Pregnant People - Key Activity 14

KEY ACTIVITY #14:

Group Prenatal Care, Including Centering Pregnancy

 

This key activity involves the following elements of person-centered population-based care: care coordination; address social needs.

 

Overview

Group care models are particularly well suited to prenatal patients, given their focus on anticipatory guidance and creating spaces for peer support. Bringing patients with similar needs together for healthcare encounters increases the time available for the educational component of the encounter, improves efficiency, and reduces repetition. Group prenatal care has been shown to improve peer support, provider satisfaction and patient outcomes. Group prenatal care also can be cost-effective for CHCs and health systems.[1] It is important that, when considering the implementation of group prenatal care, your practice maintains the capacity to address individual patient needs and complications that might arise in the group but will then warrant one-on-one attention.

CenteringPregnancy (CP) is a group prenatal care model in which facilitators lead a cohort of eight to ten pregnant people of similar gestational age through a series of ten interactive group visits lasting 90 to 120 minutes each. Sessions driven by Centering’s curriculum cover medical and nonmedical aspects of pregnancy, including nutrition, common discomforts, stress management, labor and delivery, breastfeeding, and infant care. It is a promising prenatal care model that a growing body of evidence suggests can improve birth outcomes, improve rates of postpartum visit completion, and increase satisfaction with prenatal care. Research conducted so far suggests that CP holds promise especially for supporting improved birth outcomes for specific populations at highest risk for preterm birth, infant mortality, and other adverse health outcomes. In particular, studies have found that it reduced the risk of preterm birth for Black and African American individuals and their babies, supporting the value of the model as an option for this population.

There are over 40 CenteringPregnancy and related group prenatal care models in California. CP presents an opportunity to better engage patients in their prenatal care and to create welcoming clinical spaces for populations at increased risk of poor birth outcomes. For more information on CP, visit the Centering Healthcare Institute.

Evidence suggests patients who participate in group prenatal care have better prenatal knowledge, feel more ready for labor and delivery, are more satisfied with care, and initiate breastfeeding more often. There is no evidence that suggests that group prenatal care causes harm. Group prenatal care models are designed to improve patient education and include opportunities for social support while maintaining the standard risk screenings and physical assessments of individual prenatal care. Studies appear to demonstrate obstetric outcomes that are at least equivalent to individual prenatal care and even improved for some populations.

Concerns regarding increasing healthcare costs, healthcare provider availability, dissatisfaction with wait times, and the minimal opportunity for education and support associated with the individual care model have given rise to interest in group prenatal care.

Action steps and roles

1. Review group prenatal care interventions to identify which model may be appropriate for your practice and the populations it serves.

Suggested team member(s) responsible: Practice leadership, care team, financial lead, billers and coders.

There are several group prenatal models available including CenteringPregnancy. Learn about the models through research and by speaking with other health centers or organizations that are conducting group prenatal care as well as reaching out directly to the model developer. Remember that there will be costs associated with training and certifying your practice, depending upon the group prenatal care model you select to implement.

 

2. Assess the health center’s capacity to implement a group prenatal care model.

For the assessment, consider patient panel, provider capacity, physical space available to convene the groups, and clinicians and staff who would serve on an implementation team. Some prenatal group models have assessments that health centers and organizations can complete to guide this decision-making process. In the event that your health center does not have the capacity, consider researching available group prenatal care programs in your service area and community to refer clients to.

Determine if an opt-in or opt-out approach would be utilized for group prenatal groups enrollment. Consider whether some group visits can be conducted virtually.

 

3. Develop and maintain a set of referral resources and communication pathways.

Referral and communication pathways between obstetric providers, community-based organizations, and state and public health agencies can enhance access to, and utilization of, services and supports for pregnant and postpartum families.

Making referrals encompasses a spectrum of potential information-giving and supportive behaviors ranging from providing information on specific services to follow-up on service utilization and outcomes and assessment of the quality of referrals.[2] “Cold” and “warm” are often used to describe referral behaviors at two points along this spectrum.[3] A cold referral means providing information to the client about another agency or service, and it is then the client’s responsibility to contact the agency or service.[4] A warm referral involves contacting another agency or service provider on the client’s behalf. This entails calling and making an appointment for the client, providing support to overcome barriers to care, and following up to determine if the appointment has been kept.[5]

 

4. Ensure resources are available in languages representative of the populations in the health center’s service area.

Review resource lists to ensure availability in preferred languages spoken in the community, and when possible, refer patients to resources and services that are available in their preferred language.

 

5. Educate clinicians and staff on group prenatal care.

Educate health center staff on the value of group prenatal care and how it will be integrated into health center care services. Ensure providers and staff have the necessary information and materials to make referrals to group prenatal care. Some group prenatal care models (e.g., CenteringPregnancy) may charge for staff training and site certification.

 

6. Ensure a core implementation team is available to support group prenatal care.

Establish a core implementation team with dedicated time to implement group prenatal care with fidelity. Ensure facilitators receive necessary training to create a trauma-informed and culturally responsive environment.

 

7. Conduct continuous quality improvement.

Solicit feedback from individuals who participated in group visits to identify opportunities for program improvement and ensure that the intervention is culturally responsive and trauma-informed. Convene group facilitators and educators for check-ins and sharing of lessons learned and strategies for engagement and group facilitation.

Implementation tips

Specific group prenatal care models can be challenging to initiate and maintain. The cost of initiating some group prenatal care models in current obstetric practices may be a barrier to implementation. Take time to research options and ensure leadership buy-in to implement and sustain group care.