Does a maternal-fetal medicine-ecentered labor and delivery coverage model put the 'M' back in MFM?

作者：Brandt Justin S^*; Srinivas Sindhu K; Elovitz Michal E; Bastek Jamie A

来源：American Journal of Obstetrics and Gynecology, 2014, 210(4): 333.e1.

DOI：10.1016/j.ajog.2014.01.008

• labor and delivery coverage model
• maternal-fetal medicine
• maternal morbidity

OBJECTIVE: Maternal morbidity is increasing in the United States. Our objectives were to examine whether a labor and delivery (L&D) provider model with regular maternal-fetal medicine (MFM) coverage decreases the rates of maternal morbidity during delivery hospitalizations and has an impact on obstetrician-gynecologist residents' perceptions of safety and education.
STUDY DESIGN: We performed a retrospective cohort study to compare the rates of maternal morbidity before and after the implementation of an MFM-centered coverage model on L&D. Outcomes were identified using International Classification of Diseases, ninth revision, codes. The primary outcome was a composite of severe maternal morbidity. Additionally, obstetrician-gynecologist residents completed an anonymous survey asking them to compare coverage models, and their Council on Resident Education in Obstetrics and Gynecology examination scores were compared.
RESULTS: Data from 4715 deliveries were included. There were no differences in composite morbidity or individual adverse outcomes. Most residents (81.3%) preferred the new provider model, with median 5-point Likert scores indicating perceived increases in safety and education. Mean Council on Resident Education in Obstetrics and Gynecology scores improved in the 18 residents exposed to both models.
CONCLUSION: Although the MFM-centered provider model appears to have had a positive impact on residents' perceptions of safety and education, it was not associated with significant changes in severe maternal morbidity.

• 出版日期2014-4