Implementation of a new prenatal care model to reduce office visits and increase connectivity and continuity of care: protocol for a mixed-methods study

BMC Pregnancy and Childbirth

Study Protocol

Megan Branda¹  Jonathan Inselman¹  Susan M. Sobolewski²  Abimbola O. Famuyide²  Ellen Brodrick²  Anne Baron²  Misty Baker²  Bobbie S. Gostout²  Angela Sivly²  Roger W. Harms²  Kate Nesbitt³  Lenae M. Barkey⁴  Rajeev Chaudhry⁵  Dawn Finnie⁶  Megan A. Morris⁶  Annie LeBlanc⁶  Jennifer L. Ridgeway⁶ 

[1] Department of Health Sciences Research, Mayo Clinic, 200 1st Street SW, 55905, Rochester, MN, USA;Obstetrics Division, Mayo Clinic, 200 1st Street SW, 55905, Rochester, MN, USA;Office of Risk Management, Mayo Clinic, 200 1st Street SW, 55905, Rochester, MN, USA;Practice Administration, Mayo Clinic, 200 1st Street SW, 55905, Rochester, MN, USA;Primary Care Internal Medicine, Mayo Clinic, 200 1st Street SW, 55905, Rochester, MN, USA;Center for Innovation, Mayo Clinic, 200 1st Street SW, 55905, Rochester, MN, USA;Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1st Street SW, 55905, Rochester, MN, USA;Department of Health Sciences Research, Mayo Clinic, 200 1st Street SW, 55905, Rochester, MN, USA;

关键词: Prenatal care;    Patient-focused care;    Health services research;    Program evaluation;   

DOI  :  10.1186/s12884-015-0762-2

 received in 2014-10-15, accepted in 2015-11-25,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundMost low-risk pregnant women receive the standard model of prenatal care with frequent office visits. Research suggests that a reduced schedule of visits among low-risk women could be implemented without increasing adverse maternal or fetal outcomes, but patient satisfaction with these models varies. We aim to determine the effectiveness and feasibility of a new prenatal care model (OB Nest) that enhances a reduced visit model by adding virtual connections that improve continuity of care and patient-directed access to care.Methods and designThis mixed-methods study uses a hybrid effectiveness-implementation design in a single center randomized controlled trial (RCT). Embedding process evaluation in an experimental design like an RCT allows researchers to answer both “Did it work?” and “How or why did it work (or not work)?” when studying complex interventions, as well as providing knowledge for translation into practice after the study. The RE-AIM framework was used to ensure attention to evaluating program components in terms of sustainable adoption and implementation.Low-risk patients recruited from the Obstetrics Division at Mayo Clinic (Rochester, MN) will be randomized to OB Nest or usual care. OB Nest patients will be assigned to a dedicated nursing team, scheduled for 8 pre-planned office visits with a physician or midwife and 6 telephone or online nurse visits (compared to 12 pre-planned physician or midwife office visits in the usual care group), and provided fetal heart rate and blood pressure home monitoring equipment and information on joining an online care community.Quantitative methods will include patient surveys and medical record abstraction. The primary quantitative outcome is patient-reported satisfaction. Other outcomes include fidelity to items on the American Congress of Obstetricians and Gynecologists standards of care list, health care utilization (e.g. numbers of antenatal office visits), and maternal and fetal outcomes (e.g. gestational age at delivery), as well as validated patient-reported measures of pregnancy-related stress and perceived quality of care. Quantitative analysis will be performed according to the intention to treat principle. Qualitative methods will include interviews and focus groups with providers, staff, and patients, and will explore satisfaction, intervention adoption, and implementation feasibility. We will use methods of qualitative thematic analysis at three stages. Mixed methods analysis will involve the use of qualitative data to lend insight to quantitative findings.DiscussionThis study will make important contributions to the literature on reduced visit models by evaluating a novel prenatal care model with components to increase patient connectedness (even with fewer pre-scheduled office visits), as demonstrated on a range of patient-important outcomes. The use of a hybrid effectiveness-implementation approach, as well as attention to patient and provider perspectives on program components and implementation, may uncover important information that can inform long-term feasibility and potentially speed future translation.Trial registrationTrial registration identifier: NCT02082275Submitted: March 6, 2014

【 授权许可】

CC BY   
© Ridgeway et al. 2015