Examining the evidence. Current Diabetes Reports, 16(12), 1–8.
21.
IckovicsJ. R.EarnshawV.LewisJ. B.KershawT. S.MagriplesU.StaskoE.RisingS. S.CassellsA.CunninghamS.BernsteinP. (2016). Cluster randomized controlled trial of group prenatal care: Perinatal outcomes among adolescents in New York City health centers. American Journal of Public Health, 106(2), 359–365.
22.
JohnstonK. J.AllenL.MelansonT. A.PittsS. R. (2017). A “patch” to the NYU emergency department visit algorithm. Health Services Research, 52(4), 1264–1276.
23.
KennedyH. P.FarrellT.PadenR.HillS.JolivetR.WillettsJ.RisingS. S. (2009). “I Wasn’t Alone”—A study of group prenatal care in the military. Journal of Midwifery & Women’s Health, 54(3), 176–183.
24.
KilfoyleK. A.VreesR.RakerC. A.MattesonK. A. (2017). Nonurgent and urgent emergency department use during pregnancy: An observational study. American Journal of Obstetrics and Gynecology, 216(2), 181e1–181e7.
25.
KirshS. R.AronD. C.JohnsonK. D.SanturriL. E.StevensonL. D.JonesK. R.JagoshJ. (2017). A realist review of shared medical appointments: How, for whom, and under what circumstances do they work?BMC Health Services Research, 17(1), 1–13.
26.
KozhimannilK. B.HardemanR. R.Alarid-EscuderoF.VogelsangC. A.Blauer-PetersonC.HowellE. A. (2016). Modeling the cost-effectiveness of doula care associated with reductions in preterm birth and cesarean delivery. Birth, 43(1), 20–27.
27.
KozhimannilK. B.HardemanR. R.AttanasioL. B.Blauer-PetersonC.O’BrienM. (2013.). Doula care, birth outcomes, and costs among Medicaid beneficiaries. American Journal of Public Health, 103(4), e113–e121.
28.
MagriplesU.KershawT. S.RisingS. S.MasseyZ.IckovicsJ. R. (2008). Prenatal health care beyond the obstetrics service: Utilization and predictors of unscheduled care. American Journal of Obstetrics and Gynecology, 198(1), 75e1–75e7.
29.
MalikS.KothariC.MacCallumC.LiepmanM.TareenS.RhodesK. V. (2017). Emergency department use in the perinatal period: An opportunity for early intervention. Annals of Emergency Medicine, 70(6), 835–839.
30.
MazzoniS. E.CarterE. B. (2017). Group prenatal care. American Journal of Obstetrics and Gynecology, 216(6), 552–556.
31.
MooreB. J.StocksC.OwensP. L. (2017). Trends in emergency department visits, 2006–2014 (HCUP Statistical Brief #227). Agency for Healthcare Research and Quality.
32.
OldsD. L. (2006.). The nurse-family partnership: An evidence-based preventive intervention. Infant Mental Health Journal, 27(1), 5–25.
33.
PicklesimerA. H.BillingsD.HaleN.BlackhurstD.Covington-KolbS. (2012). The effect of CenteringPregnancy group prenatal care on preterm birth in a low-income population. American Journal of Obstetrics and Gynecology, 206(5), 415e1–415e7.
34.
RavenM. C.LoweR. A.MaselliJ.HsiaR. Y. (2013). Comparison of presenting complaint vs discharge diagnosis for identifying “nonemergency” emergency department visits. Journal of the American Medical Association, 309(11), 1145–1153.
35.
RisingS. S. (1998). CenteringPregnancy: An interdisciplinary model of empowerment. Journal of Nurse-midwifery, 43(1), 46–54.
36.
RisingS. S.KennedyH. P.KlimaC. S. (2004). Redesigning prenatal care through CenteringPregnancy. Journal of Midwifery & Women’s Health, 49(5), 398–404.
37.
RosenbaumP. R.RubinD. B. (1983). The central role of the propensity score in observational studies for causal effects. Biometrika, 70(1), 41–55.
38.
RosenbaumP. R.RubinD. B. (1985). Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. The American Statistician, 39(1), 33–38.
39.
Roussos-RossD.PrietoA.GoodinA.WatsonA. K.BrightM. A. (2020). Increased Tdap and influenza vaccination acquisition among patients participating in group prenatal care. The Journal of Primary Prevention, 41(5), 413–420.
40.
RubinD. B. (2007). The design versus the analysis of observational studies for causal effects: Parallels with the design of randomized trials. Statistics in Medicine, 26(1), 20–36.
41.
RuiP.KangK. (2017). National Ambulatory Medicare Care Survey: 2017 emergency department summary tables. National Center for Health Statistics.
SerranoN.PrinceR.FondowM.KushnerK. (2018). Does the primary care behavioral health model reduce emergency department visits?Health Services Research, 53(6), 4529–4542.
44.
StiefelM.NolanK. (2012). A Guide to measuring the triple aim: Population health, experience of care, and per capita cost [IHI innovation series White paper]. Institution for Healthcare Improvement.
45.
Tanner-SmithE. E.Steinka-FryK. T.LipseyM. W. (2012). A multi-site evaluation of the CenteringPregnancy programs in Tennessee: Final report prepared for the Tennessee Department of Health. Peabody Research Institute, Vanderbilt University.
46.
Urban Institute. (2018). Strong start for mothers and newborns evaluation: Year 5 project synthesis [Volume 2: Awardee-Specific Reports].
47.
Uscher-PinesL.PinesJ.KellermannA.GillenE.MehrotraA. (2013). Deciding to visit the emergency department for non-urgent conditions: A systematic review of the literature. The American Journal of Managed Care, 19(1), 47–59.
48.
VladutiuC. J.StringerE. M.KandasamyV.RuppenkampJ.MenardM. K. (2019). Emergency care utilization among pregnant Medicaid recipients in North Carolina: An analysis using linked claims and birth records. Maternal and Child Health Journal, 23(2), 265–276.
49.
WadsworthK. H.ArchibaldT. G.PayneA. E.ClearyA. K.HaneyB. L.HovermanA. S. (2019). Shared medical appointments and patient-centered experience: A mixed-methods systematic review. BMC Family Practice, 20(1), 1–13.
