Shah Jaimin S, Revere F Lee, Toy Eugene C
Department of Obstetrics and Gynecology, UT Health - The University of Texas at Houston, McGovern Medical School, Houston, TX, USA.
Department of Management and Policy, UT Health - The University of Texas at Houston, School of Public Health, Houston, TX, USA.
Matern Child Health J. 2018 Dec;22(12):1738-1742. doi: 10.1007/s10995-018-2569-z.
Introduction Early prenatal care can improve pregnancy outcomes, reduce complications, and ensure a healthier pregnancy. Unfortunately, many pregnant women do not seek early care. This research provides a framework for improving prenatal care in a low income community-based obstetrics clinic. Methods A multi-disciplinary quality improvement initiative was implemented at a large federally qualified health clinic in Houston, Texas to improve the rate of early entry into prenatal care by identifying barriers through patient surveys, focus groups, stakeholder feedback, and improving processes to reduce these barriers. Results A significant increase in early prenatal care was achieved by redesigning operational and clinical processes to improve access to care, expand patient education and outreach, increase resources, extend hours of operation, and increase presumptive insurance eligibility. Three months post implementation, an increase of 44.5% (p < 0.001) occurred in patients who had a prenatal visit in the first trimester. Patients with early prenatal care had better obstetrical and neonatal outcomes; however, the results were not statistically significant likely due to the small sample size. Discussion This quality improvement project provides various strategies and resources for other community-based clinics to consider when seeking improvement in their rates of early prenatal care.
引言 早期产前护理可改善妊娠结局、减少并发症并确保孕期更健康。不幸的是，许多孕妇并未寻求早期护理。本研究为改善低收入社区产科诊所的产前护理提供了一个框架。方法 在得克萨斯州休斯敦一家大型联邦合格健康诊所实施了一项多学科质量改进计划，通过患者调查、焦点小组、利益相关者反馈来识别障碍，并改进流程以减少这些障碍，从而提高早期接受产前护理的比例。结果 通过重新设计运营和临床流程以改善就医机会、扩大患者教育和外展服务、增加资源、延长营业时间并提高推定保险资格，早期产前护理显著增加。实施三个月后，孕早期进行产前检查的患者增加了44.5%（p < 0.001）。接受早期产前护理的患者有更好的产科和新生儿结局；然而，由于样本量小，结果无统计学意义。讨论 这个质量改进项目为其他社区诊所寻求提高早期产前护理比例时提供了各种策略和资源以供参考。
