The Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Prenatal Care Recommendations.

Objective: To describe MiPATH (the Michigan Plan for Appropriate Tailored Healthcare in pregnancy) panel process and key recommendations for prenatal care delivery.
Methods: We conducted an appropriateness study using the RAND Corporation and University of California Los Angeles Appropriateness Method, a modified e-Delphi process, to develop MiPATH recommendations using sequential steps: 1) definition and scope of key terms, 2) literature review and data synthesis, 3) case scenario development, 4) panel selection and scenario revisions, and 5) two rounds of panel appropriateness ratings with deliberation. Recommendations were developed for average-risk pregnant individuals (eg, individuals not requiring care by maternal-fetal medicine specialists). Because prenatal services (eg, laboratory tests, vaccinations) have robust evidence, panelists considered only how services are delivered (eg, visit frequency, telemedicine).
Results: The appropriateness of key aspects of prenatal care delivery across individuals with and without common medical and pregnancy complications, as well as social and structural determinants of health, was determined by the panel. Panelists agreed that a risk assessment for medical, social, and structural determinants of health should be completed as soon as individuals present for care. Additionally, the panel provided recommendations for: 1) prenatal visit schedules (care initiation, visit timing and frequency, routine pregnancy assessments), 2) integration of telemedicine (virtual visits and home devices), and 3) care individualization. Panelists recognized significant gaps in existing evidence and the need for policy changes to support equitable care with changing practices.
Conclusion: The MiPATH recommendations offer more flexible prenatal care delivery for average-risk individuals.
Competing Interests: Financial Disclosure Steven J. Bernstein reports money was paid to his institution from the Blue Cross Blue Shield of Michigan/Blue Care Network, the U.S. Department of Veterans Affairs, and the U.S. Agency for Healthcare Research and Quality. He also served and currently serves as an external physician on the Utilization Management and Clinical Quality Committees for Blue Cross Blue Shield of Michigan and Blue Care Network. He received an honorarium for each committee meeting. The other authors did not report any potential conflicts of interest.
(Copyright © 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)