Assessing Change in Medical Management of Early Pregnancy Loss before and after Implementation of a Learning Collaborative for Initiation of Mifepristone Use

ObjectivesExPAND Mifepristone is a one-year learning collaborative providing support for mifepristone provision in primary care for early pregnancy loss (EPL) or abortion. This study measured change in prevalence of medical management of EPL at a federally qualified health center (FQHC) that participated in ExPAND Mifepristone's pilot year. Secondary objectives were to describe changes in referral patterns and medication choice for EPL.MethodsTo quantify changes in medical management of EPL, we conducted a retrospective data query using International Classification of Diseases-10 codes during two time periods: pre-implementation (January 1, 2019 - February 29, 2020) and post-implementation (August 1, 2021 - June 30, 2022). Manual chart review was used to assess change in referral patterns for EPL.ResultsThere were 193 patients with EPL in the pre-implementation period and 115 post-implementation. Pre-implementation, 8.3% (n=16) of EPL patients received medical management versus 15.7% (n=18) post-implementation (p=0.046). The percentage of all patients with EPL who received misoprostol alone was 8.3% pre- and 8.7% (p=0.91) post-implementation. Treatment with mifepristone plus misoprostol increased to 44.4%. EPL referrals to Obstetrics/Gynecology (OB/GYN) decreased from 14.0% to 1.7% (p=0.001). The most frequent reason for referral was procedural management.ConclusionAfter participation in ExPAND Mifepristone, there was an increase in medical management for EPL by PCPs and referrals to OB/GYN declined. ExPAND Mifepristone can help facilitate PCP use of mifepristone plus misoprostol for medical management of EPL.Key Words: Primary Care, Early Pregnancy Loss, Mifepristone, Women's Health, Referral. Early pregnancy loss is common, impacting approximately 10-14% of clinically recognized pregnancies. Primary care providers (PCPs) have the knowledge and skills to offer comprehensive reproductive healthcare to their patients although barriers exist. ExPAND Mifepristone is a learning collaborative designed to help PCPs use mifepristone for EPL and/or abortion. Aside from beginning to use mifepristone, it was not known if or how participation in the ExPAND Mifepristone learning collaborative changed clinical practice. After participation in the learning collaborative, one FQHC network in Illinois increased medical management of EPL and had fewer referrals to OB/GYN.