Examining pregnancy-specific smartphone applications: what are patients being told?

OBJECTIVE: The objective of this study is to evaluate the informative content of two free, pregnancy-specific smartphone applications and their accuracy and adherence to prenatal care guidelines. STUDY DESIGN: This is a qualitative analysis of the information delivered through two free, pregnancy-specific smartphone applications (apps): Text4Baby (T4B) and Baby Center's 'My Pregnancy Today' (BC). All information from conception through 2 weeks postpartum were transcribed and coded independently by two physician researchers. Content was analyzed and assigned thematic codes. The proportion of content each app delivered per theme was then calculated and the χ(2)-test was used to compare thematic frequency between apps. RESULTS: A total of 609 pieces of daily content were transcribed; 698 message themes were coded and analyzed. Most information delivered by T4B was about fetal development (23.8%) or prenatal care (16.6%); most content from BC was about normal pregnancy symptoms (20.1%) or maternal well-being (21.1%); the differences between apps for each of these themes were statistically significant (P<0.05). A total of four messages contained incomplete or ambiguous content; neither app delivered overtly incorrect medical information. T4B and BC had a similar proportion of information that was in-line with the American College of Obstetrics and Gynecology Guidelines for Prenatal Care. Neither app delivered any messages about contraception. CONCLUSION: T4B and BC are free, pregnancy-specific apps with different focuses. Neither app delivers comprehensive prenatal information, as evidenced by the absence of information about postpartum contraception. More information is needed to determine the role of such apps in prenatal care.

Methods for evaluating the provision of well child care.

BACKGROUND: Well child visits are important for reducing the incidence of avoidable illness and disease. The Omnibus Reconciliation Act of 1989 (OBRA '89) set goals for well child or Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) visits. Many health plans are evaluated in terms of the number of well child visits provided, yet the method used for collecting the data influences the indicator results and conclusions drawn from them. METHODS: In a retrospective cohort design, medical record review and administrative data were compared as methods for ascertaining the number of well child visits received by Iowa Medicaid-eligible children for the period from July 1, 1997 through December 31, 1998. Compliance with the American Academy of Pediatrics' "Recommendations for Preventive Pediatric Health Care" periodicity guidelines was assessed. RESULTS: Using administrative data, 29.6% (n = 1,489) of children received a well child visit. If medical record review was used, 39.6% (n = 1,003) of children had a visit. The concordance between the rates was quite low (kappa = 0.30). Medical record review supported that an EPSDT visit was provided for only 68% of the children who had a claim or encounter billed as providing well child care (n = 441). DISCUSSION: Administrative data may underestimate the performance of EPSDT visits in comparison to medical record review. In addition, having a claim for an EPSDT visit did not necessarily mean the child received the basic components of a well child exam. The methodology for performance indicators used to evaluate health plans should be carefully validated.