"The issues that our clients deal with aren't just specific to prenatal": Prenatal care coordination as an integrated care model

Abstract

Objectives

Integrated care models show promise in addressing the factors that lead to inequities in perinatal health outcomes. This report describes how Prenatal Care Coordination (PNCC) functions as an Equity Promoting Integrated Care (EPIC) model.

Study design

A multi-method study aimed to evaluate the implementation and impact of PNCC, a Medicaid-funded perinatal program in Wisconsin.

Methods

In 2023, we conducted individual semi-structured interviews (N = 15) and focus groups (N = 4) with coordinators at five sites. Sites varied by geographic region, populations served, team size, and organizational differences. The parent study assessed PNCC implementation overall using the Consolidated Framework for Implementation Research (CFIR). The updated CFIR was used for initial deductive coding. We then applied concepts from the Equity-Promoting Integrated Care (EPIC) framework to develop themes and subthemes.

Results

A meta-theme was "integrated model of care," reflecting how participants discussed the complexity of the care they provide and the intersecting systems they navigate to meet clients' needs. Four themes illustrate how PNCC coordinators are leveraging components of EPIC models: "Enhancing clients' skills," "Bridging gaps in care," "Providing person-centered care to build trust," and "Having a broader community presence."

Conclusions

Given persistent inequities in perinatal outcomes in the US, our findings represent critical insight into the potential impact of integrated care models. Clinicians should consider strengthening relationships to support patient participation in integrated care community services. Future research is needed to optimize the implementation and reach of integrated care models such as PNCC and leverage their potential to improve perinatal outcomes.