The evolution of prenatal care


prenatal care

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In an effort to improve the experience of pregnant patients, Mayo Clinic researchers decided to take a different approach to prenatal care.


A shift in perspective

Current prenatal care for a pregnancy consists of 12-14 visits with an obstetrician. These visits, however, are often just brief check-ins to make sure everything is progressing well. Previous research has focus on giving high-risk patients more time with their healthcare providers, while cutting back on unnecessary visits for low-risk patients. While these studies have demonstrated that fewer visits are safe, patients reported less satisfaction overall.

Researchers at the Mayo Clinic devised a new approach, called the OB Nest, in an effort to improve patient experience as well as perceived value. So far, the team has received positive feedback from families.

"Traditionally, pregnancy is treated as a sickness," says Yvonne Butler Tobah, MD, a Mayo Clinic obstetrician and lead author of this study. "We wanted our care to reflect the normal, life-bringing event that it is, and we looked for a way to transform prenatal care into a wellness, patient-oriented experience."



The Department of Obstetrics and Gynecology, in collaboration with the Center for Innovation, worked with patients and staff to collect and prioritize ideas to improve the way pregnant women and their families experience prenatal care. Along with the department, the Care Experience Program, which is part of the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, took this information and these ideas and designed evidence-based practice improvements for prenatal care.

OB Nest study participants — all of whom were experiencing low-risk pregnancies — entered the program with a specific nurse identified as their lead contact. They received eight scheduled office visits (more were optional) and home monitoring equipment for fetal heart rate and maternal blood pressure. In addition, they could take part in an online care community with other OB Nest participants and nurses from the OB Nest care team.

"My schedule is very hectic," says Seri Carney, MD, a mom who participated in the OB Nest study during pregnancy with her second child. "It was really nice to only have to go in for my appointments every other month. My husband and I didn't have to worry as often about arranging our work schedules for the appointments. We could listen to the heartbeat whenever we wanted," says Dr. Carney. "Our daughter was 4 at the time, and doing it at home meant that she could get involved, too. That was really fun. It also felt like it made me more aware of the movements and heartbeat of my baby."

In her third trimester, when Dr. Carney noticed her baby's heartbeat was a little low, she was able to email her care team. They reacted right away and got Carney in for a stress test. All was fine, and within a few weeks, she and her family welcomed baby Luisa Jane.

The OB Nest research project is part of Mayo Clinic's healthcare delivery research efforts, and aligns with the Institute for Healthcare Improvement Triple Aim.

"This fulfills the holy grail of what patients expect today," says Abimbola Famuyide, MBBS, chair of the Department of Obstetrics and Gynecology, and study principal investigator. "How can we continue to improve patient experience and clinical outcomes, while, at the same time, keep costs down?"

Improving the patient experience, in the case of OB Nest, includes empowering expectant women to truly engage in, and take control of, their care. Dr. Famuyide and his team saw how beneficial it was to have one nurse serve as the point person for each woman's care and concerns. Concurrently, fewer office visits saved healthcare provider resources, while reducing patient burden.

This practice transforming research is leading to permanent changes in the way women receive prenatal care across Mayo Clinic. It is part of the goal of the Mayo Model of Community Care, to deliver wellness-focused, high-value health care — improving access, convenience and patient satisfaction, while lowering costs.

The team will present its findings in an oral presentation during the 2016 Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists (ACOG), May 14-17, 2016.