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Laborist model of care: who is using it?
Sindhu K Srinivas1, Julie Shocksnider, Donna Caldwell
1University of Pennsylvania, Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, Philadelphia, PA, USA. ssrinivas@obgyn.upenn.edu
Objective:
Utilization of the laborist model in the provision of obstetric (OB) care appears to be growing. In collaboration with the National Perinatal Information Center/Quality Analytic Services (NPIC/QAS), we assessed the utilization of this model of care delivery and hospital-level characteristics associated with its use.
Methods:
A cross-sectional electronic survey of all NPIC/QAS member hospitals (26 states) was performed in February 2010. Questions assessed staffing and clinical capabilities and utilization of laborists. The association between laborists and hospital-level characteristics were calculated using chi-square analyses or Fisher's exact tests for categorical variables and t tests for continuous variables.
Results:
Ninety-three percent of hospitals (69/74) responded and only those that provide OB services were analyzed (N = 68). Nearly 40% (25/68) of hospitals responded that they are utilizing laborists. Delivery volume is significantly associated with implementation of laborists whereas OB level, presence of residents and fellows, and geography were not.
Conclusion:
Laborists are being introduced into the OB care delivery model rapidly. This is the first assessment of their use in a large sample of US hospitals. Given the millions of women who deliver each year, it is imperative to evaluate the impact of this model on patient safety and outcomes.
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