Jeannette R Ickovics1, Valerie Earnshaw1, Jessica B Lewis1, Trace S Kershaw1, Urania Magriples1, Emily Stasko1, Sharon Schindler Rising1, Andrea Cassells1, Shayna Cunningham1, Peter Bernstein1, Jonathan N Tobin1. 1. Jeannette R. Ickovics, Valerie Earnshaw, Jessica B. Lewis, Trace S. Kershaw, Emily Stasko, and Shayna Cunningham are with the Yale School of Public Health, New Haven, CT. Urania Magriples is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven. Sharon Schindler Rising is with the Centering Healthcare Institute, Boston, MA. Andrea Cassells and Jonathan N. Tobin are with the Clinical Directors' Network, New York, NY. Peter Bernstein is with the Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
Abstract
OBJECTIVES: We compared an evidence-based model of group prenatal care to traditional individual prenatal care on birth, neonatal, and reproductive health outcomes. METHODS: We performed a multisite cluster randomized controlled trial in 14 health centers in New York City (2008-2012). We analyzed 1148 pregnant women aged 14 to 21 years, at less than 24 weeks of gestation, and not at high obstetrical risk. We assessed outcomes via medical records and surveys. RESULTS: In intention-to-treat analyses, women at intervention sites were significantly less likely to have infants small for gestational age (< 10th percentile; 11.0% vs 15.8%; odds ratio = 0.66; 95% confidence interval = 0.44, 0.99). In as-treated analyses, women with more group visits had better outcomes, including small for gestational age, gestational age, birth weight, days in neonatal intensive care unit, rapid repeat pregnancy, condom use, and unprotected sex (P = .030 to < .001). There were no associated risks. CONCLUSIONS:CenteringPregnancy Plus group prenatal care resulted in more favorable birth, neonatal, and reproductive outcomes. Successful translation of clinical innovations to enhance care, improve outcomes, and reduce cost requires strategies that facilitate patient adherence and support organizational change.
RCT Entities:
OBJECTIVES: We compared an evidence-based model of group prenatal care to traditional individual prenatal care on birth, neonatal, and reproductive health outcomes. METHODS: We performed a multisite cluster randomized controlled trial in 14 health centers in New York City (2008-2012). We analyzed 1148 pregnant women aged 14 to 21 years, at less than 24 weeks of gestation, and not at high obstetrical risk. We assessed outcomes via medical records and surveys. RESULTS: In intention-to-treat analyses, women at intervention sites were significantly less likely to have infants small for gestational age (< 10th percentile; 11.0% vs 15.8%; odds ratio = 0.66; 95% confidence interval = 0.44, 0.99). In as-treated analyses, women with more group visits had better outcomes, including small for gestational age, gestational age, birth weight, days in neonatal intensive care unit, rapid repeat pregnancy, condom use, and unprotected sex (P = .030 to < .001). There were no associated risks. CONCLUSIONS: CenteringPregnancy Plus group prenatal care resulted in more favorable birth, neonatal, and reproductive outcomes. Successful translation of clinical innovations to enhance care, improve outcomes, and reduce cost requires strategies that facilitate patient adherence and support organizational change.
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