The Center for Peripartum Optimization

Study Overview
=================
Brief Summary
-----------------
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.

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

Conditions
-----------------
Obstetric Complication, High Risk Pregnancy, Multidisciplinary Communication, Communication

Intervention / Treatment
-----------------
* Other: Seen in clinic


Participation Criteria
=================
Eligibility Criteria
-----------------
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

Ages Eligible for Study
-----------------
Maximum Age: 60 Years

Sexes Eligible for Study
-----------------
Female

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Study<br>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<br>* 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 hospitals Adverse outcomes Intensive Care Unit admissions Opioid use NICU admissions Patient satisfaction Cost of inpatient admission Cost of outpatient care Hospital readmissions rate<br>|
| Control<br>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 | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
obstetric anesthesia, telemedicine