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

• Published in: American journal of obstetrics and gynecology Vol. 221; no. 6; pp. 638.e1 - 638.e8
• Main Authors: Butler Tobah, Yvonne S., LeBlanc, Annie, Branda, Megan E., Inselman, Jonathan W., Morris, Megan A., Ridgeway, Jennifer L., Finnie, Dawn M., Theiler, Regan, Torbenson, Vanessa E., Brodrick, Ellen M., Meylor de Mooij, Marnie, Gostout, Bobbie, Famuyide, Abimbola
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2019
• Subjects: Adult; alternative prenatal care; Blood Pressure Determination; connected prenatal care; Delivery of Health Care - methods; Female; Heart Rate, Fetal; Humans; innovative prenatal care; low-risk prenatal care; Obstetric Nursing - methods; Obstetrics - methods; Patient Acceptance of Health Care; Patient Satisfaction; Pregnancy; Prenatal Care - methods; prenatal telemedicine; Quality of Health Care; reduced prenatal visits; remote prenatal care; Self Care - methods; Sphygmomanometers; Stress, Psychological - psychology; telehealth and pregnancy; telehealth obstetric care; Telemedicine - methods; Ultrasonography, Doppler; virtual prenatal care; reduced prenatal visits; telehealth obstetric care; innovative prenatal care; remote prenatal care; virtual prenatal care; alternative prenatal care; connected prenatal care; low-risk prenatal care; telehealth and pregnancy; prenatal telemedicine
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2019.06.034

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). To evaluate the acceptability and effectiveness of OB Nest, a reduced-frequency prenatal care model enhanced with remote home monitoring devices and nursing support. A single-center randomized controlled trial, composed of pregnant women, aged 18–36 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 prescheduled 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 of gestation. Effectiveness was analyzed by comparing adherence to the American College of Obstetricians and Gynecologists recommended routine prenatal and ancillary services, maternal and fetal safety outcomes, and healthcare utilization. Three hundred pregnant women at <13 weeks of 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, patients in OB Nest had higher satisfaction on a 100-point validated modified Littlefield and Adams Satisfaction scale (OB Nest = 93.9% vs usual care = 78.9%, P < .01). Pregnancy-related stress, measured, on a 0–2 point PreNatal Maternal Stress validated scale, with higher scores indicating higher levels of stress, was lower among OB Nest participants at 14 weeks (OB Nest = 0.32 vs usual care = 0.41, P < .01) and at 36 weeks of gestation (OB Nest = 0.34 vs usual care = 0.40, P < .03). There was no statistical difference in perceived quality of care. Adherence to the provision of American College of Obstetricians and Gynecologists 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 (OB Nest = 171.2 minutes vs usual care = 108.2 minutes, 95% confidence interval, 48.7–77.4). 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.