The BirthPlace collaborative practice model: results from the San Diego Birth Center Study

Area of Science:

• Maternal and Child Health
• Health Services Research
• Comparative Effectiveness Research

Background:

• Healthcare reform emphasizes quality and cost-effectiveness in perinatal services.
• Integrated collaborative practice models, like The BirthPlace program, offer an alternative to traditional care.
• Previous studies highlighted freestanding birth center safety, but lacked data on collaborative practice models with concurrent comparison groups.

Purpose of the Study:

• To compare the safety, cost-effectiveness, and patient satisfaction of a collaborative perinatal care model (The BirthPlace program) with traditional physician-led hospital-based care.
• To evaluate the outcomes of a freestanding birth center integrated within a larger health network.
• To address the lack of prospective cohort studies on collaborative practice-freestanding birth center models.

Main Methods:

• Prospective cohort study comparing The BirthPlace program with traditional perinatal care.
• Recruited approximately 2,000 birth center and 1,350 traditional care subjects.
• Collected data via medical record abstraction and patient questionnaires, comparing prenatal, intrapartum, postpartum, and infant outcomes, costs, and patient satisfaction.

Main Results:

• Preliminary results indicate similar maternal and infant morbidity and mortality rates between the groups.
• The birth center group demonstrated fewer major maternal intrapartum complications and NICU admissions.
• The birth center model showed lower average costs for pregnancy-related services ($4,550 vs. $5,535) and higher rates of spontaneous vaginal delivery and exclusive breastfeeding.

Conclusions:

• The collaborative practice model utilizing a freestanding birth center shows comparable safety to traditional care.
• This model demonstrates reduced resource utilization, leading to lower costs for payers.
• The BirthPlace program presents a viable, high-quality, and cost-effective alternative for perinatal services within an integrated health system.