PEACE

A new model for pregnancy loss

Opportunity

Miscarriage is the most common complication of pregnancy, affecting one in five pregnancies. Improved technology in home testing means that women know sooner than ever that they are pregnant. Despite this, prenatal care does not start until late in the first trimester, leaving many patients unsure about where to turn if they suspect a problem early on.  

This uncertainty, paired with the difficulty patients face in accessing timely, comprehensive outpatient services, leads to high utilization rates of emergency services when miscarriage symptoms occur. Unfortunately, the use of the emergency department (ED) in this case can lead to frustration and delays in care.

Intervention

PEACE is an integrated family planning and urgent pregnancy care model that fills this gap in care. It provides an office-based care option for the diagnosis, counseling management, and prevention of early pregnancy complications with an evidence-based approach that centers around the patient’s priorities.

A custom triage tool that can be used in-person, over the phone or online determines which patients can be seen safely in an outpatient setting vs. patients who should present to the ED.

Shifting care from the ED to an office-based setting enables the PEACE team to provide timely, comprehensive, and, most importantly, compassionate care.

Impact 

PEACE improves patient experience and quality of care by decreasing variation. Instead of waiting for hours in the ED, patients have access to same-day, walk-in, and after-hours services. This streamlined access to care results in reduced stress and anxiety and gets patients to resolution faster. PEACE also reduces the cost associated with miscarriage, saving an estimated $500 per case.  

PEACE services are currently available at the Hospital of the University of Pennsylvania, Penn Medicine Washington Square, and Penn Medicine Cherry Hill.

Phase 3: How we work
Collaborators

Courtney Schreiber, MD, MPH
Jennifer Moore-Conrow, MFS
Arden McCallister, MPH
Shayna Nagel, RN
Janet Williams

Innovation leads

Katy Mahraj, MSI
Deirdre Darragh, MA
Roy Rosin, MBA
Mike Begley, MA

Funding

Innovation Accelerator Program

Innovation Methods

Vapor test
A vapor test offers a product or service that does not yet exist. Vapor tests will help you answer the question, "Does anyone want this?" and generate credible evidence for demand.
 
Vapor tests require carefully designed soft landings to protect against poor user experience. An example of a vapor test would be showing a product or service on a website to see how many people express interest by clicking on it.
 
In this case, a soft landing would involve showing an "out of stock" or "not accepting new clients at this time" message when users click on the offering. 
Vapor test

We iteratively developed and tested a triage tool to determine which patients could be seen safely in an outpatient setting versus patients who should present to the ED.

We piloted an initial version in-person in the ED, with providers identifying and completing the triage tool as if they would refer the patient to PEACE. Through chart review, we validated whether the decision that would have been made using the tool was appropriate for the patient based on the outcome of their ED visit and subsequent follow-up.

We modified the tool several times based on lessons learned and expanded testing to phone-based triage at two OB practices. With this, we were able to validate that information gathered over the phone was adequate to triage patients appropriately.