Evaluation of the Prenatal Care Referral Process at a Student-Run Women's Health Clinic​

Abstract

Background: Early entry into the medical system is critical for both maternal and fetal health, as it allows for the timely identification and management of pregnancy-related complications, chronic conditions, and modifiable risk factors1. Student-run free clinics (SRFCs) can serve as points of entry into healthcare for underserved populations by offering primary and preventive care services to individuals who face significant barriers. However, these clinics are often restricted in the scope of the services they can provide due to limited resources and infrequent clinic operations 2. As a result, SRFCs must rely on referrals to external institutions. Given the importance of initiating comprehensive prenatal care early in pregnancy, we sought to evaluate the efficacy and efficiency of our referral process for prenatal patients at our student-run clinic. Methods: This was a retrospective chart review of pregnant patients seen by the Indiana University Women’s Health Coalition (WHC) between January 1, 2023 and March 31, 2025. Staffed by an Obstetrician Gynecologist, the WHC is the gynecologic and prenatal care division of the Indiana University Student Outreach Clinic a free, student-run clinic that serves the Indianapolis community. We reviewed the charts of patients presenting to the WHC who were confirmed to be pregnant, intended to continue their pregnancy, and had not yet established prenatal care elsewhere. Data were extracted from appointment scheduling logs, patient navigator spreadsheets, and electronic medical records at the WHC and the referral hospital. Demographic data were collected including patient age at presentation, home ZIP code, and primary language. Pregnancy-related data such as gestational age at presentation, gravidity and parity were also collected. Outcome variables collected include the date of the patient’s first WHC visit, total number of WHC visits, referral initiation dates, and the date of the first prenatal appointment at the referral hospital. The primary outcome was the proportion of patients referred from the WHC to initiate prenatal care who completed their first prenatal visit. The secondary outcome was the average time (in days) it took from date of the patient’s first appointment at the WHC to the date of their first attended prenatal appointment at the referral hospital. Descriptive statistics were used to determine both the primary and secondary outcomes, as well as to summarize the demographics of the sample. This study was deemed exempt by the institutional review board. Results: A total of 13 patients met inclusion criteria. The average patient age at presentation was 28.5 years. English was the primary language for most patients (6 of 13), followed by Spanish (5 of 13). The average distance from the patients’ home ZIP code to the referral hospital was 7.9 miles. Most patients were primigravida (61.5%), presenting at an average estimated gestational age of 16 weeks + 4 days. Of the 13 patients included, 11 attended a prenatal visit at the referral hospital, yielding a referral success rate of 84.6%. The average interval between the patient’s initial visit at the WHC and the first attended prenatal appointment at the referral hospital was 21.2 days. Conclusion: This review suggests that the referral process from the WHC to the partner hospital is effective and efficient, with most patients successfully connecting to prenatal care in a timely fashion. Although the process is efficient, there remains an opportunity for further optimization.