# Adapting COVID-19 Prenatal Care Innovations for Patients At Risk of Adverse Pregnancy Outcomes: a Mixed Methods Study of the Plan for Appropriate Tailored Healthcare in Pregnancy

> **NIH NIH R21** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $188,565

## Abstract

PROJECT SUMMARY/ABSTRACT
BACKGROUND: Prenatal care is a critical lever for improving maternity outcomes for the 4 million women who
give birth annually. Yet, the traditional model of care—a uniform 14 in-person visits—overtreats and unduly
burdens many patients. The COVID-19 pandemic rapidly transformed prenatal care delivery, prompting
adoption of hybrid prenatal care models (reduced visit schedules with telemedicine). These changes are the
basis for new national prenatal care consensus recommendations: the Plan for Appropriate Tailored
Healthcare in pregnancy (PATH). Reduced visit schedules and telemedicine are supported by evidence and
expert opinion, but it is unclear how hybrid prenatal care models will affect care utilization, health outcomes,
and patient and provider experience, particularly for marginalized patient groups with the worst baseline
outcomes. While PATH is promising for removing access barriers, changes could have unintended
consequences (e.g. more unscheduled or delayed care). Thus, there is a critical need to evaluate the effects of
hybrid prenatal care models to inform adaptations for widespread implementation for medically average-risk
and marginalized patient populations.
OVERALL STRATEGY: This research aims to understand how hybrid prenatal care models affect service
utilization and health outcomes for average-risk patients, especially those from marginalized groups (low-
income, Black, and rural patients). To achieve these goals, we will conduct econometric analyses to compare
prenatal care utilization and outcomes from two institutions that have initiated and maintained hybrid prenatal
care models to the present (Michigan Medicine, University of Pittsburgh Medical Center) with a control site
(Indiana University) that adopted the hybrid prenatal care model only from March-May 2020 before returning to
traditional care. We will used mixed methods to integrate EHR data with in-depth qualitative interviews to
explain differences in utilization and critical adaptations needed to improve prenatal care delivery for average-
risk and key marginalized groups.
RESEARCH AIMS: Our study’s aims are: 1) Evaluate the effects of hybrid prenatal care models on care
utilization and health outcomes for average-risk patients. 2) Explore how patient and provider factors affect
utilization of hybrid prenatal care models to inform critical adaptations for optimizing prenatal care.
IMPACT: This timely investigation is highly likely to exert a sustained, powerful impact on prenatal care
delivery, maternal and neonatal outcomes, and equity, with potential for particular benefit among marginalized
pregnant patients.

## Key facts

- **NIH application ID:** 10906822
- **Project number:** 5R21HD109408-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Alex Peahl
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $188,565
- **Award type:** 5
- **Project period:** 2023-08-14 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10906822

## Citation

> US National Institutes of Health, RePORTER application 10906822, Adapting COVID-19 Prenatal Care Innovations for Patients At Risk of Adverse Pregnancy Outcomes: a Mixed Methods Study of the Plan for Appropriate Tailored Healthcare in Pregnancy (5R21HD109408-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10906822. Licensed CC0.

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