Modified Project Summary/Abstract Section While not the intended target of restrictions, care for pregnancy loss often overlaps with induced termination care and can be affected by policy changes. With the recent changes to reproductive health policies in multiple states, as well as the lack of baseline monitoring of pregnancy loss and treatment trends and the known patient-level variation in pregnancy loss care, it is imperative to document clinician and patient experiences of navigating pregnancy loss care and to develop data collection systems that can be used to monitor changes in practices and outcomes over time. The goals of the proposed study are to assess: 1) the extent to which pregnancy loss management practices are influenced by newly enacted policies; 2) the implications of these new policies and practice changes for patient-centered quality care; and 3) which institutional factors may be influential in supporting patient-centered care despite restrictions. We will conduct an exploratory sequential mixed methods study with the following three aims: AIM 1 – Characterize clinician knowledge and decision-making related to clinical management protocols for pregnancy loss in states with new policy restrictions. Using a combination of rapid qualitative analysis (RQA) and traditional thematic qualitative methods, we will conduct in-depth interviews with clinicians (n=30-40) providing pregnancy loss care, recruiting across practice settings, practice types, and state policy. In this analysis we will document real-time decision-making and understand practice changes and the barriers and facilitators of evidence-based patient-centered care. AIM 2 – Document patient experiences with pregnancy loss management practices in states with and without new policy restrictions. We will conduct in-depth semi-structured qualitative interviews with patients (n=40-50) experiencing pregnancy loss, with representation across first and second trimester, state policy, and demographic characteristics. Using a similar approach to Aim 1, we will seek to understand patient understanding and effects of policy changes and the barriers and facilitators of high-quality care. AIM 3 – Monitor and evaluate the impact of new policies on first and second trimester pregnancy loss management practices using EPIC and EPIC Cosmos electronic medical record data. We will first develop and internally-validate a set of search filters to identify pregnancy loss treatments, complications, and delays in care (Aim 3a), will then validate externally at other institutions to confirm fidelity (Aim 3b), and then will apply to four case study institutions in most and least restrictive policy environments to assess changes in care related to state policy using a differences-in-differences analysis, and assess impact on differences in care using a triple-differences analysis (Aim 3c). We will then apply filters to aggregate data in EPIC Cosmos to assess national trends (Aim 3d).