Advertisement

56: Does a MFM centered L&D provider model put the “M” back in MFM?

      Objective

      Maternal morbidity is rising in the US. Our objectives were to examine whether a labor & delivery (L&D) provider model with regular MFM presence 1) decreases the rates of maternal morbidity during delivery hospitalizations, 2) impacts OBGYN residents’ perceptions of safety and educational opportunities, and 3) impacts OBGYN residents’ CREOG performance.

      Study Design

      We performed a retrospective cohort study to compare rates of maternal morbidity before and after the implementation of a MFM centered provider model on L&D. In the pre-exposure period (PRE: 7/1/2011-2/1/2012), MFM was available for high risk consultations, but did not regularly staff L&D; in the post-exposure period (POST: 7/1/2012-2/1/2013), MFM staffed all L&D patients daily from 7am-6pm. Morbidity was identified using ICD-9 codes based on previously published work. The primary outcome was a composite of maternal morbidities (Table). In addition, OBGYN residents exposed to both provider models completed an anonymous survey to compare both models, and their CREOG exam scores were compared.

      Results

      Data from 4,715 deliveries (PRE: 2,286; POST: 2,429) were included. There were no differences in the composite of maternal morbidity or individual adverse maternal outcomes (Table). 81.3% of residents preferred the new provider model, with median 5-point Likert scores indicating perceived increases in safety (4.0), resident knowledge (4.0), and resident procedural comfort (4.0). Mean CREOG scores from PRE to POST improved in the 18 residents exposed to both models overall (+6.9%, p=0.015) and in the OB section (+6.1%, p=0.047).

      Conclusion

      Although the MFM centered provider model appears to have positively impacted resident perceptions of safety and education, it was not associated with significant changes in maternal morbidity. It is possible that a significant difference was not observed due to the infrequent occurrence of these outcomes. Moreover, a composite outcome based on ICD-9 codes may not adequately reflect the positive impact of this culture change on L&D.
      Tabled 1Maternal morbidity on L&D with a MFM centered provider model
      Figure thumbnail fx1
      Morbidity composite outcome based on ICD-9 codes from Callaghan WM et al. AJOG. 2008;199:e1-133.e8. P-values determined by chi square test. Data presented as n (%).