Group prenatal care successes, challenges, and frameworks for scaling up: a case study in adopting health care innovations

Claire Masters; Rogie Royce Carandang; Jessica B Lewis; Ashley Hagaman; Rebecca Metrick; Jeannette R Ickovics; Shayna D Cunningham

doi:10.1186/s43058-024-00556-1

Group prenatal care successes, challenges, and frameworks for scaling up: a case study in adopting health care innovations

Implement Sci Commun. 2024 Mar 4;5(1):20. doi: 10.1186/s43058-024-00556-1.

Authors

Claire Masters¹, Rogie Royce Carandang², Jessica B Lewis³, Ashley Hagaman^{4

5}, Rebecca Metrick^{4

6}, Jeannette R Ickovics⁴, Shayna D Cunningham⁷

Affiliations

¹ Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, 06510, USA.
² Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, 06030, USA.
³ Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06519, USA.
⁴ Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06510, USA.
⁵ Center for Methods in Implementation and Prevention Sciences, Yale University, New Haven, CT, 06510, USA.
⁶ Sinai Urban Health Institute, Chicago, IL, 60608, USA.
⁷ Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, 06030, USA. scunningham@uchc.edu.

Abstract

Background: Group prenatal care enhances quality of care, improves outcomes, and lowers costs. However, this healthcare innovation is not widely available. Using a case-study approach, our objectives were to (1) examine organizational characteristics that support implementation of Expect With Me group prenatal care and (2) identify key factors influencing adoption and sustainability.

Methods: We studied five clinical sites implementing group prenatal care, collecting qualitative data including focus group discussions with clinicians (n = 4 focus groups, 41 clinicians), key informant interviews (n = 9), and administrative data. We utilized a comparative qualitative case-study approach to characterize clinical sites and explain organizational traits that fostered implementation success. We characterized adopting and non-adopting (unable to sustain group prenatal care) sites in terms of fit for five criteria specified in the Framework for Transformational Change: (1) impetus to transform, (2) leadership commitment to quality, (3) improvement initiatives that engage staff, (4) alignment to achieve organization-wide goals, and (5) integration.

Results: Two sites were classified as adopters and three as non-adopters based on duration, frequency, and consistency of group prenatal care implementation. Adopters had better fit with the five criteria for transformational change. Adopting organizations were more successful implementing group prenatal care due to alignment between organizational goals and resources, dedicated healthcare providers coordinating group care, space for group prenatal care sessions, and strong commitment from organization leadership.

Conclusions: Adopting sites were more likely to integrate group prenatal care when stakeholders achieved alignment across staff on organizational change goals, leadership buy-in, and committed institutional support and dedicated resources to sustain it.

Trial registration: The Expect With Me intervention's design and hypotheses were preregistered: https://clinicaltrials.gov/study/NCT02169024 . Date: June 19, 2014.

Associated data

ClinicalTrials.gov/NCT02169024

Grants and funding

UL1 TR001863/TR/NCATS NIH HHS/United States