Impact of the laborist model on obstetric care

Research Summary:
Evaluating the impact of the laborist model of obstetric care on maternal and neonatal outcomes*

Inventor of PeriGen advanced fetal monitoringBy Emily Hamilton, MD CM, Senior Vice President of Clinical Research

This study, published in the August 13th issue of the American Journal of Obstetrics & Gynecology, examines outcomes before and after the introduction of a laborist model of care. Surprisingly, very few differences were noted when comparing changes over time in the hospitals with laborists to changes over the same period of time in the matched hospitals without laborists. This paper describes an interesting methodology to try and tease apart the effect of various factors on obstetrical outcomes. This is relevant because most quality improvement initiatives are studied in a before-and-after fashion and not in a prospective randomized trial.

The study is discharge summary data to NPIC between 1998 and 2011. Results from three hospitals where laborists were introduced were compared to six control hospitals matched for delivery volume, geographical area, teaching hospital status and level of neonatal nursery.

Once adjustment was made for several patient-related factors, no differences were observed in the odds ratio (OR) for any of the neonatal outcomes or for cesarean rates. The OR was reduced only for induction of labor (0.85 95%CI 0.71-0.99) and for Preterm Birth (0.83 95%CI 0.72-0.96). Although the OR for Preterm Birth was reduced this was not accompanied by a change in the OR for the birth of babies weighing

In short, the introduction of laborists was associated with a change in medical behavior (Induction of labor) and some change in actual outcome (preterm births), but not in low-birth-weight babies. A question that springs to mind immediately is the role of unmeasured factors such as policies to curtail elective induction of labor prior to 39 weeks that became common during this timeframe and were not adopted by all hospitals at the same time. Evidently the desire to improve is alive and well in many hospitals and there is no single solution for all.

Reference:
*Srinivas SK, Small DS, Macheras M, Hsu JY, Caldwell D, Lorch S. Evaluating the impact of the laborist model of obstetric care on maternal and neonatal outcomes. Am J Obstet Gynecol. 2016 Aug 13. https://www.ncbi.nlm.nih.gov/pubmed/27530491

By | 2016-11-08T14:09:04+00:00 November 10th, 2016|Articles, Media Coverage, News, Research Papers, Resources, Uncategorized, Updates|1 Comment

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  1. Armando Russo MD FACOG CPE November 10, 2016 at 5:10 pm

    No surprise here. There are as many Laborist/Ob Hospitalist programs as facilities. Each is tailored to the needs and the culture of the community. That being said, we see a good trend but some challenges remain. One of the obvious benefits is standardization (via agreement) of many of the common tasks, diagnostic work-ups and, where appropriate, treatments. A team works better together if there is an understanding of the goals. Clearly, the unfortunate Achilles heel of all programs staffed by Laborists/Hospitalists that do not have community practices is that every patient is new and there is no prior doctor-patient relationship. In modern Ob practice this is a structurally impossible hurdle to overcome because, as we all know (at least in American Ob practice), everything is related to the outcome. No matter how diligent we think we may be adhering to practice protocols and using sound judgment, an adverse event, in the eyes of the public and some of our colleagues, becomes a matter of dispute. This does not mean we should abandon efforts to improve Ob practice, it’s just a reminder that for now, this is reality. As we get better data, we may be able to prove that this new paradigm of care is really better for the patient as well as the obstetrician.

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