Evaluation of the miscarriage care initiative: A program to integrate comprehensive early pregnancy loss management in primary care settings

Abstract

BACKGROUND AND OBJECTIVES: Managing early pregnancy loss (EPL) with expectant, medication, and manual vacuum aspiration (MVA) management in primary care is safe, effective, and acceptable, yet, few family physicians provide all three care options. We implemented the Miscarriage Care Initiative (MCI) to help primary care organizations serving underserved communities and family medicine residencies integrate comprehensive EPL treatment options into practice. This study evaluates the effect of the MCI on provision of EPL care and family physicians’ professional growth. METHODS: This mixed-methods, cross-sectional study included family physician clinical champions from 13 sites who completed the MCI in 2013-2016. Participants were invited to complete surveys and phone interviews to assess their perceptions, experiences, and changes in clinical practice. We used descriptive statistics to summarize survey data; transcripts were coded and ex-amined through thematic analysis. RESULTS: All respondents completed surveys, and 11 (84.6%) completed in-terviews. After the MCI, nearly all sites (92.3%) offered expectant and medication management options; eight (61.5%) provided MVA for EPL. All residencies integrated comprehensive EPL management into their didactic curricula. Common challenges to integrating care included administrative resistance around EPL management similarities to abortion, and time to navigate logistics. The MCI supported family physicians’ leadership development and may contribute to increased continuity of care. CONCLUSIONS: The MCI successfully expanded the availability of EPL management options and residency training in primary care. Future research should explore the program’s sustainability on EPL care provision and training, and strategies to scale up such a model.