(975) Organizational Readiness Factors Predicting Group Prenatal Care Implementation Success: Analysis from a Multi-Site Randomized Trial

Objective:
High group prenatal care (GPC) engagement improves outcomes while low engagement eliminates benefits, potentially explaining recent negative trials. We identified organizational readiness factors that predict high patient engagement in GPC programs.

Study Design:
Secondary analysis of ongoing multi-site RCT (2021-2026) examining organizational predictors of GPC implementation success. At the 2.5-year midpoint, GPC teams from 6-sites attending a mandatory booster training completed 19-item organizational readiness assessments. Items were scored as implemented when ≥50% of site team agreed. Pearson correlations examined associations between mid-study organizational factors and patient engagement: recruitment (% of eligible patients enrolled in study), receipt (≥1 visit), and retention (≥5 visits).

Results:
Clinical sites enrolled 307 patients total and 26/36 GPC team members (72%) completed readiness assessments. Mean GPC engagement outcomes were 58.4% (307/526) for recruitment (range: 36.2% – 83.1%, SD = 16.5%), 73.2% (150/205) for receipt, (range: 54.5% – 100%, SD = 15.4%), and 48.3% (99/205) for retention (range: 9.1% – 75.0%, SD = 23.6%). Though not statistically significant, the highest predictors of organizational readiness included dedicated facilitator time (r=0.80; p=0.06), patient incentives (r=0.69, p=0.13), GPC as the default care (r=0.55, p=0.26), and staff champions (r=0.33, p=0.52). Structural, process, and financial factors were implemented across sites.

Conclusion:
This exploratory analysis suggests operational readiness factors—particularly dedicated facilitator time and patient incentives—show the strongest associations with GPC implementation success. The consistently high implementation of other factors across sites prevented assessment of their predictive value. Given small site sample (n=6), most correlations did not reach statistical significance despite moderate effect sizes. Quality improvement initiatives should target operational readiness gaps since the substantial site variation in retention (9.1%-75.0%) indicates that these barriers may be addressed through implementation.