Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research


Evaluating maternal and neonatal outcomes: A comparison of 2 models of obstetric care delivery

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Project Number: R40 MC 17164-02
Grantee: University of Pennsylvania
Department/Center: Obstetrics and Gynecology
Project Date: 2/1/2010

Final Report

Pending

Principal Investigator

Sindhu K. Srinivas, MD, MSCE
Assistant Professor
3451 Walnut Street P-221 Franklin Building
Philadelphia, PA  19104
Phone: 215-898-0825
Email: ssrinivas@obgyn.upenn.edu

Age

  • Women/Maternal
  • Prenatal
  • Perinatal/Infancy (0-12 months)

Abstract

Over 4 million women give birth annually in the United States making delivery one of the most common reasons for hospital care. The large number of births each year amplifies the population health significance of minor changes in maternal and neonatal complications. The "laborist" in obstetric care, modeled after the "hospitalist" in general medicine, was introduced over 5 years ago as a plausible model of obstetric care delivery where physicians are employed by hospitals to staff labor and delivery with the underlying premise being continuous coverage on labor and delivery without competing clinical duties. Although the idea for the laborist was initiated largely due to perceived improvement in patient outcomes with the hospitalist model, there are several differences between these two highlighting the need to have specific studies dedicated to evaluating maternal and neonatal outcomes in the laborist model. Our conceptual framework is that the laborist model of care will provide more continuous clinical coverage and oversight. This continuous clinical coverage will result in a greater academic focus and interest in the science of labor and delivery, resulting in improved outcomes of care. However, the impact of this model of care has never been studied. Prior to providing guidance to hospital administrators and obstetrical leaders suggesting widespread adoption of this model of care, rigorous research is needed to study the effect of this model on maternal and neonatal outcomes as well as economic implications of this model in comparison to the traditional model of obstetric care delivery. We have assembled a unique research team and are collaborating with the National Perinatal Information Center (NPIC/QAS)- a non-profit organization with a charter membership of major perinatal centers across the US (74 member hospitals representing 26 states). NPIC/QAS member hospitals will be surveyed to assess the number of hospitals with a laborist model (exposed hospitals). Using a matched sampling methodology, this study will compare pregnancy outcomes of unexposed (non laborist) and exposed (laborist) hospitals from the largest available dataset of laborist and non-laborist hospitals using a multiple time series statistical approach to control for differences in casemix, hospital systems, and structural factors between laborist and non-laborist hospitals. Improvement in outcomes is plausible with such a model of obstetric care but has never been formally studied. If in fact this model of obstetric care delivery leads to demonstrable changes in maternal and neonatal outcomes there is the potential to revolutionize obstetric care delivery and improve the quality of obstetric care delivered. This proposal directly relates to the goals of the Maternal and child Health Bureau (MCHB) as well as to the stated goals of Healthy People 2010. This study would be the first analytic assessment of this model of care. The results will allow us to create a vision for maternal and child health by strengthening the knowledge base regarding models of obstetric care delivery (MCHB priority area #1) and will enable us to develop and promote health services and systems designed to improve quality of maternal and child care (MCHB priority area #3). The combination of our research team and NPIC/QAS' track record in collaborating with this type of work provides a unique opportunity to answer a critical public health question that affects millions of women and children annually.

Publications

Listed is descending order by year published.

Srinivas SK, Lorch SA. The laborist model of obstetric care: we need more evidence. Am J Obstet Gynecol. 2012 Jul;207(1):30-5. doi: 10.1016/j.ajog.2011.10.009. Epub 2011 Oct 15. PubMed PMID: 22138138.

Srinivas SK, Shocksnider J, Caldwell D, Lorch S. Laborist model of care: who is using it? J Matern Fetal Neonatal Med. 2012 Mar;25(3):257-60. doi: 10.3109/14767058.2011.572206. Epub 2011 Apr 20.

Keywords

Labor & Delivery, Pregnancy, Perinatal, Health Care Quality

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