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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Postpartum Visit.

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Strategy. Group Prenatal Care

Approach. Promote the use of Group Prenatal Care models that encourage and facilitate postpartum visit attendance

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Overview. Group prenatal care (GPC) is a patient-centered approach that consists of small groups of women with similar gestational ages receiving all of their prenatal care in a group setting. Attending five or more GPC sessions, as opposed to individual sessions, appears to increase the likelihood that pregnant women who are enrolled in Medicaid will attend postpartum visits. The additional engagement and education in the group setting may be factors in the increased likelihood of attendance.[1] However, evidence suggests that outcome measures from GPC tend to focus on neonatal rather than maternal health outcomes; therefore, more studies with stronger designs are needed to support these findings.[2]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings). This strategy is also supported as “Group Prenatal Care” in the What Works for Health Database.

Source. Peer-Reviewed Literature and What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Quality of Care. This strategy promotes the degree to which healthcare services meet established standards aimed at achieving optimal health outcomes.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Outreach (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of healthcare providers and systems partnered with Title V that offer and promote group prenatal care (GPC) models to their patients. (Indicates the adoption and implementation of the strategy)
  • Number of GPC sessions oversaw by Title V held that include education, support, and planning for postpartum care and visit attendance. (Shows the focus and intentionality of the strategy in promoting postpartum care)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of healthcare providers and systems partnered with Title V that offer and promote group prenatal care (GPC) models to their patients. (Indicates the adoption and implementation of the strategy)
  • Percent of GPC sessions oversaw by Title V held that include education, support, and planning for postpartum care and visit attendance. (Shows the focus and intentionality of the strategy in promoting postpartum care)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of community-based organizations partnered with healthcare systems to design, implement, and evaluate GPC models tailored to the needs and preferences of the community. (Indicates the community collaboration of the strategy)
  • Number of policies, guidelines, and reimbursement mechanisms established to support the sustainable integration of GPC into maternal health service delivery. (Shows the systems change and enabling factors for the strategy)

OUTCOME MEASURES:

  • Number of healthcare systems and payers that adopt and scale up GPC as a standard option and best practice for promoting optimal maternal health outcomes, including postpartum care. (Indicates the institutionalization and spread of the strategy)
  • Number of communities and populations that achieve significant and sustained improvements in postpartum visit attendance, maternal health outcomes, and patient satisfaction through the widespread availability and usability of high-quality GPC. (Shows the population-level impact and return on investment of the strategy)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of community-based organizations partnered with healthcare systems to design, implement, and evaluate GPC models tailored to the needs and preferences of the community. (Indicates the community collaboration of the strategy)
  • Percent of policies, guidelines, and reimbursement mechanisms established to support the sustainable integration of GPC into maternal health service delivery. (Shows the systems change and enabling factors for the strategy)

OUTCOME MEASURES:

  • Percent of healthcare systems and payers that adopt and scale up GPC as a standard option and best practice for promoting optimal maternal health outcomes, including postpartum care. (Indicates the institutionalization and spread of the strategy)
  • Percent of communities and populations that achieve significant and sustained improvements in postpartum visit attendance, maternal health outcomes, and patient satisfaction through the widespread availability and usability of high-quality GPC. (Shows the population-level impact and return on investment of the strategy)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Heberlein, E., Smith, J., Willis, C., Hall, W., Covington-Kolb, S., & Crockett, A. (2020). The effects of CenteringPregnancy group prenatal care on postpartum visit attendance and contraception use. Contraception, 102(1), 46–51. https://doi.org/10.1016/j.contraception.2020.02.010.
[2] Tucker, C. M., Felder, T. M., Dail, R. B., Lyndon, A., & Allen, K. C. (2021). c. MCN. The American journal of maternal child nursing, 46(6), 314–322. https://doi.org/10.1097/NMC.0000000000000766.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.