The effect of tailored prenatal care policies with telemedicine on outpatient clinic operations

To describe changes in clinical operations and efficiency following implementation of a tailored prenatal care delivery policy including telemedicine visits. We conducted a simulation study of a new tailored prenatal care policy with varying visit schedules (9 visits for low-risk patients, 14 visits for high-risk patients) and modality (in-person or hybrid with telemedicine visits) compared to traditional care delivery (14 in-person visits for all patients). We used data from a single academic health system to establish key assumptions about patient characteristics and clinic capacity. We assumed 25% of outpatient clinical volume was available for telemedicine. The dataset included 4968 patients.. We performed a discrete event simulation in C++ evaluating the differential effects of tailored vs traditional prenatal care policies. Simulation parameters included dynamic patient arrival times, patient preference for hybrid prenatal care, and patient risk level. The simulation was run over a 10-year time horizon over 1000 replications. We reported critical operational metrics, including patient delays, the percentage of overbooked appointments, and the overall proportion of unused clinic capacity, for low and high-risk patients based on their preference for in-person or hybrid visits. Implementation of the tailored prenatal care policy resulted in shorter care delays in weeks for all patients (low-risk in-person: 3.5; high-risk in-person: 0.5; low-risk hybrid 3.7; high-risk hybrid 0.6) [Figure 1]. Tailored policies also resulted in decreased percentages of overbooked appointments (percent difference for low-risk in-person: 9.5%; high-risk in-person: 3.2%; low-risk hybrid 14.1%; high-risk hybrid 6.8%) [Figure 2]. Unused clinic capacity was 3% lower with tailored prenatal care policies across all clinics. Tailored prenatal care delivery policies with visit schedules based on medical risk and telemedicine improve clinical operations, including patient delays, overbooked appointments, and overall utilization of clinic capacity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)