2022 was a catalytic year for pregnancy care. Pregnant patients and their providers adapted to a new healthcare landscape. Maternal health has been transformed in multiple ways by the COVID-19 pandemic and the overturning of Roe v. Wade. The new state of obstetrics presents a compelling opportunity to evolve pregnancy care in the years ahead. As we tackle the worsening maternal health crisis, we will continue to build Delfina Care based on what we learned in 2022.
Flexibility is paramount. As core clinical services shifted back to in-person visits, patients increasingly sought the best aspects of virtual care they had enjoyed in the last two years. Pregnant patients shared that they aim to maximize the quality of in-person clinical visits while engaging virtually with monitoring, counseling, and education services. At Delfina, we continued to observe strong preferences for engaging with care virtually in 2022, particularly from pregnant patients with previous pregnancies – an effect previously reported by others (Flugeisen et al. 2017). Simultaneously, providers facing a snowballing staffing crisis this year motivated us to maximize the time-savings delivered by Delfina Care. Providers observing improved practice efficiency in turn also reported increased flexibility to adapt to patient needs and preferences without compromising quality.
Hybrid care is the future of obstetrics. Pregnancy care workflows that hybridize in-person and virtual care like OB Nest, pioneered by the Mayo Clinic (Butler Tobah et al. 2016), and the University of Michigan’s 4-1-4 system (Peahl et al. 2020) are becoming fixtures for low-risk patients at clinics around the country. This year, ACOG continued to iteratively assess and standardize the innovation of hybrid models via their Plan for Appropriate Tailored Healthcare in Pregnancy (PATH) Recommendations. Learning from these models, Delfina Care expanded in 2022 to enable multiple evidence-based hybrid workflows based on the clinical needs of each population.
Social determinants drive improvement. The ongoing disparities in maternal health reinforced the imperative for physicians to fulfill Rudolf Virchow’s mandate of serving as “the natural attorneys” of those who need us most. We are grateful for the partnership of OBGYN physicians serving marginalized populations covered by Medicaid. We worked closely with them this year to more deeply understand the often overlapping and mutually reinforcing social and clinical needs of our patients. Patient time spent with our Delfina Guides, doulas leading the team in addressing a patient’s social needs, correlated with improvements in engagement with care. This finding is reinforced by previous studies: with doulas incorporated into their care team, patients engage more closely with care (Hans et al. 2018) and achieve better pregnancy outcomes (Thurston et al. 2019). Our prenatal virtual care model, while helpful for all patients, has resonated particularly strongly with patients reporting challenges with childcare, transportation, or inflexible employment.
Data-driven care delivers outsized impact. In 2022, our team used large datasets to systematically identify inflection points for impact in the clinical course of pregnancy. For instance, data-driven preeclampsia prevention workflows are substantially more effective when initiated prior to 16 weeks gestation (Bujold et al. 2010). We partnered with Mayo Clinic to rigorously study these key events and their related outcomes. We learned how to optimize our approach to ethically achieve better outcomes for diverse populations, while saving overall provider time and cost. Our health plan partners have been innovating internally and partnering with OBGYN providers to align incentives to leverage interventions at these inflection points for outcomes improvement.
In the coming year, we look forward to serving pregnant patients with increasingly impactful technology and continuing to learn as we serve. We welcome you to join us to make a measurable positive impact on maternal and child health with data-driven care.