title: Does a maternal-fetal medicine-centered labor and delivery coverage model put the 'M' back in MFM?
abstract: OBJECTIVE
  Maternal morbidity is increasing in the United States. Our objectives were to examine whether a labor and delivery (L&D) provider model with regular maternal-fetal medicine (MFM) coverage decreases the rates of maternal morbidity during delivery hospitalizations and has an impact on obstetrician-gynecologist residents' perceptions of safety and education.
  
  
  METHODS
  We performed a retrospective cohort study to compare the rates of maternal morbidity before and after the implementation of an MFM-centered coverage model on L&D. Outcomes were identified using International Classification of Diseases, ninth revision, codes. The primary outcome was a composite of severe maternal morbidity. Additionally, obstetrician-gynecologist residents completed an anonymous survey asking them to compare coverage models, and their Council on Resident Education in Obstetrics and Gynecology examination scores were compared.
  
  
  RESULTS
  Data from 4715 deliveries were included. There were no differences in composite morbidity or individual adverse outcomes. Most residents (81.3%) preferred the new provider model, with median 5-point Likert scores indicating perceived increases in safety and education. Mean Council on Resident Education in Obstetrics and Gynecology scores improved in the 18 residents exposed to both models.
  
  
  CONCLUSIONS
  Although the MFM-centered provider model appears to have had a positive impact on residents' perceptions of safety and education, it was not associated with significant changes in severe maternal morbidity.
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: justin.brandt@uphs.upenn.edu.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Brandt
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Sindhu K
authors.initials: SK
authors.lastname: Srinivas
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Michal E
authors.initials: ME
authors.lastname: Elovitz
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Bastek
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001623:Betamethasone / Q000008:administration & dosage; D015331:Cohort Studies; D036861:Delivery, Obstetric; D004363:Drug Utilization; D004521:Educational Measurement; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006176:Gynecology / Q000193:education; D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency; D007751:Labor, Induced / Q000706:statistics & numerical data; D008427:Maternal Health Services / Q000458:organization & administration*; D008505:Medical Staff, Hospital; D017146:Models, Organizational; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000517:prevention & control*; D009774:Obstetrics / Q000193:education; D010343:Patient Admission / Q000706:statistics & numerical data; D010414:Pennsylvania; D010561:Personnel Staffing and Scheduling; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000517:prevention & control*; D047928:Premature Birth / Q000517:prevention & control; D012189:Retrospective Studies; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D001623:Betamethasone
keywords: labor and delivery coverage model; maternal morbidity; maternal-fetal medicine