1. Boston Medical Center’s Labor and Delivery Collaborative Model Richard Long, Jennifer Pfau, Jordana Price and Michelle Sia Boston University School of Medicine Department of Family Medicine Department of Obstetrics and Gynecology April 2016 STFM

2. Disclosures Nothing to Disclose

3. Boston Medical Center New England’s largest safety net hospital 496-bed academic medical center 75% of patients are from underserved populations 31% of patients do not speak English as a primary language

4. History of the Collaborative Model at Boston Medical Center 1996-2006 discontinuous FM attending and resident coverage 2006- 24-hour presence/coverage by Family Medicine attending on Labor and Delivery 2007- Institution of new algorithm for distribution of patients between OB/Midwifery/Family Medicine services Keys to success= merged billing, interdisciplinary approach to patient care, focus on individual skill sets Pecci et al. How We Built Our Team: Collaborating with Partners to Strengthen Skills in Pregnancy, Delivery, and Newborn Care. J Am Board Fam Med 2012;25:511–521.

5. Boston University Medical Center Family Medicine Residency Program 10 residents per year (2011) Divided among 3 primary clinical CHC sites -Codman Square Community Health Center -East Boston Neighborhood Health Center -South Boston Community Health Center Faculty practices at multiple sites

6. MCH Faculty- Department of Family Medicine Non-fellowship trained= 13 providers Fellowship trained= 5 providers 12-hour in-house shifts, 365/24/7 coverage Supervise/teach Family Medicine, OB, ED residents (in addition to Pediatric residents on the well baby unit/pediatric inpatient floor)

7. Total OB Volume and Volume by Service

8. FM, CNM and OB Delivery Volume

9. OB CS FM NVD OB NVD FM CS % CS by FM Total of 1,433 CSs in 6 years AND covered the Postpartum Service (MBS)! CS and NVD by Service: FM and OB 547 372

10. Deliveries by Health Center 12/1/2014-11/30/2015 Prenatal SiteTermPretermNATotalPercentage # Births% % %Births Of Total Births BMC1,00186%15814%00%1,15946% Codman Square12289%1511%00%1375% Dorchester House9389%1211%00%1054% East Boston74394%466%00%78931% Harvard Street2100%00%0 2 Mattapan4690%510%00%512% Roslindale2596%14%00%261% South Boston4396%24%00%452% South End14100%00%0 141% Upham's Corner7595%45%00%793% Whittier Street4592%48%00%492% Other4272%1628%00%582% No Prenatal550%5 00%100% Grand Total2,25689%26811%00%2,524100%

11. BU Collaborative Model How do we teach this to residents? MCH Core Curriculum FM Process Integration RN, CNM, OB role in FM residents’ education FM, RN, CNM role in OB residents’ education

12. MCH Curriculum ALSO course (new PGY2) Teams Training (new PGY1) 1:4 Wednesday PM seminar 1:4 Monday PM resident lectures 1:4 monthly M&M (MCH) Gnosis EFM training (annual, collaborative) OB simulations (1-2/yr, collaborative) Clinical Experience -L&D -Mother Baby Service

13. FM Process Integration FM participation on OB QAI committee, Perinatal Committee, Perinatal Safety Committee, Simulation Committee (several include nursing participation) Interdisciplinary rounds every shift Interdisciplinary Case Reviews Teams Training FM & OB residents share responsibilities on L&D Demonstration of collaborative care, teaching and learning

14. How do we evaluate how we teach it? In-Service exam scores # residents including maternity care in post- graduate practices/ fellowship Resident delivery distribution per provider discipline supervising/teaching Resident evaluations/ Faculty evaluations 360° evaluation BU Collaborative Model

15. FM Resident Deliveries by Attending 2015 505 NVDs 263 (52.1%) supervised by CNM 184 (36.4%) supervised by FM 58 (11.5%) supervised by OB 12 C-sections 5 (41.7%) supervised by FM 7 (58.3%) supervised by OB 2578 deliveries at BMC; 992 OB deliveries (372 NVD and 620 C-sec), 834 by CNMs and 752 FM deliveries (547 NVD, 205 C-sec) *OB and ED resident delivery data is not reported

16. Family Medicine Residency Graduates- OB Experience After Graduation Graduation YearTotal graduates L&D Care in first Job (including MCH fellows)MCH Fellowship 2001 210 2002 640 2003 600 2004 600 2005 600 2006 610 2007 630 2008 611 2009 621 2010 630 2011 622 2012 610 2013 610 2014 1011 2015 931

17. In-Training Exam Maternity Questions

18. BU Collaborative Model How else do we teach this to residents? How else can we evaluate how we teach it? That’s why we’re all here. We will help each other teach and evaluate better! Thank you!

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