P2.131: Evaluating prenatal visits as a linkage between obstetrics and pediatric primary care

Background: The AAP recommends pediatric prenatal visits (PPV) during the third trimester to help families establish a pediatric medical home, provide anticipatory guidance of infant care, and identify psychosocial issues that may impact pediatric care. There are disparities in access to the prenatal pediatric visit with Urban lower socioeconomic households have higher barriers to care. Prenatal visits in these populations have a myriad of benefits potentially influence breastfeeding decisions, decrease emergency department visits, and positively impact the doctor-patient relationship.

In 2020 a health system in Washington DC implemented DC Safe Babies Safe Moms (SBSM), a major health system transformation to decrease perinatal maternal and child health disparities, including improving transitions of care in the health care continuum. One element was to build an innovative process for warm referrals from prenatal services to pediatrics for the prenatal pediatric visit. We aim to describe the inter-professional collaboration workflow and evaluate the outcomes of the visits.

Methods: All mothers receiving prenatal care at the SBSM site complete a holistic screening in the third trimester that includes asking if they have a pediatrician and if they would like to schedule a PPV with a SBSM pediatric provider. If yes referrals are made, then the parent is called to schedule the appointment. The visit is completed as a telehealth and includes all topics recommended in Bright Futures including emphasis on scheduling the newborn visit prior to leaving the hospital with the chosen pediatrician. PPV visits are billed with the ICD-10 code Z76.81.

The study population was identified as children born at MedStar Washington Hospital Center to expectant persons who had completed a visit with the prenatal visit billing code above between 6/2021 and 8/2024. Those pediatric patient’s charts were reviewed for documentation of progress notes indicating completion of newborn, 2 week, 1 ,2 3, 6, 9, and 12 month well child visits (WCVs).

Results: 85 mothers were identified as participating in a prenatal visit, however only 76 pediatric patients were able to be identified in the electronic medical record system. Of those 76 pediatric patients, 16 had at least 1 WCVs at MedStar Community Pediatrics. Of the 16 who had completed at least 1 visit, 8 completed all recommended WCVs. The average number of visits attended in the first year of life was 5.3, among those who had attended at least 1 WCV.

Conclusion: Pediatric prenatal visits in high-risk populations are associated with attendance of infants to recommended well child visits and preventive care. Inter-professional protocols and workflows to schedule prenatal pediatric visits can create vital links to pediatric care. Future research on the benefits and challenges of the pediatric prenatal visit is still needed to understand how to best improve this process.