Assessing Change in Medical Management of Early Pregnancy Loss before and after Implementation of a Learning Collaborative for Initiation of Mifepristone Use.

Objectives: ExPAND Mifepristone is a one-year learning collaborative providing support for mifepristone provision in primary care for early pregnancy loss (EPL) or abortion. This study measured change in prevalence of medical management of EPL at a federally qualified health center (FQHC) that participated in ExPAND Mifepristone's pilot year. Secondary objectives were to describe changes in referral patterns and medication choice for EPL.

Methods: To quantify changes in medical management of EPL, we conducted a retrospective data query using International Classification of Diseases-10 codes during two time periods: pre-implementation (January 1, 2019 - February 29, 2020) and post-implementation (August 1, 2021 - June 30, 2022). Manual chart review was used to assess change in referral patterns for EPL.

Results: There were 193 patients with EPL in the pre-implementation period and 115 post-implementation. Pre-implementation, 8.3% (n=16) of EPL patients received medical management versus 15.7% (n=18) post-implementation (p=0.046). The percentage of all patients with EPL who received misoprostol alone was 8.3% pre- and 8.7% (p=0.91) post-implementation. Treatment with mifepristone plus misoprostol increased to 44.4%. EPL referrals to Obstetrics/Gynecology (OB/GYN) decreased from 14.0% to 1.7% (p=0.001). The most frequent reason for referral was procedural management.

Conclusion: After participation in ExPAND Mifepristone, there was an increase in medical management for EPL by PCPs and referrals to OB/GYN declined. ExPAND Mifepristone can help facilitate PCP use of mifepristone plus misoprostol for medical management of EPL.

Key words: Primary Care, Early Pregnancy Loss, Mifepristone, Women's Health, Referral.