Resident Versus Attending Prenatal Care Models: an Analysis of the Effects of Race and Insurance on Appointment Attendance

Abstract

Objective To describe patient differences by prenatal care (PNC) model and identify factors that interact with race to predict more attended prenatal appointments, a key component of PNC adherence. Methods This retrospective cohort study used administrative data targeting prenatal patient utilization from two OB clinics with different care models (resident vs. attending OB) from within one large midwestern healthcare system. All appointment data among patients receiving prenatal care at either clinic between September 2, 2020, and December 31, 2021, were extracted. Multivariable linear regression was performed to identify predictors of attended appointments within the resident clinic, as moderated by race (Black vs. White). Results A total of 1034 prenatal patients were included: 653 (63%) served by the resident clinic (appointments = 7822) and 381 (38%) by the attending clinic (appointments = 4627). Patients were significantly different across insurance, race/ethnicity, partner status, and age between clinics (p < 0.0001). Despite prenatal patients at both clinics being scheduled for approximately the same number of appointments, resident clinic patients attended 1.13 (0.51, 1.74) fewer appointments (p = 0.0004). The number of attended appointments was predicted by insurance in crude analysis (β = 2.14, p < 0.0001), with effect modification by race (Black vs. White) in final fitted analysis. Black patients with public insurance attended 2.04 fewer appointments than White patients with public insurance (7.60 vs. 9.64) and Black non-Hispanic patients with private insurance attended 1.65 more appointments than White non-Hispanic or Latino patients with private insurance (7.21 vs. 5.56). Conclusion Our study highlights the potential reality that the resident care model, with more care delivery challenges, may be underserving patients who are inherently more vulnerable to PNC non-adherence at care onset. Our findings show that patients attend more appointments at the resident clinic if publicly insured, but less so if they are Black than White.

Time Differences From Abnormal Cervical Cancer Screening to Colposcopy Between Insurance Statuses

“…Rather, differential levels of resources for various hospital-based clinics may contribute to this disparity. While this study did not investigate specific reasons for prolonged follow-up, previous studies have found that patients in resident OB/GYN practices cited inconvenient appointment availability and longer times spent waiting prior to seeing a provider as reasons to cancel appointments 14,19 . Beyond gynecologic settings, Medicaid-insured patients have been widely shown to face longer waiting room times than privately insured patients 20 .…”

“…While this study did not investigate specific reasons for prolonged follow-up, previous studies have found that patients in resident OB/GYN practices cited inconvenient appointment availability and longer times spent waiting prior to seeing a provider as reasons to cancel appointments. 14,19 Beyond gynecologic settings, Medicaid-insured patients have been widely shown to face longer waiting room times than privately insured patients. 20 However, the presented findings suggest that canceled appointments cannot fully explain the delay, as intervals to first scheduled colposcopy remained significantly longer among the resident practice group regardless of cancelations.…”