Bleeding and cramping early in pregnancy are common symptoms, which can in some cases signal a serious problem, such as an ectopic pregnancy or the beginning of a miscarriage, a common complication despite often being treated as taboo. In fact, according to the March of Dimes, miscarriage during the first half of the first trimester of pregnancy (before 12 weeks) occurs in roughly 1 in every 4 pregnancies, affecting about one million women in the U.S. each year. However, because the majority of miscarriages occur early in the first trimester - often before news of the pregnancy has been shared with friends and family - many choose to suffer in silence. The secrecy that so often surrounds the issue of miscarriage has, as a result, led to a lot of misinformation – including the perception that it is rare, or the woman's fault - and a stigma surrounding the experience.
Additionally, because most women don’t start receiving obstetric care until the second half of the first trimester, they may find themselves making a choice between waiting and worrying, or seeking emergency department care when they suspect something may be wrong. In addition to the immense stress and emotional turmoil these issues cause, these emergency cases also result in potentially avoidable hospital admissions and costs to patients and the hospital.
Now, a team of obstetricians and women’s health specialists from Penn Medicine are working to create a Pregnancy Early Assessment CEnter (PEACE). By offering streamlined care specifically to women in their first trimester, PEACE will deliver a new model of care designed to identify and tackle issues for women with signs of complications in early pregnancy. Not only will the center improve the patient experience and outcomes, but it could also ultimately reduce costs associated with miscarriage care.
“Right now the approach to managing women at risk of miscarriage is too haphazard. Women who experience cramping or bleeding early in their pregnancy may be concerned that something is wrong, but they may not know where to turn or have trouble accessing a timely appointment,” said Courtney Schreiber, MD, program director at the Penn Family Planning and Pregnancy Loss Center. “Our model serves women on an urgent-care basis and is full service so that evaluation and management are streamlined.”
The benefit of PEACE to patients is clear: Women will get the care they need in a setting created specifically for them and staffed by clinicians and technicians who focus on their specific set of needs. But the center, newly funded by Penn Medicine’s Innovation Accelerator Program – a program of the Penn Center for Health Care Innovation – hopes to create a ripple effect of benefits that extends beyond patients, to providers and the overall health system.
Previous studies have shown that expanded office-based miscarriage care can save almost $250 per case when compared with traditional miscarriage care, and that expanding women’s treatment can result in lower direct medical costs.
Studies conducted by the Penn team have also found that poor women are more likely to seek emergency care for early pregnancy concerns than are non-poor women. Because emergency services have higher copays than office-based care, Schreiber said this means the women who can least afford it are spending the most on their miscarriage management.
“We hope to improve the patient experience, support our colleagues providing prenatal care, and reduce emotional and financial costs,” Schreiber explained. “If our hypothesis that this model will benefit patients, providers and health systems proves true, our next goal will be to make this program available to more women.”
Prior to receiving its initial funding from the Innovation Accelerator Program, Schreiber’s team worked to collect data from patients and obstetricians, in order to better understand how they feel about the current process and services available. Of the providers interviewed, many said they felt they lack the appropriate tools to help patients with miscarriage. Patients interviewed for the preliminary data were from diverse socio-economic backgrounds, and many expressed frustration at the number of visits required to obtain definitive care.
With the grant from the Innovation Accelerator Program, Schreiber’s team was given four months to test the PEACE model. At the end of the test period, the team will present their findings to a panel of leaders from the Penn Center for Health Care Innovation for the opportunity to receive additional funding to support the program.
The team is currently studying patient volume, patient satisfaction, and referrals to see if the PEACE model is effective. Over time, the team will measure emergency room visits before and after the program, number of blood transfusions for miscarriage patients, and cost.
"Under the current model, patients often experience long wait times and may undergo unnecessary surgery. The PEACE model being tested by Dr. Schreiber's team has the potential to improve the patient experience and be more efficient and cost-effective," said Deborah A. Driscoll, MD, chair of the department of Obstetrics and Gynecology at Penn Medicine. "Many ER visits and hospital admissions could be avoided if women have access to a full-service urgent care practice early in their pregnancy."