ESTABLISHMENT OF A COMPREHENSIVE CARE PROGRAM (CCP) AS A COMPLEMENT TO FERTILITY EVALUATION/TREATMENT TO IDENTIFY CO-MORBIDITIES, MAXIMIZE AWARENESS AND IMPROVE OVERALL HEALTH, FERTILITY AND OBSTETRICAL OUTCOMES

Abstract

Maternal health prior to and during pregnancy is of paramount importance, with the best time to optimize maternal health being prior to pregnancy. Reproductive endocrinologists (REI) are often now the sole provider that patients seek when suffering from infertility and thus, have the unique opportunity to counsel women at a critical juncture, not only in relation to pregnancy, but to establish overall optimal health. We aimed to establish a CCP at our center to identify and connect patients in need with all appropriate specialists prior to attempts at pregnancy. All new patients seen at a single site of our academic institution were analyzed for entry eligibility into the CCP based on identified co-morbidities. Participating departments included Maternal Fetal Medicine (MFM), Mental Health (MH), Nutrition, Cardiology, and Endocrinology. Patients were included based on medical and obstetrical history, physical exam, medications &/or laboratory abnormalities (including screening endocrine and lipid assays). Participating CCP providers met monthly to advance the program. Referrals were made internally within the established provider group with a focus on expedited consultations. A database was established to allow results and recommendations to be readily communicated among the team. After excluding patients for missing chart data, 628 new patients were analyzed. Of those, 160 (25%) met entry criteria for the program with 88 (55%) being referred to MFM, 54 (34%) to MH, 23 (14%) to Nutrition, 9 (6%) to Cardiology and 3 (2%) to Endocrinology; some patients were referred to multiple subspecialties. Telemed was extensively utilized. The referral compliance rate for initial CCP consultation reached 100%. Preliminary outcome data shows outcome improvement. Establishment of a CCP focused on those pursuing fertility care along with a detailed initial intake and expanded laboratory panel allowed us to identify approximately 1/4 of our practice requiring referral for consultation with another medical discipline. Streamlining the referral process and Telemed increased compliance. Objective data being collected will determine the impact of early coordinated multidisciplinary-care establishment on obstetric and overall health outcomes. Our CCP program has enhanced the opportunity for our patients to make meaningful and expeditious life changes to maximize health.