Leveraging Longitudinal Clinical Laboratory Results to Improve Prenatal Care
Leveraging Longitudinal Clinical Laboratory Results to Improve Prenatal Care
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DOI：
10.37765/ajmc.2021.88582
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发表时间：
2021-02-01
影响因子：
3.2
通讯作者：
Crossey, Michael J.
中科院分区：
文献类型：
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作者：
VanNess, Richard;Swanson, Kathleen M.;Crossey, Michael J.
目的：为了评估的影响，提供实验室产生的近实时的临床见解怀孕的医疗补助成员管理式医疗机构（MCO）护理coordinators.Study设计：一个前瞻性的，非随机可行性研究进行了11个月以上的产前护理质量指标和临床结果的实验室产生的临床见解的好处。措施包括早期识别怀孕和分娩，以促进护理，产前实验室检测，急诊室（艾德）访问，早产，新生儿重症监护病房（NICU）的招生和stay.METHODS长度的护理差距：每周MCO护理协调员提供了一个实验室生成的产前有针对性的干预模块（TIM），以补充他们现有的系统在纵向，以病人为中心的格式。护理协调员联系登记在产前或产后服务的TIM，确定伴随的健康状况，缺少产前护理，和risks.RESULTS：产前TIM确定了1355怀孕的成员，其中77%（n = 1040）在第一个三个月检测到的患者。共有488名婴儿在分娩后24小时内得到确认。64%的妇女至少有80%的产前护理差距与实验室检测关闭。与未进行产前护理的妇女相比，进行产前护理的妇女的艾德就诊率（17%对23%）和新生儿重症监护室入院率（11%对18%）更低。调整混杂因素后，正在进行的产前护理在降低艾德访问和新生儿重症监护病房acceptance.CONCLUSIONS：之间的创新合作MCO和临床实验室的质量措施，提高了产前成员参加医疗补助的可能性有一个边界的影响。
OBJECTIVES: To assess the impact of providing laboratory-generated near-real-time clinical insights for pregnant Medicaid members to managed care organization (MCO) care coordinators.STUDY DESIGN: A prospective, nonrandomized feasibility study was conducted over 11 months to examine the benefits of laboratory-generated clinical insights on prenatal care quality metrics and clinical outcomes. Measures included early identification of pregnancy and births to facilitate care, care gaps with prenatal laboratory testing, emergency department (ED) visits, preterm births, and neonatal intensive care unit (NICU) admissions and length of stay.METHODS: Weekly MCO care coordinators were provided a laboratory- generated prenatal targeted intervention module (TIM) to supplement their existing systems in a longitudinal, patient-centric format. Care coordinators contacted patients for enrollment in prenatal or postpartum services based on the TIM, which identified concomitant health conditions, missing prenatal care, and risks.RESULTS: The prenatal TIM identified 1355 pregnant members, 77% (n = 1040) of whom were detected in the first trimester. A total of 488 births were identified within 24 hours of parturition. Sixty-four percent of women had at least 80% of prenatal care gaps associated with laboratory testing closed. Women with ongoing prenatal care had fewer ED visits (17% vs 23%) and NICU admissions (11% vs 18%) compared with those without prenatal care. After adjusting for confounders, ongoing prenatal care had a borderline effect at decreasing the probability of having an ED visit and a NICU admission.CONCLUSIONS: An innovative collaboration between an MCO and a clinical laboratory improved quality measures for prenatal members enrolled in Medicaid.