Miscarriage is the most common complication of pregnancy, affecting 1 million U.S. women annually. Care models for this patient population are highly variable across practices and regions.
Obstetric practices generally schedule pregnant women for their first appointment towards the end of the first trimester – leaving many women unsure about where to turn if they suspect a problem early on. This uncertainty, paired with the difficulty patients face accessing timely, and comprehensive outpatient services leads to high utilization rates of emergency services when symptoms of miscarriage occur.
A full-service, patient-centered approach to delivering urgent care for women with signs of miscarriage improves patient experience and quality of care and reduces the cost associated with miscarriage care.
In partnership with a team led by Courtney Schreiber, MD, MPH, we set out to test the core assumptions of our integrated, outpatient model for management of pregnancy loss, called the Pregnancy Early Access Center (PEACE). Over the course of six months, we ran eight pilots to explore the following questions:
- Can we safely identify and route patients from the emergency department to PEACE?
- Can we catch patients soon enough to avoid emergency department visits?
- What is the scope of unmet need for PEACE services in Philadelphia?
Based on insights from these pilots, we developed a triage tool that can be used in-person, via phone, or online to determine which patients can be seen safely in an outpatient setting vs. patients who should present to the emergency department (ED). In early pilots, we were able to identify more than 50% of patients who were appropriate for PEACE while keeping 100% of patients who needed the ED in place.
From this work, the team undertook a randomized controlled trial to validate the PEACE triage tool, studying the use of the tool in three different EDs in Philadelphia. PEACE has also developed new patient-facing and provider-facing referral materials to spread the word about its services.
PEACE services are now available at the Hospital of the University of Pennsylvania (HUP), Penn Medicine Washington Square, and Penn Medicine Cherry Hill.