Table 4, Summary of Findings of Included Clinical Studies - Interdisciplinary Care Approach for Perinatal Patients in Acute Care Settings: Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Main Study Findings	Authors’ Conclusion
Non-Randomized Cohort Study: Rosenstein et al. 2015⁶
Clinical Outcomes	Privately Insured patients (Intervention)	Publicly Insured Patients (Control)	“[…] the expansion of midwifery and laborist services in a collaborative practice model at a single community hospital was associated with a decreased primary cesarean delivery rate and an increased rate of VBAC” (p 6)
Private Practice Model	Collaborative Model	P value	Before	After	P value
Primary cesarean sections
n/N (%)	381/1201 (31.7)	130/521 (25.0)	P = 0.005	208/1340 (15.5)	80/498 (16.1)	P = 0.78
*OR (95% CI)**	0.56 (0.39–0.81)	P = 0.002	0.80 (0.54–1.17)	P = 0.25
Vaginal births after cesarean section
n/N (%)	60/452 (13.3)	52/232 (22.4)	P = 0.002	142/420 (33.8)	59/220 (26.8)	P = 0.07
*OR (95% CI)**	2.03 (1.08–3.80)	P = 0.03	0.74 (0.41–1.36)	P = 0.34
Composite of short-term adverse neonatal outcomes (5 minute APGAR <7, umbilical artery pH<7.0, umbilical artery base excess >12)
n/N (%)	21/1649 (1.3)	17/749 (2.3)	P = 0.07	47/420 (2.7)	18/220 (2.5)	P = 0.84
*OR (95% CI)**	1.47 (0.57–3.75)	P = 0.42	0.72 (0.30–1.71)	P = 0.45
CI = confidence interval; OR = odds ratio. * Adjusted for maternal age, race/ethnicity, education, gestational age, epidural, induction of labour, maternal medical complication, birth weight, delivery year, and with an interaction term for insurance type.
Uncontrolled, Single-Group Before-and-After Study: Krolikowski-Ulmer et al. 2018⁷
Clinical Outcomes, Percentage of events (95% CI)	Labourist Only Period (from 2011 to 2013)	Collaborative Period (from 2014 to 2016)	“[…] a collaborative care model on the obstetric floor at this Institution has had a positive impact on patient care outcomes and staff satisfaction.” (p 534)
Induction of labour	46.5 (45.5 to 47.5)	28.9 (27.9 to 29.8)
Primary cesarean sections	14.6 (14.0 to 15.3)	13.7 (13.0 to 14.4)
Total (primary and repeat) cesarean sections	28.5 (27.6 to 29.4)	27.8 (26.9 to 28.7)
Vaginal births after cesarean section	12.9 (11.4 to 14.6)	15.1 (13.4 to 16.9)
CI = confidence interval.

Main Study Findings

Authors’ Conclusion

Non-Randomized Cohort Study: Rosenstein et al. 2015⁶

Clinical Outcomes

Privately Insured patients (Intervention)

Publicly Insured Patients (Control)

“[…] the expansion of midwifery and laborist services in a collaborative practice model at a single community hospital was associated with a decreased primary cesarean delivery rate and an increased rate of VBAC” (p 6)

Private Practice Model

Collaborative Model

P value

Before

After

P value

Primary cesarean sections

n/N (%)

381/1201 (31.7)

130/521 (25.0)

P = 0.005

208/1340 (15.5)

80/498 (16.1)

P = 0.78

OR* (95% CI)

0.56 (0.39–0.81)

P = 0.002

0.80 (0.54–1.17)

P = 0.25

Vaginal births after cesarean section

n/N (%)

60/452 (13.3)

52/232 (22.4)

P = 0.002

142/420 (33.8)

59/220 (26.8)

P = 0.07

OR* (95% CI)

2.03 (1.08–3.80)

P = 0.03

0.74 (0.41–1.36)

P = 0.34

Composite of short-term adverse neonatal outcomes

(5 minute APGAR <7, umbilical artery pH<7.0, umbilical artery base excess >12)

n/N (%)

21/1649 (1.3)

17/749 (2.3)

P = 0.07

47/420 (2.7)

18/220 (2.5)

P = 0.84

OR* (95% CI)

1.47 (0.57–3.75)

P = 0.42

0.72 (0.30–1.71)

P = 0.45

CI = confidence interval; OR = odds ratio.

* Adjusted for maternal age, race/ethnicity, education, gestational age, epidural, induction of labour, maternal medical complication, birth weight, delivery year, and with an interaction term for insurance type.

Uncontrolled, Single-Group Before-and-After Study: Krolikowski-Ulmer et al. 2018⁷

Clinical Outcomes, Percentage of events (95% CI)

Labourist Only Period (from 2011 to 2013)

Collaborative Period (from 2014 to 2016)

“[…] a collaborative care model on the obstetric floor at this Institution has had a positive impact on patient care outcomes and staff satisfaction.” (p 534)

Induction of labour

46.5 (45.5 to 47.5)

28.9 (27.9 to 29.8)

Primary cesarean sections

14.6 (14.0 to 15.3)

13.7 (13.0 to 14.4)

Total (primary and repeat) cesarean sections

28.5 (27.6 to 29.4)

27.8 (26.9 to 28.7)

Vaginal births after cesarean section

12.9 (11.4 to 14.6)

15.1 (13.4 to 16.9)

CI = confidence interval.

From: Interdisciplinary Care Approach for Perinatal Patients in Acute Care Settings: Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Cover of Interdisciplinary Care Approach for Perinatal Patients in Acute Care Settings: Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Interdisciplinary Care Approach for Perinatal Patients in Acute Care Settings: Clinical Effectiveness, Cost-Effectiveness, and Guidelines [Internet].

Gauthier K, Argáez C.

Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Jun 7.

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Table 4Summary of Findings of Included Clinical Studies