Current prenatal care adheres to a historically fixed schedule of 12 visits during pregnancy. Although reduced prenatal visit bundles have been shown to be safe, patients reported diminished satisfaction and reduced quality of prenatal care. We aimed to evaluate the impact of a program that optimized non-visit care coupled with reduced office visits using a novel prenatal care model (OB Nest) configured to improve patient outcomes.METHODS:
We conducted a randomized controlled trial at Mayo Clinic Rochester, a tertiary academic center. Only women who met criteria for low risk pregnancy were included. OB Nest (n=150) included 8 scheduled office visits, a dedicated nurse, and home monitoring supplies for fetal heart rate and blood pressure and access to an online care community. Usual care (UC, n=150) consisted of 12 visits according to ACOG guidelines. 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.RESULTS:
Clinical and demographic parameters were similar between the two groups. OB Nest (OBN) improved patients' satisfaction with care (OBN=95% vs UC=77%, P<.0001), decreased pregnancy-related stress (OBN=1.34 vs UC=1.41, P=.02) and decreased office visits (OBN=9.2 vs UC=11.2, P<.0001). There was no difference in perceived quality of care, unplanned visits, maternal or fetal outcomes.CONCLUSION/IMPLICATIONS:
OB Nest is a novel prenatal care model that improves patient satisfaction, decreases in-office healthcare utilization and maintains prenatal care standards.