A Comparison of Outcomes Between Joint and Physician‐Only Obstetric Practices

Abstract

Since 1981, the cesarean birth rate of a joint practice has been consistently lower than that of physician-only practices at a private community hospital in Yolo County, California. This study sought to determine whether differences in perinatal outcomes were influenced by women's use of a joint versus a physician-only practice or were associated with parity, maternal age, or newborn birthweight. Data from the hospital's 1634 consecutive singleton births in 1990 were examined, using a prospective concurrent analytic cohort study design. Chi square statistics and stepwise logistic regressions were used for data analysis. The joint practice had a significantly lower rate of total cesarean births (9.3%) compared with the physician-only practices (17.7%); the frequencies of severe lacerations were 1.0 percent and 6.4 percent, respectively. No significant differences were found in parity, birthweight, or newborn outcomes in the two types of practice. Type of practice was the major determinant of cesarean birth (p < 0.0001). All variables studied, including type of practice, were significant determinants of primary cesarean birth. Parity and practice type were significant determinants of third- and fourth-degree lacerations (p < 0.0001). The type of practice from which women receive care is significantly associated with both method of birth and possibility of severe perineal trauma.

Obstetrician and Nurse–Midwife Collaboration

“…12 As demonstrated in this project and previous studies at the hospital, outcomes of the collaborative practice in Davis, California, meet or exceed measures of excellence, despite an economically and socially diverse population with significant risk factors for operative delivery, poor perinatal outcomes, and health disparities. [1][2][3][4][5][6] The primary objective of this study was to assess whether maternity care practices and perinatal outcomes differed among women attended prenatally in federally qualified health centers compared with the collaborative private practice. Prenatal care site was examined as a proxy for socioeconomic and insurance status considering that the majority of women in the private practice have employee-sponsored or personal health insurance policies (more than 85%), whereas the federally qualified health center serves exclusively uninsured and low-income women enrolled in government health insurance programs.…”

“…31 Further, data from the practice suggest that optimal maternity care is fostered within the collaborative model and cannot be exclusively attributed to the demographics or clinical characteristics of the patient population. [1][2][3][4]32,33 Therefore, patients' belief systems may not be a barrier to collaborative practice elsewhere, using the model of care described.…”

“…Practice members actively participated in efforts to identify key administrative factors and clinical guidelines that have contributed to the longevity and success of the collaboration. [1][2][3][4] This quality assessment project had three additional goals: 1) articulate a shared philosophy of collaborative maternity care developed through an iterative process undertaken by interprofessional group members, 2) re-evaluate the evidence base for intrapartum management as part of ongoing clinical guidelines review, and 3) analyze de-identified electronic medical record data from 2000 to 2010 to assess whether maternity care practices or perinatal outcomes differed among firsttime mothers who were seen prenatally by a nursemidwife in a federally qualified health center compared with those seen by a nurse-midwife or obstetrician or both in the collaborative private practice.…”

“…The patient population, collaborative practice, and selected perinatal outcomes have been described previously. [1][2][3][4] Women seen prenatally by members of the collaborative practice give birth at Sutter Davis Hospital, a 45-bed community facility with a level I nursery located in a college town situated between two major metropolitan areas and expansive agricultural areas.The collaborative practice philosophy includes extensive prenatal education, shared decision-mak- …”

“…Interprofessional clinicians believe that high-touch, low-tech care practices resulted in the limited use of pharmacologic pain relief methods and obstetric interventions, and optimal perinatal outcomes observed previously at the site. [1][2][3][4] Further, postpartum patient satisfaction has ranked in the 91st through 95th percentiles over the past decade according to Press-Ganey national surveys. The objective of this quality assessment study was to re-evaluate the model of care and maternity services provided by the collaborative practice, and assess both adherence to stated philosophy and the quality of resultant maternalneonatal outcomes in the socially and economically diverse child bearing population.…”