Utilizing a novel resident education initiative to provide reproductive endocrinology and infertility care for underinsured women

Abstract

Few reports exist in the literature describing infertility evaluations or care in patients covered by Medicaid, but disparities in access are well documented. The objective of this study was to describe the health care received by a cohort of underinsured women with infertility after implementation of a novel quality improvement project designed to increase access to reproductive endocrinology and infertility (REI) specialists. Retrospective observational study. We created a system for provision of infertility consultations from the REI division at an academic tertiary care institution. The Obstetrics and Gynecology (OB/Gyn) resident clinic at our institution provides care for primarily African American underinsured women. Patients are screened in by Ob/Gyn residents staffing routine gyn clinic when a patient presents with infertility. As part of their REI curriculum, Ob/Gyn residents reviewed patient charts in virtual visits under supervision of REI faculty. Patients were then provided diagnostic guidance, management recommendations and access to cost-saving research programs. Patients receive their individualized recommendations and associated costs to make informed healthcare decisions. Patient charts are maintained on a shared electronic medical record list for ongoing management. Charts from the first year of the service were reviewed for demographic and clinical information. This project was reviewed by the University of Pennsylvania Institutional Review Board and determined to be exempt as a Quality Improvement project. Twenty-eight consultations were performed for underinsured women in the first year of service. Of these patients, 22 patients (78%) had Medicaid insurance. Two patients (7%) were seen in the REI office after initial consultation. Nine (22%) completed bloodwork and 10 patients (35%) underwent pelvic ultrasounds. Six evaluations of fallopian tube patency were completed via either imaging (hysterosalpingogram) or surgery (chromopertubation). Eight patients (28%) initiated ovulation induction. Five patients (17%) achieved pregnancy. Pelvic ultrasounds and blood work were fully covered by all insurance. Though our resident clinic remains unable to provide standard infertility treatments like IUI and IVF to our Medicaid patients, patients were still take advantage of the robust REI division at our institution. Academic institutions may be able to connect uninsured and underinsured patients with advice and diagnostics by utilizing resident educational opportunities to offset a portion of financial barriers.