Improving Effective Prenatal Care for New Obstetric Patients Using a Standardized Intake Template and Pregnancy Risk Calculator.

Introduction: Kenya has the 16 Methods: This quality improvement initiative consisted of two core interventions implemented over four Plan-Do-Study-Act cycles. Each 2-week cycle was guided by a test of change, and the data were analyzed at the end of each cycle. The first core intervention was implementing a new obstetric standard of care, based on 32 evidence-based guidelines from the World Health Organization and the Kenya Ministry of Health, which were embedded into a standardized intake template at the initial prenatal visit. The second core intervention was implementing a pregnancy risk calculator, using the Alberta Antenatal Risk Assessment, to classify each new obstetric patient's pregnancy as low, moderate, or high risk. Results: This project achieved its aim statement and increased effective prenatal care from 21% to 77% in 8 weeks. Implementing the standardized intake template increased the mean standard-of-care score from 42% to 83%, with the greatest improvements seen in documenting a complete medical history and ordering prenatal labs. The number of high- or moderate-risk pregnancies identified was 33%, providing an opportunity for timely referral to the high-risk pregnancy clinic. Conclusion: The tools used in this quality improvement initiative provided a low-cost method to promote high-quality prenatal care. The standardized intake template can be adapted to other countries and contexts; further studies are needed to evaluate its impact on birth outcomes. This is the first known report of the implementation of a pregnancy risk calculator in Kenya to identify high-risk pregnancies. Further research is needed to analyze its effectiveness and to develop and validate a pregnancy risk calculator for sub-Saharan Africa.