Understanding High Utilization of Emergency Obstetric Care in Pregnant Women of Low Socioeconomic Status [170

Abstract

INTRODUCTION: Drivers and impact of low-value care use in pregnant women with high levels of emergency care utilization are poorly understood. METHODS: Deidentified records of all obstetric triage visits from October 2013 to August 2014 at an urban academic medical center were analyzed for utilization trends and clinical outcome. We conducted semistructured interviews with 40 low-income women presenting to obstetric triage after 16 weeks of gestation, purposively sampling those presenting for a fourth or higher visit (high utilizers) or a first visit at term (low utilizers). Interviews were recorded and coded by theme. RESULTS: Six thousand seven hundred and ninety-four triage visits representing 3,539 patients occurred during the study period with 1.9 mean visits per patient. High utilizers made up 10.9% of the sample and were more likely than other triage users to report prior psychosocial trauma (17.8% compared with 7.7%, P<.001) and medical illness (64.0% compared with 47.5%, P<.001). High utilizers were less likely than other triage users to deliver at our center (16% compared with 42%, P<.001); those who did were more likely to deliver preterm (22.6% compared with 12.3%, P=.02). Interview participants perceived triage care to be of higher quality and more accessible than outpatient prenatal care. High utilizers reported social dysfunction and difficulty coping with pregnancy. Low utilizers reported social stability and self-efficacy. CONCLUSION: High emergency utilization can be a signal of unmet need. Interventions targeting perinatal disparities should incorporate low-income patient perspectives by leveraging emergency visits, addressing social determinants, and promoting access to quality prenatal care.