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

Objective: To assess concordance between family physician obstetric privile ge delineation and actual care delivered, and describe associated clinical and educational collaborations between family medicine and obstetrics and g ynecology. Methods: We conducted a descriptive retrospective review of the care and co mplications of 962 consecutive patients admitted to a family medicine obste tric 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 t o obstetricians (data missing for 11 patients). Spontaneous vaginal deliver ies 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 ident ified in 604 obstetric deliveries, 615 complications (66.4%) in 418 deliver ies 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 fami ly 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. ((C) 2000 by The American College of Obstetricians and Gynecologists.).