Background: The rapidly rising prevalence of gestational diabetes mellitus (GDM) poses major challenges to the efficient, timely and sustainable provision of prenatal care. A GDM pregnancy has a significant impact on pregnancy outcomes, health service resources, and a substantial financial and time impost on women. 

Aim: This study had two aims; the first, to assess whether the implementation of a novel, woman-focussed, digitally-supported model of care would improve efficiency without compromising clinical outcomes in a cohort of women with GDM.  Secondly, we aimed to undertake a cost-minimisation analysis of the new model of care, compared with conventional care.  

Methods: A digitally-supported model of care was developed, implemented and evaluated using a prospective pre-post study design in 2020-21 at a quaternary centre with a culturally diverse population. Within a reduced-visit, shared-CDE/Dietitian appointment schedule we introduced six culturally and linguistically tailored, co-created educational videos, home delivery of equipment and prescriptions, and a smartphone app-to-clinician portal for glycaemic review and management. Outcomes were prospectively recorded by an electronic medical record. Associations between model of care and maternal and neonatal characteristics and birth outcomes were examined for all women and separately by treatment received (diet, metformin, insulin). Our hospital cares for approximately 1200 women with GDM per annum providing the basis for overall costing. Service costs were estimated using the resource method, where resource volumes and costs were gathered from experts within the health service. Patient costs were estimated using results from a short survey completed by a subset of the study population.

Results: Comparing pre-implementation (n=598) and post-implementation (n=337) groups, maternal (onset, mode of birth) and neonatal (birthweight, large for gestational age-LGA, nursery admission) clinical outcomes were clinically equivalent for novel model of care compared to conventional care. Health service costs showed a modest saving of A$17,442 in the intervention group over a 12-month period. Cost savings for the woman were estimated at $5676 per patient after accounting for mitigation of lost wages, childcare expenses, and travel expenses. This reduction led to an overall saving of $679,872 for the cohort of 1200 women due to the reduction in face-to-face visits.  

Conclusion: This woman-focussed, digitally-supported radical service redesign demonstrates reassuring clinical outcomes in a culturally diverse GDM cohort. It also demonstrated substantial cost savings without compromising clinical outcomes. Despite the lack of randomisation, this intervention has potential generalisability for GDM care and important key learnings for service redesign in the digital era.