EHR Optimization Forecasts Birth Volume with Predictive Model

EHR optimization allowed for a model to successfully predict an initial decline in births associated with COVID-19 at a university healthcare system, according to a study published in JAMA Network Open that highlights EHR optimization for internal planning.

The cohort study looked at all pregnancy episodes within the health system’s EHR retrospectively from 2017 and modeled prospectively to 2021.

The predictive model projected an initial decline in births starting in November of 2020 and persisting until spring of 2021.

The researchers found that the model had predicted the initial birth decline correctly; while pregnancies increased steadily over the study period (4,100 pregnancies in 2017 compared to 4,620 pregnancies in 2020), following the March 15, 2020 mandated COVID-19 pandemic societal shutdown, pregnancy episode initiation dropped by 14 percent.

“In this cohort study, we demonstrated EMR data on pregnancy episode volumes and projected birth volumes could be monitored and projected with accuracy without waiting for changes in birth volume to signal decreasing (or increasing) birth rates after major societal events,” the study authors wrote.

The prospective modeling of pregnancies suggests that a birth rate surge can be anticipated for summer 2021, the authors noted.

“We documented an anticipated decline in births after the COVID-19 pandemic, starting in November of 2020 and persisting until spring of 2021, after which is projected a rebound in anticipated births that may exceed anticipated birth volume based on annual trajectories derived from the prior 5 years of institutional data,” the study authors wrote.

“Our data suggest that the anticipated decrease in the birth rate may be best explained by lower conception rates in the weeks and months immediately following the March 2020 COVID-19 pandemic major societal shutdown,” they continued.

The researchers analyzed factors that may have attributed to lower birth rates, including access to fertility treatment and preterm birth rates.

After COVID-19 was declared a national emergency in March 2020, access to assisted reproductive technologies such as in vitro fertilization (IVF) significantly decreased, the authors noted. The researchers found that between early April and the end of June 2020, there were no IVF patients who began a pregnancy episode.

“We also examined all patients who had a pregnancy episode opened within 30 days of a reproductive endocrinology visit,” the authors wrote. “While the decrease in reproductive endocrinology services during the mandated shutdown contributed to overall decreased pregnancy episodes, it only explains 33 percent of the total decrease.”

“Our study documented that decreased access to infertility treatment contributes to decreasing pregnancy rates but does not fully explain it,” they wrote.

The researchers also analyzed the association of preterm birth rates with delivery volume projections. Since pregnancy episodes are closed after delivery, a significant increase in preterm births may have contributed to the appearance of decreased pregnancy episode volumes.

However, the study found that the overall preterm birth rates decreased after the onset of the COVID-19 pandemic. Other health systems have reported similar findings, the study authors noted.

Prior to July 2020, the preterm birth rate was 13.3 percent at the health system (12.0 preterm births per week out of 89.8 weekly births), compared to 10.2 percent from July to December 2020 (9.1 preterm births out of 89.7 weekly births).

Predictive models of pregnancy episode volume through EHR optimization may aid healthcare executives as they plan for periods of high and low delivery volume. This same kind of modeling can be applied to estimate anticipated birth rates for epidemiologic surveillance, the authors noted.

“At this time, continued infections of and death from COVID-19, vaccine rollout initiatives, and varied societal reopening may require continued surveillance to determine the full impact of the COVID-19 pandemic on birth rates,” the study authors wrote.