Improving care coordination for socially complex perinatal patients: A human-centered design study.

Introduction: Designing novel solutions to address care fragmentation in the perinatal ecosystem requires rigorous evaluation of current workflows and engagement of the wide net of stakeholders supporting patient care. Human-centered design (HCD) is an established methodology for identifying challenges faced by patients and providers in clinical workflows, with the goal of producing actionable insights to inform interventions. This study used an HCD approach to (1) understand transitions of perinatal care within a safety-net system and (2) identify barriers that informed design opportunities to improve care coordination for socially complex pregnant patients. Methods: We conducted semi-structured interviews with patients, clinical providers (physicians, midwives, nurses, social workers), and community-based organization (CBO) staff working in a safety-net healthcare system. Interviews were analyzed using an HCD approach to inductive thematic analysis. Results: Thirty-four interviews were conducted with 42 participants, including 13 patients, 22 clinical providers, and seven community-based or public health stakeholders. We developed six insight statements, with themes centered around fragmented communication, limited integration between clinical and community systems, uncertainty surrounding information-sharing policies, and inconsistent implementation of substance-use-related protocols. Participants also highlighted disruptions to continuity of care and variability in discharge planning that contributed to confusion and eroded trust in the care team. Conclusions: Using an HCD approach, we identified key challenges in care coordination for socially complex perinatal patients. Interventions that seek to strengthen informational continuity between clinical and community-based providers offer promise for improved perinatal care delivery in safety-net systems.