Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, 55905, USA.
BMC Pregnancy Childbirth. 2021 Jan 21;21(1):71. doi: 10.1186/s12884-021-03557-3.
Traditional prenatal care includes up to 13 in person office visits, and the cost of this care is not well-described. Alternative models are being explored to better meet the needs of patients and providers. OB Nest is a telemedicine-enhanced program with a reduced frequency of in-person prenatal visits. The cost implications of connected care services added to prenatal care packages are unclear.
Using data from the OB Nest randomized, controlled trial we analyzed the provider and staff time associated with prenatal care in the traditional and OB Nest models. Fewer visits were required for OB Nest, but given the compensatory increase in connected care activity and supplies, the actual cost difference is not known. Nursing and provider staff time was prospectively recorded for all patients enrolled in the OB Nest clinical trial. Published 2015 national wages for healthcare workers were used to calculate the actual labor cost of providing either traditional or OB Nest prenatal care in 2015 US dollars. Overhead expenses and opportunity costs were not considered.
Total provider cost was decreased caring for the OB Nest participants, but nursing cost was increased. OB Nest care required an average of 160.8 (+/- 45.0) minutes provider time and 237 (+/- 25.1) minutes nursing time, compared to 215.0 (+/- 71.6) and 99.6 (+/- 29.7) minutes for traditional prenatal care (P < 0.01). This translated into decreased provider cost and increased nursing cost (P < 0.01). Supply costs increased, travel costs declined, and overhead costs declined in the OB Nest model.
In this trial, labor cost for OB Nest prenatal care was 34% higher than for traditional prenatal care. The increased cost is largely attributable to additional nursing connected care time, and in some practice settings may be offset by decreased overhead costs and increased provider billing opportunities. Future efforts will be focused on development of digital solutions for some routine nursing tasks to decrease the overall cost of the model.
ClinicalTrials.gov Identifier: NCT02082275 .
传统的产前护理包括多达 13 次的门诊就诊，但其费用尚未得到充分描述。目前正在探索替代模式，以更好地满足患者和医护人员的需求。OB Nest 是一种具有较少门诊就诊次数的远程医疗增强型项目。将连接护理服务添加到产前护理套餐中所涉及的成本尚不清楚。
我们使用来自 OB Nest 随机对照试验的数据，分析了传统和 OB Nest 模式下产前护理所涉及的医护人员和员工时间。OB Nest 模式所需的就诊次数较少，但鉴于连接护理活动和用品的补偿性增加，实际成本差异尚不清楚。OB Nest 临床试验中的所有患者的护理和医护人员时间都进行了前瞻性记录。使用 2015 年公布的美国医疗保健工作者工资来计算以 2015 年美元计的传统或 OB Nest 产前护理的实际劳动力成本。未考虑间接费用和机会成本。
OB Nest 参与者的总医护人员成本降低，但护理成本增加。OB Nest 护理平均需要 160.8（+/-45.0）分钟的医护人员时间和 237（+/-25.1）分钟的护理时间，而传统产前护理则需要 215.0（+/-71.6）和 99.6（+/-29.7）分钟（P<0.01）。这转化为医护人员成本降低和护理成本增加（P<0.01）。OB Nest 模式下的供应成本增加，差旅成本下降，间接费用下降。
在这项试验中，OB Nest 产前护理的劳动力成本比传统产前护理高 34%。增加的成本主要归因于额外的护理连接护理时间，在某些实践环境中，可能会因间接费用降低和医护人员计费机会增加而得到部分抵消。未来的工作重点将放在开发一些常规护理任务的数字解决方案上，以降低该模式的总体成本。
ClinicalTrials.gov 标识符：NCT02082275。
