title: Evaluating the impact of the laborist model of obstetric care on maternal and neonatal outcomes.
abstract: BACKGROUND
  The laborist model of obstetric care represents a change in care delivery with the potential of improving maternal and neonatal outcomes.
  
  
  OBJECTIVE
  We evaluated the effectiveness of the laborist model of care compared to the traditional model of obstetric care using specific maternal and neonatal outcome measures.
  
  
  METHODS
  This is a population cohort study with laborist and nonlaborist hospitals matched 1:2 on delivery volume, geography, teaching status, and neonatal intensive care unit level using data from the National Perinatal Information Center/Quality Analytic Services database. A before-and-after study design with an untreated comparison group analyzed with the method of difference-in-differences was used to examine the impact of laborists on maternal and neonatal outcome measures within the 3 years after implementing the laborist system, after adjusting for secular trends, sociodemographic factors, and maternal medical conditions. The final outcome measures evaluated included cesarean delivery, chorioamnionitis, induction of labor, preterm birth, prolonged length of stay, Apgar at 5 minutes of <7, birth asphyxia, birth injury, birth trauma, and neonatal death.
  
  
  RESULTS
  We studied nearly 550,000 women from 24 hospitals (8 laborist and 16 nonlaborist hospitals) from 1998 through 2011. Implementation of laborists was associated with fewer labor inductions (adjusted odds ratio, 0.85; 95% confidence interval, 0.71-0.99) and decreased rate of preterm birth (adjusted odds ratio, 0.83; 95% confidence interval, 0.72-0.96) after controlling for confounders. Laborists did not impact the cesarean delivery rate, chorioamnionitis, or prolonged length of stay.
  
  
  CONCLUSIONS
  Implementation of the laborist model was associated with a significant reduction in labor induction rate and preterm birth without adversely affecting other outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. Electronic address: ssrinivas@obgyn.upenn.edu.
authors.forename: Sindhu K
authors.initials: SK
authors.lastname: Srinivas
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Dylan S
authors.initials: DS
authors.lastname: Small
authors.affiliation: Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Macheras
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Jesse Y
authors.initials: JY
authors.lastname: Hsu
authors.affiliation: National Perinatal Information Center/Quality Analytic Services, Providence, RI.
authors.forename: Donna
authors.initials: D
authors.lastname: Caldwell
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Scott
authors.initials: S
authors.lastname: Lorch
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002821:Chorioamnionitis / Q000453:epidemiology*; D015331:Cohort Studies; D065187:Controlled Before-After Studies; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D020445:Hospitalists; D006761:Hospitals; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data*; D007743:Labor, Obstetric; D007902:Length of Stay / Q000706:statistics & numerical data; D009774:Obstetrics / Q000458:organization & administration*; D016017:Odds Ratio; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D055815:Young Adult
keywords: laborist; maternal and neonatal outcomes; obstetrics; pregnancy