Does changing residency obstetric call to a group model significantly impact patient continuity?

Abstract

BACKGROUND AND OBJECTIVES: Group sharing of prenatal care and inpatient obstetric (OB) call is increasingly replacing single-provider longitudinal models including in family medicine (FM) residencies. Such change in care models could impact continuity of prenatal and delivery care. The University of Rochester’s family medicine residency program changed the resident maternal care coverage to an obstetric group model from a single-provider model in 2016 to improve work-life balance, which provided an opportunity to examine how these two practice styles impacted provider continuity. METHODS: We performed a retrospective chart review of family medicine resident-assigned obstetric patients receiving care at the University of Rochester’s residency clinic. The study evaluated provider continuity differences in two models of prenatal care and obstetric call: (1) single provider model (SPM) with one primary provider and one backup support resident vs (2) OB group-provider model (GPM) with three to four resident providers and one primary provider. RESULTS: The average number of different providers seen significantly increased in the GPM vs SPM (3.47 vs 2.87, P=.02), however the average percentage of prenatal visits with either a primary or designated backup provider was not statistically different (83.1% vs 90.1%, P=.07). Among delivery continuity measures, there was no significant difference between models in the percentage of deliveries attended by the primary or designated backup residents compared with nongroup providers. (76.9% vs 82.3%, P=.51). CONCLUSIONS: This study provides quantitative evidence on how differing models of residency maternal care coverage impact continuity of care. Study findings did not show an inferiority of an OB group-provider model compared to a single-provider model when considering how often patients were seen prenatally and delivered by providers from their continuity group.