Strong Start for Mothers and Newborns: Impact on OB Triage Visits

Abstract

Introduction: The Strong Start for Mothers and Newborns Initiative was launched in 2012 as an effort to reduce preterm birth rates, improve birth outcomes, and reduce costs of medical care for those enrolled in Medicaid or the Children’s Health Insurance Program [1]. The Strong Start program modeled a maternity medical home, which includes the services of an additional project manager, registered nurse care coordinator, and two community health workers, with the aim to provide enhanced wrap around prenatal and psychosocial services. Previous studies have shown that implementation of patient-centered medical home models of care among patients with chronic diseases have led to decreases in frequency of ED visits among these patients [2,3]. However, research is lacking regarding the effectiveness of implementation of a maternity medical home model of care on reduction of Obstetric (OB) Triage visits. Methods: This retrospective chart review compared rates of OB Triage visits between two cohorts of women: Strong Start Maternity Medical Home participants and non-Strong Start controls within an urban county hospital network. Results: While the mean number of OB Triage visits among Strong Start participants (0.78; 95% CI 0.70-0.86) was higher than non-Strong Start controls (0.58; 95% CI 0.52-0.64)(P<0.001) the acuity was also greater. Among Strong Start participants, Odds Ratio of >1 OB Triage visits was 2.16 (1.77, 2.62) and Odds Ratio of >2 OB Triage visits was 2.50 (1.94, 3.22) compared to controls (p <0.001). Conclusions: Triage care services increased, among participants of a maternity medical home model of care despite increased access to prenatal education and prenatal service. Further research is necessary to determine trends in OB Triage chief complaints, highlight modifiable factors that may allow a reduction in OB Triage visits, and determine the cost effectiveness of patient enrollment in a maternity medical home model of care.