Background: Group prenatal care is a promising strategy to improve perinatal outcomes. Research in larger more diverse populations with attention to adherence is needed to inform clinical practice recommendations. We examined the impact of group prenatal care on preterm birth and low birth weight in a large metropolitan hospital, accounting for patient adherence, over an 8.5-year period. Materials and Methods: We analyzed data from 9,348 pregnant women with a live, singleton birth who received group (CenteringPregnancy or Expect With Me) or individual prenatal care at Vanderbilt University Medical Center from January 2009 through June 2016. Propensity scores were used for matching based on year of delivery, age, race, pregnancy risk, and adequacy of care. The propensity score matched sample included 1,384 group and 5,055 individual prenatal care patients (total = 6,439 women). Preterm birth (<37 weeks gestation) and low birth weight (<2,500 g) were obtained from systematic medical review. Risks were estimated using Poisson regression. Results: Controlling for individual visits, receiving group prenatal care resulted in significantly lower risk of having a preterm birth (Rate ratio [RR] 0.63, 95% confidence interval [CI] 0.49–0.81) and low birth weight baby (RR 0.62, 95% CI 0.47–0.81), compared to receiving individual care only. Women with ≥5 group prenatal care visits experienced even greater benefits: 68% (RR = 0.32; 95% CI 0.22–0.45) and 66% (RR = 0.34; 95% CI 0.23–0.50) risk reduction in preterm birth and low birth weight, respectively. Conclusions: Participation in group prenatal care may improve birth outcomes. Efforts to promote adoption and sustainability of group prenatal care by health systems may be warranted.

Despite biomedical advances and intervention efforts, rates of preterm birth and other adverse outcomes in the United States have remained relatively intransigent. Evidence suggests that group prenatal care can reduce these risks, with implications for maternal and child health as well as substantial cost savings. However, widespread dissemination presents challenges, in part because training and health systems have not been designed to deliver care in a group setting. This manuscript describes the design and evaluation of Expect With Me, an innovative model of group prenatal care with a strong integrated information technology (IT) platform designed to be scalable nationally. Expect With Me follows clinical guidelines from the American Congress of Obstetricians and Gynecologists. Expect With Me incorporates the best evidence-based features of existing models of group care with a novel integrated IT platform designed to improve patient engagement and support, enhance health behaviors and decision making, connect providers and patients, and improve health service delivery. A multisite prospective longitudinal cohort study is being conducted to examine the impact of Expect With Me on perinatal and postpartum outcomes, and to identify and address barriers to national scalability. Process and outcome evaluation will include quantitative and qualitative data collection at patient, provider, and organizational levels. Mixed-method data collection includes patient surveys, medical record reviews, patient focus groups; provider surveys, session evaluations, provider focus groups and in-depth interviews; an online tracking system; and clinical site visits. A two-to-one matched cohort of women receiving individual care from each site will provide a comparison group (n = 1,000 Expect With Me patients; n = 2,000 individual care patients) for outcome and cost analyses. By bundling prevention and care services into a high-touch, high-tech group prenatal care model, Expect With Me has the potential to result in fundamental changes to the health care system to meet the “triple aim:” better healthcare quality, improved outcomes, and lower costs. Findings from this study will be used to optimize the dissemination and effectiveness of this model. ClinicalTrials.gov, NCT02169024 . Retrospectively registered on June 18, 2014.

Group care models, in which patients with similar health conditions receive medical services in a shared appointment, have increasingly been adopted in a variety of health care settings. Applying the Triple Aim framework, we examined the potential of group medical care to optimize health system performance through improved patient experience, better health outcomes, and the reduced cost of health care. A systematic review of English language articles was conducted using the Cochrane Controlled Trials Register (CENTRAL), MEDLINE/PubMed, Scopus, and Embase. Studies based on data from randomized control trials (RCTs) conducted in the US and analyzed using an intent-to-treat approach to test the effect of group visits versus standard individual care on at least one Triple Aim domain were included. Thirty-one studies met the inclusion criteria. These studies focused on pregnancy (n = 9), diabetes (n = 15), and other chronic health conditions (n = 7). Compared with individual care, group visits have the potential to improve patient experience, health outcomes, and costs for a diversity of health conditions. Although findings varied between studies, no adverse effects were associated with group health care delivery in these randomized controlled trials. Group care models may contribute to quality improvements, better health outcomes, and lower costs for select health conditions.

To have public health impact, evidence-based interventions (EBIs) must be implemented appropriately at meaningful scale. The Center for Disease Control and Prevention’s Replicating Effective Programs and Diffusion of Effective Behavioral Interventions programs disseminate select EBIs by providing program materials and training health providers on their appropriate use and implementation. Sociometrics’ HIV/AIDS Prevention Program Archive (HAPPA) and Program Archive for Sexuality, Health, and Adolescents (PASHA) are likewise the largest EBI collections targeting sexual risk behaviors in the private sector. This study examined the extent to which organizations that obtain EBIs from HAPPA and PASHA implement, adapt and evaluate them and factors associated with program implementation. Survey data were collected from 123 organizations that acquired, and had been in possession for a minimum of six months, at least one EBI from HAPPA or PASHA between January 2009 and June 2011. Data regarding program characteristics and date of acquisition were obtained from Sociometrics’ sales and marketing databases. Logistic regression was used to assess barriers to program implementation. Among organizations that obtained an EBI from Sociometrics intending to implement it, 53% had implemented the program at least once or were in the process of implementing the program for the first time; another 22% were preparing for implementation. Over the three-year time period assessed, over 11,381 individuals participated in these interventions. Almost two-thirds (65%) of implementers made changes to the original program. Common adaptations included: editing content to be more current and of local relevance (81%); adding, deleting or modifying incentives for participation (50%); changing the location in which the program takes place (44%); and/or changing the number, length and/or frequency of program sessions (42%). In total, 80% of implementers monitored program delivery. Participant outcomes were tracked by 78%; 28% of which used evaluation designs that included a control or comparison group. Lack of adequate resources was significantly associated with decreased likelihood of program implementation (odds ratio = 0.180, p <0.05). Findings provide greater understanding of implementation processes, barriers and facilitators that may be used to develop strategies to increase the appropriate use of EBIs.