(669) Evaluating the Impact of a Novel Shared Medical Appointment Model for Gestational Diabetes Care

Optimizing care delivery for gestational diabetes (GDM) has the potential to improve maternal and fetal/neonatal outcomes. The Shared Medical Appointment (SMA) has emerged as a novel tool to improve access as well as patient engagement and satisfaction by providing group care for patients sharing a common diagnosis. This study evaluated the impact of introducing an SMA model for GDM care.

Study Design:

This a retrospective cohort study with a pre/post design at 2 hospitals in a single health system. All patients with a diagnosis of GDM who delivered >20 weeks from 1/1/2018-12/31/2022 were included. The SMA model was initiated 1/1/2021 with 8 patient slots/week, capturing 45% of the GDM patient population. Prior to this, all patients with GDM had traditional MFM consults. Patient demographic and clinical data were compared before and after initiation of the SMA. The primary outcome was a composite of GDM-related adverse obstetric outcomes including fetal demise, macrosomia ( > 4000g), NTSV cesarean delivery, and NICU admission. Multivariable logistic regression evaluated the primary outcome before and after instituting the GDM SMA. Yearly incidence of the primary outcome was evaluated for the entire obstetric population during this period to assess for a secular trend.

Results:

2,309 patients with GDM were included (4.8% of all delivered patients during the study period) with 821 cases of the primary outcome (35.6%). Patient characteristics pre/post introduction of the SMA are depicted in Table 1. Significant differences were noted in maternal age and OBCMI (higher post-SMA) and nulliparity and pregravid BMI (higher pre-SMA). On adjusted analysis, there was a lower adjusted odds ratio (aOR) for the primary outcome (0.826, 95% CI 0.685-0.995, p = 0.044) with the SMA, driven by decreased odds of NICU admission (Table 2). There was no evidence of a secular trend in the primary outcome.  

Conclusion:

Innovations in care delivery for pregnancy complications like GDM have potential to improve obstetric outcomes. Further research can clarify implementation strategies and generalizability of this approach.