Applying the chronic care model to prenatal care: Patient activation, productive interactions, and prenatal outcomes

Objective: To demonstrate how the chronic care model can be applied in prenatal care. Methods: This study was conducted through analysis of data generated in the women's health and family medicine departments of one community hospital and two medical centers across three states (Georgia, Nevada, and Virginia). 159 low-risk obstetric patients were monitored throughout their pregnancy for patient activation and biometric measures including: blood pressure at each appointment, baby's gestational age at birth, and mode of delivery. Patient activation was assessed with the validated, licensed patient activation measure. Results: Patient activation was strongly associated with the Prenatal Interpersonal Processes of Care metric (F (2, 155) = 3.41, p <.05). Also, increased age, decreased Prenatal Interpersonal Processes of Care, fewer pregnancies, and increased diastolic blood pressure were associated with an increased likelihood of cesarean delivery and the model correctly predicted 81% of cases. Conclusion: Women who identified as feeling more activated reported more positive pregnancy experiences, and women who reported more positive pregnancy experiences were more likely to experience a vaginal delivery. Practice implications: Activated patients, more positive prenatal experience, and improved delivery outcomes can be achieved through applying the chronic care model.