JMIR Publications

ABSTRACT

Background:

Background:

Emergency Room (ER) utilization during pregnancy is common, contributing to high-cost, low-value care. Together, gaps in patient education and inaccessibility of preventive services have been identified as key reasons for ER presentation during pregnancy. Digital platforms present a promising solution for providing educational resources and provider services that may fill gaps in routine prenatal care, thereby reducing the use of low-value in-person care.

Objective:

Objective:

We describe the relationship between use of Maven, a virtual healthcare platform that provides digital prenatal services, and in-person care avoidance (ER or office visit) during pregnancy. Specifically, the aims of this study are to examine: 1) how utilization of a digital health platform is associated with in-person care avoidance, 2) how pregnancy-related knowledge may serve as a mechanism for this association. To assess aim 2, we test a) how utilization of a digital health platform is associated with better understanding of warning signs and medically accurate information, and b) how understanding medically accurate information and warning signs is associated with in-person care avoidance in a population of pregnant Maven users.

Methods:

Methods:

In this retrospective study of commercially insured pregnant people, we used adjusted logistic regression to examine the relationship between virtual platform use, avoidance of in-person care, and the digital platform’s influence on users’ pregnancy-related knowledge (learning medically accurate information and recognizing warning signs). Demographics, medical history, and in-person care avoidance were self-reported.

Results:

Results:

Of 5263 users, 280 (5.3%) reported that digital services helped them avoid in-person care. More users who reported avoiding in-person care also reported that the digital platform helped them understand warning signs (231/280 - 82.5%) and learn medically accurate information (185/280 - 66.1%). In adjusted models, all modes of digital service utilization (assessed as quartiles) were associated with avoiding in-person care in a dose-response manner (e.g., virtual provider appointments: Q2 aOR 1.57; 95% CI: 1.00-2.41; Q3 aOR 2.53; 95% CI: 1.72-3.72; Q4 aOR 5.26; 95% CI: 3.76-7.42). Users were more likely to avoid in-person care if they reported that the digital platform helped them recognize warning signs (aOR 3.55; 95% CI 2.60-4.94) or learn medically accurate information (aOR 2.05; 95% CI 1.59-2.67).

Conclusions:

Conclusions:

These results suggest that digital platforms can provide the information and tools that patients need to recognize warning signs, avoid medical misinformation, and recognize when in-person care is medically appropriate. Future work is needed to assess the best uses of virtual care and the role of emerging technologies in prenatal care delivery.