Novel prenatal care model improves patient outcomes

A novel prenatal care model, named OB Nest by its creators, has been found to improve patient satisfaction while maintaining prenatal care standards and reducing the need for office visits during pregnancy.

The results of using the newly devised program were presented at the 2016 annual meeting of the American College of Obstetricians and Gynecologists (ACOG) by Yvonne S Butler Tobah, MD, who is an instructor in obstetrics-gynecology at the Mayo Clinic, Rochester, Minnesota. The paper Dr Tobah presented on behalf of herself and coinvestigators from Mayo, “OB Nest-a novel approach to prenatal care,” was recognized for its excellence at the ACOG meeting with an award of second prize.

The development of the new prenatal care model was undertaken in light of the traditionally fixed schedule of 12 visits during pregnancy that has been typical of prenatal care. When these visits have been reduced, decreased patient satisfaction and the perception of a lower quality of care have been apparent, despite the fact that the less-intensive schedule has been found to be safe.

The investigators embarked on a randomized, controlled trial at the Mayo Clinic, which is a tertiary academic center. The trial included 300 study participants, all of whom were women meeting the criteria for a low-risk pregnancy. The study group was randomized either to OB Nest or to usual care, and was evenly divided into these 2 subgroups. While usual care was defined as adhering to ACOG guidelines for a standard 12 office visits, the OB Nest included 8 scheduled office visits as well as a dedicated nurse, access to an online care community, and home monitoring supplies for measuring blood pressure and fetal heart rate.

Results of the study showed that the 2 patient groups had similar clinical and demographic factors. For the primary outcome of perceived quality of care, no difference was found between the groups, and there was also no difference noted between the groups for the secondary outcomes of unplanned visits and maternal or fetal outcomes.

Notably, however, the OB Nest model improved other primary outcomes such as patient satisfaction (95%) when compared with the traditional model of usual care (77%, P<.0001). Use of this model was observed to translate into a decrease in office visits (9.2) versus usual care (11.2, P<.0001). Finally, the use of OB Nest as opposed to usual care caused pregnancy-related stress to decline, at 1.34 versus 1.41 for usual care (P=.02).

Currently, ACOG guidelines on prenatal care recommend that for women with an uncomplicated pregnancy, they should receive visits every 4 weeks for the first 28 weeks of pregnancy, every 2 to 3 weeks until 36 weeks of pregnancy, and weekly thereafter. This recommendation can in fact translate into an expected prenatal care schedule of 14 visits in a 40-week pregnancy. Prenatal care is intended to reduce the risk of complications from pregnancy for the mother and for her infant(s), as well as to ensure that any medications the mother is taking during pregnancy are safe.