Collaborative care for obstetric patients at low and high risk: an evolving model

In this article we describe a program that evolved from collaborative care given to a low-risk population into collaborative care that included patients at high risk.

The study population comprised women attending a prenatal program in an urban, underserved neighborhood. Clinic records were reviewed for number of patient enrollments and total patient visits, as well as providers utilized. Episodic audit over a 3-year period of 180 of 869 patients initiating prenatal care was done. Data from vital statistics for 1992 and 1993 were evaluated for adequacy of prenatal care and yearly births for the census tract served. Analysis was descriptive.

Almost all of the patient population served was found to be at psychosocial high risk. Approximately 10% had significant obstetric or medical complications. Infections, especially sexually transmitted diseases, were common. Fewer than 1% of the patients were referred to another provider for treatment. The program demonstrated an increase in patient volume, improved retention of patients for complete prenatal care and delivery, a reduction in patients receiving no or inadequate care, and a reduction in yearly births.

The collaborative practice model may be extended to high-risk populations.