A novel
prenatal care model ( OB Nest) optimizes antenatal care and improves patient satisfaction by leveraging technology and reducing the number of office visits during
pregnancy.
According to the ACOG recommendations the current
antenatal care consists of at least 12-14 visits with an obstetrician, with
majority being just brief visits to ensure fetal well-being. Researchers in the
past have focused on decreasing the number of visits in low risk pregnancies so
that resources and time can be diverted towards high risk pregnancies. But this has resulted in
less patient satisfaction and was found unsafe for maternal and fetal well-being.
"Traditionally,
pregnancy is treated as a sickness," says Yvonne Butler Tobah, M.D., lead
author of this study. "We wanted our care to reflect the normal,
life-bringing event that it is, and [we] looked for a way to transform prenatal
care into a wellness, patient-oriented experience."
Researchers
at Mayo clinic embarked on a randomized, controlled trial enrolling 300 women,
all of whom met criteria for low risk pregnancies. The patients were randomized
to either OB-Nest (134 patients) or usual antenatal care practice (133
patients) according to ACOG guidelines of standard 12 office visits. Both the groups received lab testing, imaging,
immunizations, and appropriate anticipatory guidance according to ACOG
guidelines.
Patients in
the OB Nest group had 8 scheduled office visits and six "virtual
care" visits with a lead nurse either via phone or email. They also
received home monitoring supplies for measuring blood pressure and fetal heart
rate and reporting them online regularly. They also were a part of online community that
included OB Nest participants and nurses from the OB Nest care team.OB Nest Online Communities reinforces the role of OB as
supportive and guiding partner in moms’ prenatal experience.
Primary
outcomes included patient satisfaction, number of clinic visits, perceived
quality of care, and pregnancy-related stress. Secondary outcomes included
unplanned visits, fetal and maternal outcomes. Data analysis was performed by
intention to treat.
When the
results of the trial were compared it was seen that patients in the OB Nest
group -- who had remote monitoring -- reported higher satisfaction about their
care at 36 weeks (95% versus 77%, respectively, P<0.001). No
difference was found in the perceived quality of care by the patients.
OB Nest patients
reported 3.4 fewer outpatient scheduled clinic appointments, and 2.85
fewer scheduled appointments with a provider (OBN=9.2 vs UC=11.2, P<.0001) than patients receiving usual
care.
No
difference was seen in terms of maternal/fetal events, incidence of cesarean
delivery, preterm birth, birthweight, or an Apgar score <7.
However,
according to Dr. Tobah the study was did not have sufficient power to detect
obstetrical outcome, only patient outcomes. The study also suffered from
ascertainment bias as the participants were not blinded. It also has limited generalizability as all the participants were Caucasians and
well educated.
Researchers are looking forward to apply
OB Nest into larger community settings, with diverse population contributing to
larger study population to compare maternal-fetal outcomes and confirm costs
savings. They are also looking to apply the study to high-risk population such
as patties with Gestational Diabetes Mellitus.
The researchers got the inspiration for
the study after a visit to the Mayo
Clinic Center of Excellence,
where remote monitoring was being done on patients with end-stage kidney
disease.
ACOG awarded the researchers second prize
in the scientific program for 2016.
Both the researchers were employee of Mayo Clinic and received grant for the study.
References:
http://www.fiercehealthcare.com/it/mayo-clinic-remote-monitoring-low-risk-pregnancies-boosts-patient-satisfaction
