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Am J Obstet Gynecol. 2019 Jun 19. pii: S0002-9378(19)30810-5. doi: 10.1016/j.ajog.2019.06.034. [Epub ahead of print]

Randomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring.

Abstract

BACKGROUND:

Standard prenatal care, consisting of 12 - 14 visits per pregnancy, is expensive and resource intensive, with limited evidence supporting the structure, rhythm, or components of care. Some studies suggest a reduced-frequency prenatal care model is as safe as the standard model of care for low risk pregnant women, but evidence is limited. We developed and evaluated an innovative, technology-enhanced, reduced prenatal visit model (OB Nest).

OBJECTIVE:

To evaluate the acceptability and effectiveness of OB Nest, a reduced frequency prenatal care model enhanced with remote home monitoring devices and nursing support.

STUDY DESIGN:

A single center randomized controlled trial, composed of pregnant women, age 18 to 36 years, recruited from an outpatient obstetric tertiary academic center in the Midwest, United States. OB Nest care consisted of 8 onsite appointments with an obstetric provider, 6 virtual visits consisting of phone or online communication with an assigned nurse, supplemented with fetal Doppler and sphygmomanometer home monitoring devices, and access to an online community of pregnant women. Usual care consisted of 12 pre-scheduled prenatal clinic appointments with obstetric providers. Acceptability of OB Nest was measured by validated surveys of patient satisfaction with care at 36 weeks, perception of stress at 14, 24 and 36 weeks and perceived quality of care at 36 weeks gestation. Effectiveness was analyzed by comparing adherence to the American College of Obstetricians and Gynecologists (ACOG) recommended routine prenatal and ancillary services, maternal and fetal safety outcomes, and healthcare utilization.

RESULTS:

300 pregnant women < 13 weeks gestation were recruited and randomized to OB Nest or usual care (150 in each arm) using a minimization algorithm. Demographic characteristics were similar between groups. Compared to usual care (UC), patients in OB Nest (OBN) had higher satisfaction on a 100-point validated modified Littlefield and Adams Satisfaction scale, (OBN=93.9% VS. UC=78.9%, p<0.01). Pregnancy-related stress, measured, on a 0-2 point PreNatal Maternal Stress (PNMS) validated scale, with higher scores indicating higher levels of stress was lower among OB Nest participants at 14 weeks(OBN=0.32 VS.UC=0.41, p<.01) and at 36 weeks gestation (OBN = 0.34 VS UC = 0.40, p<0.03). There was no statistical difference in perceived quality of care. Adherence to the provision of ACOG prenatal services was similar in both arms. Maternal and fetal clinical outcomes were similar between groups. Total reported nursing time was higher in OB Nest (OBN=171.2 minutes VS UC=108.2 minutes, 95% CI, 48.7 to 77.4).

CONCLUSION:

OB Nest is an innovative, acceptable and effective reduced frequency prenatal care model. Compared to routine prenatal care, OB Nest resulted in higher patient satisfaction and lower prenatal stress, while reducing the number of appointments with clinicians and maintaining care standards for pregnant women. This program is a step toward evidence-driven, prenatal care that improves patient satisfaction.

KEYWORDS:

Alternative prenatal care; Connected prenatal care; Innovative prenatal care; Low risk prenatal care; Prenatal telemedicine; Reduced prenatal visits; Remote prenatal care; Telehealth and pregnancy; Telehealth obstetric care; Virtual prenatal care

PMID:
31228414
DOI:
10.1016/j.ajog.2019.06.034

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