Findings show that for those receiving home visits compared to usual care:
· Infant mortality was lowered (2 versus 9 deaths)
· There were 11 fewer preterm births than controls
· More twin pregnancies were carried to term (77.7% versus 33.3%)
· There were fewer prenatal (41 versus 49) and infant (18 versus 24) rehospitalizations
· Savings to the healthcare system were significant -- over 750 hospital days and $2,880,000.
Participants in the study were 173 women with high-risk pregnancies and 194 infants. Most were low-income African American Medicaid recipients. Women in the intervention group received half of their prenatal care in the home from advanced practice nurses and half from physicians at the University of Pennsylvania hospital clinic. During the postpartum period, mothers and infants received one home visit and eight weekly phone calls from the nurse, who was also reachable daily by phone. The control group received standard prenatal and postpartum care for high risk patients, provided at the hospital clinic. For both groups, health outcomes and costs were examined during the prenatal period through a year after birth.
According to Dr. Dorothy Brooten, the study's principal investigator, "These findings demonstrate the importance of an approach that prolongs pregnancies, which improve the health of mother and child. Concurrently, we can also save money. This is especially important for patient groups at high risk for infant mortality and other pregnancy-related problems, such as low income African Americans."
The prenatal home visits involved monitoring maternal and fetal health, as well as counseling and referrals. Other advantages related to fewer hospital clinic visits, which reduced transportation problems, need for child care, and long waits to be seen. "For some women," added Dr. Brooten, "coming to the clinic for prenatal care involved 10 hours out of their day door to door."
Dr. Patricia Grady, Director of the National Institute of Nursing Research, said "The implications of this intervention for managed care are significant - improved quality of care, shortened patient stays in the hospital, and reduced costs. Furthermore, this study has successfully addressed an important health disparity involving a vulnerable population that is subject to poor pregnancy outcomes."
The intervention used in this study is a modification of a model of transitional care provided by nurses with master's degrees, developed by Dr. Brooten and colleagues, and tested with a variety of patient populations -- with similar favorable results. These patients included older people, pregnant women with diabetes, women having hysterectomies, women after unplanned Cesarean births, and very low birthweight infants.
The National Institute of Nursing Research is a component of the National Institutes of Health, U.S. Department of Health and Human Services.
The American Journal of Managed Care