The Center for Peripartum Optimization

The Center for Peripartum Optimization: An Innovative Approach to Care Coordination

In January 2017 investigators started a Center for Peripartum Optimization (CPO) with the aim of optimizing a patient's clinical status in an outpatient setting to minimize unnecessary laboratory tests and studies, costly inpatient consultations, the likelihood of post-surgical adverse events, escalations in level of care, inpatient admissions and readmissions. This research project seeks to evaluate the impact of this innovative concept on patient outcomes during the last 12 months. Investigators will accomplish this by collecting retrospective data from patients' electronic medical records in the intervention group and comparing it to data gathered from a controlled group of patients with similar comorbidities but who were not evaluated at the CPO clinic.

Study Overview

• Status: Completed
• Conditions: Communication; Obstetric Complication; High Risk Pregnancy; Multidisciplinary Communication
• Intervention / Treatment: Other: Seen in clinic

• Study Type: Observational
• Enrollment (Actual): 250

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Baltimore, Maryland, United States, 21287
      • Johns Hopkins Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: No older than 60 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

• Sampling Method: Non-Probability Sample

Study Population

This will be a retrospective study design utilizing the Johns Hopkins Hospital (JHH) electronic medical record system (EMR) "EPIC". We will be reviewing records of parturients seen at JHH in the Center for Peripartum Optimization (CPO) clinic between January 2017 to January 2018 and comparing outcome data with a matched controlled group patients not seen at the CPO clinic. This matched controlled parturient group will be identified utilizing the JHH EMR and ICD-10 comorbidity codes.

These patients will be female of child-bearing age that fits into the inclusion criteria.

Description

Inclusion Criteria:

• Records of all female, obstetric patients of child-bearing age who were evaluated in the Center for Peripartum Optimization during the period between January 2017 and January 2018.
• Controlled group will include parturients with match high risk comorbidities or history of nonobstetric surgery during pregnancy who delivered at Johns Hopkins Hospital (JHH) during July 1, 2016 - Dec 31, 2016
• Patients with any one or more of these high risk comorbidities:
• Complex spine pathologies (Scoliosis, vertebral fusion, disc disease, spinal canal defects, neuropathies, and nerve disease, etc.)
• Neurological pathology (Cerebral ischemia, tumor, increased intracranial pressure, cerebral vascular disease, etc.)
• Cardiac disease (Congenital, valvular, pulmonary hypertension, cardiomyopathy, ischemic disease, arrhythmia, etc.)
• Pulmonary disease (History of pulmonary embolism, interstitial lung disease, severe asthma, cancer, etc.)
• Morbid Obesity (Obstructive Sleep Apnea, equipment considerations)
• Hematologic Disorders (Thrombophilias, coagulopathies, patients on anticoagulation)
• Cancer
• Abnormal placentation (Previa, accreta / increta / percreta)
• Anesthetic concerns (Airway abnormalities, history of adverse anesthetic reactions or experiences (i.e. recall, anaphylaxis))
• Fetal therapy patients requiring specialized management (Ex utero intrapartum treatment (EXIT), Fetoscopic endotracheal occlusion (FETO), Twin-to-twin transfusion syndrome (TTTS), Percutaneous Umbilical Blood Sampling (PUBS), etc.)
• Chronic Pain

Exclusion Criteria:

• Records of CPO participating parturients outside the specified timeframe.
• Records of obstetric patients of child-bearing age without high-risk comorbid conditions described in inclusion criteria.
• Records of patients seen in CPO clinic that did not deliver at our institution

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Retrospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Study; We will be reviewing records of parturients seen at Johns Hopkins Hospital in the Center for Peripartum Optimization (CPO) clinic between January 2017 to January 2018	Other: Seen in clinic; We will be doing a retrospective chart review of patients seen in the Center for Peripartum Optimization to look for: Primary outcome variable.- Hospital length of stay; Secondary outcome variables.Number of admissions from outside hospitalsAdverse outcomesIntensive Care Unit admissionsOpioid useNICU admissionsPatient satisfactionCost of inpatient admissionCost of outpatient careHospital readmissions rate
Control; A matched controlled group patients not seen at the CPO clinic

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hospital length of stay	Total days of hospital admission	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of admissions from outside hospitals	The total number of admissions to any other hospitals prior to admission or after discharge	1 year
ICU admissions	Whether patient needed ICU admission or transfer	1 year
Opioids use	To determine if patient require opioid use	1 year
Neonatal Intensive Care Unit (NICU) admissions	Number of times a neonate got admitted to the NICU	1 year
Patient satisfaction	Whether patient was satisfied (yes/no) with treatment course based on survey filled out by patient.	1 year
Cost of inpatient admission	the entire admission cost of admission during hospital stay	1 year
Cost of outpatient care	The cost for outpatient care incurred by patient	1 year
Hospital readmissions rate	The number of times a patient got readmitted after discharge	1 year

Collaborators and Investigators

• Sponsor: Johns Hopkins University
• Investigators: Principal Investigator: Jamie D Murphy, MD, Johns Hopkins University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2017
• Primary Completion (Actual): January 1, 2018
• Study Completion (Actual): December 1, 2020

Study Registration Dates

• First Submitted: May 1, 2018
• First Submitted That Met QC Criteria: May 1, 2018
• First Posted (Actual): May 11, 2018

Study Record Updates

• Last Update Posted (Actual): September 13, 2021
• Last Update Submitted That Met QC Criteria: September 9, 2021
• Last Verified: July 1, 2020

More Information

Terms related to this study

• Keywords: telemedicine; obstetric anesthesia
• Other Study ID Numbers: IRB00163559

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No