title: A cost-effectiveness analysis of three staffing models for the delivery of low-risk prenatal care.
abstract: BACKGROUND
  Health care costs are increasing at more than twice the rate of inflation, thus, public officials are seeking safe and economic methods to deliver quality prenatal care to poor pregnant women. This study was undertaken to determine the relationship between the cost and effectiveness of three prenatal clinic staffing models: physician based, mixed staffing, and clinical nurse specialist with physicians available for consultation.
  
  
  METHODS
  Maternal and neonatal physiological outcome data were obtained from the hospital clinical records of 156 women attending these clinics. The women were then interviewed concerning their satisfaction with their prenatal care clinic. The financial officer from each clinic provided data on the clinic staffing costs and hours of service.
  
  
  RESULTS
  There were no differences in outcomes for the maternal-neonatal physiological variables, although newborn admission to the Neonatal Intensive Care Unit (NICU) approached significance among the clinics. The clinic staffed by clinical nurse specialists had the greatest client satisfaction and the lowest cost per visit.
  
  
  CONCLUSIONS
  The use of clinical nurse specialists might substantially reduce the cost of providing prenatal care while maintaining quality, and might thereby save valuable resources.
authors.affiliation: University of Texas Health Science Center, San Antonio 78284-7948.
authors.forename: E A
authors.initials: EA
authors.lastname: Graveley
authors.forename: J H
authors.initials: JH
authors.lastname: Littlefield
mesh_terms: D000553:Ambulatory Care / Q000191:economics* / Q000592:standards; D003362:Cost-Benefit Analysis; D004522:Educational Status; D004526:Efficiency; D005006:Ethnicity; D005260:Female; D006302:Health Services Research; D006801:Humans; D009720:Nurse Clinicians / Q000191:economics* / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D010561:Personnel Staffing and Scheduling / Q000191:economics*; D010820:Physicians / Q000191:economics* / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000191:economics* / Q000592:standards; D011787:Quality of Health Care; D012456:Salaries and Fringe Benefits; D000078329:Workforce