Model of family medicine and obstetrics-gynecology collaboration in obstetric care at the University of Michigan

Abstract

Objective: To assess concordance between family physician obstetric privilege delineation and actual care delivered, and describe associated clinical and educational collaborations between family medicine and obstetrics and gynecology. Methods: We conducted a descriptive retrospective review of the care and complications of 962 consecutive patients admitted to a family medicine obstetric service in a research-intensive academic medical center, and compared the results with a structured obstetric privilege delineation. Results: Of 962 women admitted by family medicine faculty members, 741 (77.9%) were managed exclusively by family physicians, 63 (6.6%) were comanaged by family physicians and obstetricians, and 147 (15.5%) were transferred to obstetricians (data missing for 11 patients). Spontaneous vaginal deliveries were performed in 772 patients (81%), cesarean delivery in 116 patients (12.2%), and assisted delivery by forceps or vacuum in 19 (2%) and 44 (4.6%) patients, respectively. Of 926 intrapartum obstetric complications identified in 604 obstetric deliveries, 615 complications (66.4%) in 418 deliveries were managed exclusively by family physicians consistent with privilege delineation, comanagement occurred in 56 patients with 92 complications (9.9%), and care was transferred in 130 patients with 219 complications (23.7%). Conclusion: A structured method of obstetric privilege delineation for family medicine faculty members and associated guidelines for family physician–obstetrician interactions has led to a successful family medicine obstetric service at a research-intensive, tertiary-care medical center, with a high concordance between privilege delineation and actual care delivered. This success has resulted in incremental clinical and educational collaborations that have improved the quality of women’s health care and education.