scholarly journals OB Nest Randomized Controlled Trial: A Cost Comparison of Reduced Visit Compared to Traditional Prenatal Care

2020 ◽  
Author(s):  
Regan Theiler ◽  
Yvonne Butler Tobah ◽  
Matthew Hathcock ◽  
Abimbola Famuyide
Keyword(s):  
Randomized Controlled Trial ◽  
Prenatal Care ◽  
Controlled Trial ◽  
Labor Cost ◽  
Staff Time ◽  
Randomized Controlled ◽  
Nest Model ◽  
The Cost ◽  
Provider Cost ◽  
Nursing Cost

Abstract BackgroundTraditional 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.MethodsUsing 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.ResultsTotal 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 87.8 (+/- 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. ConclusionsIn 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. Trial Registrations: ClinicalTrials.gov Identifier: NCT02082275

scholarly journals OB Nest randomized controlled trial: a cost comparison of reduced visit compared to traditional prenatal care

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Regan N. Theiler ◽  
Yvonne Butler-Tobah ◽  
Matthew A. Hathcock ◽  
Abimbola Famuyide
Keyword(s):  
Randomized Controlled Trial ◽  
Prenatal Care ◽  
Controlled Trial ◽  
Labor Cost ◽  
Staff Time ◽  
Randomized Controlled ◽  
Link Type ◽  
The Cost ◽  
Provider Cost ◽  
Nursing Cost

Abstract Background 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. Methods 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. Results 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. Conclusions 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. Trial registrations ClinicalTrials.gov Identifier: NCT02082275.

Randomized Observational Studies on the Economics of Therapies – Biometrical Experience of Two Trials

1998 ◽  
Vol 37 (01) ◽  
pp. 53-58 ◽  
Author(s):  
J. Högel ◽  
A. C. Rodloff ◽  
G. Büchele ◽  
W. Gaus
Keyword(s):  
Randomized Controlled Trial ◽  
Observational Studies ◽  
Controlled Trial ◽  
Innovative Therapy ◽  
Treatment Regimens ◽  
Randomized Controlled ◽  
Long Run ◽  
Low Costs ◽  
The Cost ◽  
Economic Studies

Abstract:Economic studies in medicine are intended to investigate costs, associated with a particular problem dealing with the indication, diagnosis or therapy, for instance, whether the high costs involved in a highly intensive or innovative therapy could be balanced by the eventual savings made, due to the shorter periods of treatment. In such situations a randomized controlled trial is necessary to find out which therapy or which therapeutical strategy is least expensive in the long run. Economic studies do, however, present some specific problems. Making a list of all the cost-relevant treatment items can be very laborious, but the use of flat rates and lump sums alone cannot lead to a complete cost analysis. Often, costs between hospitals vary more than between treatment regimens.Early and sudden deaths incur low costs and may bias the results. Furthermore, costs are distributed with a long and heavy upper tail incltJding extreme outliers. This does, in fact, complicate the estimation of the sample size. In this article, these problems are outlined and, with the help ofthe data obtained from two randomized economic trials in health care, solutions are proposed and discussed.

Pilot Randomized Controlled Trial of Diabetes Group Prenatal Care

2020 ◽  
Author(s):  
Ebony B. Carter ◽  
Kate Barbier ◽  
Pamela K. Hill ◽  
Alison G. Cahill ◽  
Graham A. Colditz ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Prenatal Care ◽  
Controlled Trial ◽  
Self Care ◽  
Group Care ◽  
Group Prenatal Care ◽  
Diabetes Group ◽  
Randomized Controlled ◽  
Individual Care ◽  
Pilot Randomized Controlled Trial

Objective This study aimed to determine the feasibility and effectiveness of Diabetes Group Prenatal Care to increase patient engagement in diabetes self-care activities. Study Design A pilot randomized controlled trial was conducted at two sites. Inclusion criteria were English or Spanish speaking, type 2 or gestational diabetes, 22 to 34 weeks of gestational age at first study visit, ability to attend group care at specified times, and willingness to be randomized. Exclusion criteria included type 1 diabetes, multiple gestation, major fetal anomaly, serious medical comorbidity, and serious psychiatric illness. Women were randomized to Diabetes Group Prenatal Care or individual prenatal care. The primary outcome was completion of diabetes self-care activities, including diet, exercise, blood sugar testing, and medication adherence. Secondary outcomes included antenatal care characteristics, and maternal, neonatal, and diabetes management outcomes. Analysis followed the intention-to-treat principle. Results Of 159 eligible women, 84 (53%) consented to participate in the study and were randomized to group (n = 42) or individual (n = 42) prenatal care. Demographic characteristics were similar between study arms. Completion of diabetes self-care activities was similar overall, but women in group care ate the recommended amount of fruits and vegetables on more days per week (5.1 days/week ± 2.0 standard deviation [SD] in group care vs. 3.4 days ± 2.6 SD in individual care; p < 0.01) and gained less weight per week during the study period (0.2 lbs/week [interquartile range: 0–0.7] vs. 0.5 lbs/week [interquartile range: 0.2–0.9]; p = 0.03) than women in individual care. Women with gestational diabetes randomized to group care were 3.5 times more likely to have postpartum glucose tolerance testing than those in individual care (70 vs. 21%; relative risk: 3.5; 95% confidence interval: 1.4–8.8). Other maternal, neonatal, and pregnancy outcomes were similar between study arms. Conclusion Diabetes group care is feasible and shows promise for decreasing gestational weight gain, improving diet, and increasing postpartum diabetes testing among women with pregnancies complicated by diabetes. Key Points

scholarly journals The Effects of Group Prenatal Care on Infant Birthweight and Maternal Well-Being: A Randomized Controlled Trial

2018 ◽  
Vol 184 (5-6) ◽  
pp. e440-e446 ◽  
Author(s):  
Amy Tanner Tubay ◽  
Kate A Mansalis ◽  
Matthew J Simpson ◽  
Nicole H Armitage ◽  
Gabriel Briscoe ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Prenatal Care ◽  
Controlled Trial ◽  
Well Being ◽  
Group Prenatal Care ◽  
Randomized Controlled

scholarly journals A Randomized Controlled Trial of the Cost-Utility of Second-Generation Antipsychotics in People with Psychosis and Eligible for Clozapine

2008 ◽  
Vol 11 (4) ◽  
pp. 549-562 ◽  
Author(s):  
Linda M. Davies ◽  
Thomas R.E. Barnes ◽  
Peter B. Jones ◽  
Shôn Lewis ◽  
Fiona Gaughran ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Second Generation ◽  
Controlled Trial ◽  
Cost Utility ◽  
Randomized Controlled ◽  
Second Generation Antipsychotics ◽  
The Cost

Pilot Randomized Controlled Trial of Diabetes Group Prenatal Care

2020 ◽  
Vol 75 (12) ◽  
pp. 715-716
Author(s):  
Ebony B. Carter ◽  
Kate Barbier ◽  
Pamela K. Hill ◽  
Alison G. Cahill ◽  
Graham A. Colditz ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Prenatal Care ◽  
Controlled Trial ◽  
Group Prenatal Care ◽  
Diabetes Group ◽  
Randomized Controlled ◽  
Pilot Randomized Controlled Trial

scholarly journals Adherence in a pragmatic randomized controlled trial on prophylactic iron supplementation during pregnancy in Maputo, Mozambique

2014 ◽  
Vol 18 (6) ◽  
pp. 1127-1134 ◽  
Author(s):  
Bright I Nwaru ◽  
Graça Salomé ◽  
Fatima Abacassamo ◽  
Orvalho Augusto ◽  
Julie Cliff ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Folic Acid ◽  
Prenatal Care ◽  
Controlled Trial ◽  
Daily Intake ◽  
Pragmatic Randomized Controlled Trial ◽  
Randomized Controlled ◽  
Risk Pregnancy ◽  
Health Centres ◽  
History Of

AbstractObjectiveAssessing the level of adherence and its determinants is important in appraising the overall effectiveness of trials. The present study aimed to evaluate the extent of adherence and its determinants in a pragmatic randomized controlled trial of Fe prophylaxis during pregnancy in Maputo, Mozambique.DesignA pragmatic randomized controlled trial.SettingTwo health centres (1o de Maio and Machava) in Maputo, Mozambique.SubjectsPregnant women (≥12 weeks’ gestation, ≥18 years old, non-high-risk pregnancy; n 4326) attending prenatal care consultations at two health centres were randomized to receive routine Fe (n 2184; 60 mg ferrous sulfate plus 400 μg folic acid daily throughout pregnancy) or selective Fe (n 2142; screening and treatment for anaemia and daily intake of 1 mg folic acid).ResultsThe level of adherence was 79 % for having two or more visits, 53 % for adequate prenatal care and 67 % for complete intake of Fe/folic acid tablets during the trial. The correlation between the adherence measures ranged between 0·151 and 0·739. Adherence did not differ by trial arm, but there were centre differences in adequate prenatal visits and intake of tablets. Older women (>20 years) and those with a history of abortion were more likely to achieve greater adherence, whereas an increased number of previous births decreased the likelihood of adherence. HIV positivity decreased the likelihood of adherence in one trial centre and increased it in the other.ConclusionsThe variation in adherence by trial centre, women’s characteristics and outcome measures suggests that adherence in trials fully depends on participants’ behaviour and can be increased by paying attention to contextual factors.

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