title: Implementation of a laborist program and evaluation of the effect upon cesarean delivery.
abstract: OBJECTIVE
  Laborist programs have expanded throughout the United States in the last decade. Meanwhile, there has been no published research examining their effect on patient outcomes. Cesarean delivery is a key performance metric with maternal health implications and significant financial impact. Our hypothesis is that the initiation of a full-time dedicated laborist staff decreases cesarean delivery.
  
  
  METHODS
  In a tertiary hospital staffed with private practice physicians, data were retrospectively reviewed for 3 time periods from 2006 through 2011. The first period (16 months) there were no laborists (traditional model), followed by 14 months of continuous in-hospital laborist coverage provided by community staff (community laborist), and finally a 24-month period with full-time laborists providing continuous in-hospital coverage. The primary hypothesis was that full-time laborists would decrease cesarean delivery rates.
  
  
  RESULTS
  Data from 6206 term nulliparous patients were retrospectively reviewed. The cesarean delivery rate for no laborist care was 39.2%, for community physician laborist care was 38.7%, and for full-time laborists was 33.2%. With adjustment via logistic regression, full-time laborist presence was associated with a significant reduction in cesarean delivery when contrasted with no laborist (odds ratio, 0.73; 95% confidence interval, 0.64-0.83; P < .0001) or community laborist care (odds ratio, 0.77; 95% confidence interval, 0.67-0.87; P < .001). The community laborist model was not associated with an effect upon cesarean delivery.
  
  
  CONCLUSIONS
  A dedicated full-time laborist staff model is associated with lower rates of cesarean delivery. These findings may be used as part of a strategy to reduce cesarean delivery, lower maternal morbidity and mortality, and decrease health care costs.
authors.affiliation: High Risk Pregnancy Center, Las Vegas, NV, USA.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Iriye
authors.forename: Wilson H
authors.initials: WH
authors.lastname: Huang
authors.forename: Jennifer
authors.initials: J
authors.lastname: Condon
authors.forename: Lyle
authors.initials: L
authors.lastname: Hancock
authors.forename: Judy K
authors.initials: JK
authors.lastname: Hancock
authors.forename: Mark
authors.initials: M
authors.lastname: Ghamsary
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Garite
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008429:Maternal Welfare; D011247:Pregnancy; D012189:Retrospective Studies; D014481:United States
keywords: cesarean delivery; hospitalist; laborist; patient safety