{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:15:27Z","timestamp":1787962527103,"version":"build-2784847793"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T00:00:00Z","timestamp":1718928000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T00:00:00Z","timestamp":1718928000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pregnancy Childbirth"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Early initiation of prenatal care is widely accepted to improve the health outcomes of pregnancy for both mothers and their infants. Identification of the various barriers to entry into care that patients experience may inform and improve health care provision and, in turn, improve the patient\u2019s ability to receive necessary care.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Aim<\/jats:title>\n                <jats:p>This study implements a mixed-methods approach to establish methods and procedures for identifying barriers to early entry to prenatal care in a medically-vulnerable patient population and areas for future quality improvement initiatives.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>An initial chart review was conducted on obstetrics patients that initiated prenatal care after their first trimester at a large federally qualified health center in Brooklyn, NY, to determine patient-specified reasons for delay. A thematic analysis of these data was implemented in combination with both parametric and non-parametric analyses to characterize the population of interest, and to identify the primary determinants of delayed entry.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The age of patients in the population of interest (<jats:italic>n<\/jats:italic>\u2009=\u2009169) was bimodal, with a range of 15 \u2013 43\u00a0years and a mean of 28\u00a0years. The mean gestational age of entry into prenatal care was 19\u00a0weeks. The chart review revealed that 8% recently moved to Brooklyn from outside of NYC or the USA. Nine percent had difficulty scheduling an initial prenatal visit within their first trimester. Teenage pregnancy accounted for 7%. Provider challenges with documentation (21%) were noted. The most common themes identified (<jats:italic>n<\/jats:italic>\u2009=\u2009155) were the patient being in transition (21%), the pregnancy being unplanned (17%), and issues with linkage to care (15%), including no shows or patient cancellations. Patients who were late to prenatal care also differed from their peers dramatically, as they were more likely to be Spanish-speaking, to be young, and to experience a relatively long delay between pregnancy confirmation and entry into care. Moreover, the greatest determinant of delayed entry into care was patient age.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Our study provides a process for other like clinics to identify patients who are at risk for delayed entry to prenatal care and highlight common barriers to entry. Future initiatives include the introduction of a smart data element to document reasons for delay and use of community health workers for dedicated outreach after no show appointments or patient cancellations.\n<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12884-024-06630-9","type":"journal-article","created":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T12:01:51Z","timestamp":1718971311000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Patient-perceived barriers to early initiation of prenatal care at a large, urban federally qualified health center: a mixed-methods study"],"prefix":"10.1186","volume":"24","author":[{"given":"Valerie N.","family":"Holt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elan","family":"Pelegr\u00ed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Hardy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Buchin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Dapkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meleen","family":"Chuang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,21]]},"reference":[{"key":"6630_CR1","volume-title":"Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA","author":"World Health Organization","year":"2019","unstructured":"World Health Organization. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA. Geneva: World Bank Group and the United Nations Population Division; 2019."},{"key":"6630_CR2","doi-asserted-by":"publisher","unstructured":"Gunja MZ, Gumas ED, Williams II RD. The U.S. Maternal Mortality Crisis Continues to Worsen: An International Comparison. To the Point (Blog). https:\/\/doi.org\/10.26099\/8vem-fc65.","DOI":"10.26099\/8vem-fc65"},{"key":"6630_CR3","doi-asserted-by":"publisher","unstructured":"Hoyert D. Maternal mortality rates in the United States, 2021. 2023. Health E-Stats. 03\/16\/2023. https:\/\/doi.org\/10.15620\/cdc:124678.","DOI":"10.15620\/cdc:124678"},{"issue":"2","key":"6630_CR4","first-page":"1","volume":"69","author":"DL Hoyert","year":"2020","unstructured":"Hoyert DL, Mini\u00f1o AM. Maternal mortality in the United States: changes in coding, publication, and data release, 2018. Natl Vital Stat Rep. 2020;69(2):1\u201318.","journal-title":"Natl Vital Stat Rep"},{"key":"6630_CR5","unstructured":"New York Health Department of Health. Maternal mortality rate per 100,000 live births, 2018\u20132020. 2023. https:\/\/www.health.ny.gov\/community\/"},{"key":"6630_CR6","unstructured":"New York State Department of Health. New York State Maternal Mortality Review Report on Pregnancy-Associated Deaths, 2018-2020. 2023. https:\/\/www.health.ny.gov\/community\/adults\/women\/maternal_mortality\/docs\/maternal_mortality_review_2018-2020.pdf."},{"key":"6630_CR7","doi-asserted-by":"publisher","unstructured":"Xu J, Murphy SL, Kochanek KD, Arias E. Mortality in the United States, 2021. 2022. NCHS Data Brief. https:\/\/doi.org\/10.15620\/cdc:122516.","DOI":"10.15620\/cdc:122516"},{"key":"6630_CR8","unstructured":"Li W, Onyebeke C, Huynh M, et al. 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Am J Epidemiol. 2018;187(3):576\u201384.","journal-title":"Am J Epidemiol"},{"issue":"9-10","key":"6630_CR23","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1002\/sim.689","volume":"20","author":"XH Zhou","year":"2001","unstructured":"Zhou XH, Eckert G, Tierney W. Multiple imputation in public health research. 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All methods were performed in accordance with the relevant guidelines and regulations. Informed consent was obtained from all patients when they enrolled in prenatal care. At all FHC clinics, the consented information is subject to quality improvement review.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"436"}}