Hybrid Care Model Provided Effective Prenatal Care During the PHE
Various prenatal health outcomes among mothers and newborns during the PHE were not impacted by the implementation of a hybrid care model.
New research indicated that the use of a hybrid care model for providing prenatal care during the COVID-19 pandemic did not alter rates of pre-eclampsia or eclampsia, maternal morbidity, cesarean delivery, or preterm birth, showing that it is not inferior to traditional in-person care.
Following the sharp growth of virtual care that took place during the COVID-19 public health emergency, curiosity surrounding its capabilities in certain specialties grew.
According to the Centers for Disease Control and Prevention (CDC), in 2021 the maternal mortality rate in the United States was 32.9 deaths per 100,000 live births. This prevalence along with limited data surrounding the integration of telehealth into prenatal care led researchers to conduct a cohort study.
Using longitudinal electronic health record data, researchers conducted a study that involved pregnant patients at Kaiser Permanente Northern California. Considering those who had a live birth or stillbirth between July 1, 2018, and October 21, 2021, the study cohort consisted of 151,464 patients. The goal of the study was to determine how a hybrid care model impacted health outcomes among this population.
While evaluating how the care model impacted patients, researchers considered primary outcomes such as pre-eclampsia and eclampsia rates, severe maternal morbidity, cesarean delivery, preterm birth, and neonatal intensive care unit (NICU) admission. Upon doing so, they also made note of rates of exposure to the hybrid care model. These consisted of unexposed (T1, delivery between July 1, 2018, and February 29, 2020), partially exposed (T2, delivery between March 1, 2020, and December 5, 2020), and fully exposed (T3, delivery between December 6, 2020, and October 31, 2021).
Among these three subgroups, the mean number of total prenatal visits was similar, falling at 9.41, 9.17, and 9.15 in T1, T2, and T3, respectively. Statistics also showed that the share of telehealth use progressively increased across these cohorts, beginning at 11.1 percent, followed by 20.9 percent, and then 21.3 percent.
NICU admission rates were also inconsistent across the three cohorts. These fell to 9.2 percent in T1, 8.3 percent in T2, and 8.6 percent in T3. Researchers also noted how an interrupted time series analysis showed how NICU admission risks changed across these cohorts. These consisted of no change in T1, a decrease in risk in T2, and an increase in risk in T3.
Also, among all primary considerations, there were no clinically relevant changes across the three subgroups.
Given these indications, researchers did not conclude that a hybrid care model was inferior to in-office care. In fact, findings alluded to its adequate performance, showing that its use following the pandemic is a fair option.
A press release also shared comments from Assiamira Ferrara, MD, PhD, a senior research scientist with the Division of Research, and lead author of the study. She explained the potential this shows for remote care substituting certain in-office visits, leading to higher convenience. This can be highly beneficial, particularly among those from underserved regions and those who battle access barriers.
Prior research has indicated the potential of telehealth in effectively delivering care for certain populations.
A study from May, for example, found that telehealth can support maternal mental health. This evaluation of interventions in randomized controlled trials aimed to determine whether telehealth could lessen mental health issues in pregnant and postpartum women. A secondary objective of the study was to learn about how various strategies affect patients.
After reviewing 44 articles that involved pregnant women or new mothers, used a telehealth intervention to treat mental health concerns, researchers found that 62 percent indicated improvements among telehealth users compared to the control group.
Although the success rate was relatively high, there is potential to develop more custom and targeted interventions for certain issues.
This study and that of Kaiser Permanente Northern California provide clear indications of how telehealth can often be a valid solution andprovide various benefits.
