title: A randomized trial of early discharge and nurse specialist transitional follow-up care of high-risk childbearing women.
abstract: In a randomized clinical trial, quality of health care as reflected in patient outcomes and cost of health care was compared between two groups of high-risk childbearing women: women diagnosed with diabetes or hypertension in pregnancy. The control group (N = 52) was discharged routinely from the hospital. The intervention group (N = 44) was discharged early using a model of clinical nurse specialist transitional follow-up care. During pregnancy, the intervention group had significantly fewer rehospitalizations than the control group. For infants of diabetic women enrolled in the study during their pregnancy, low birth weight (< or = 2,500 g) was three times more prevalent in the control group (29%) than in the intervention group (8.3%). The postpartum hospital charges for the intervention group were also significantly less than for the control group. The mean total hospital charges for the intervention group were 44% less than for the control group. The mean cost of the clinical specialist follow-up care was 2% of the total hospital charges for the control group. A net savings of $13,327 was realized for each mother-infant dyad discharged early from the hospital.
authors.affiliation: School of Nursing, University of Pennsylvania, Philadelphia 19104-6096, USA.
authors.forename: R
authors.initials: R
authors.lastname: York
authors.forename: L P
authors.initials: LP
authors.lastname: Brown
authors.forename: P
authors.initials: P
authors.lastname: Samuels
authors.forename: S A
authors.initials: SA
authors.lastname: Finkler
authors.forename: B
authors.initials: B
authors.lastname: Jacobsen
authors.forename: C A
authors.initials: CA
authors.lastname: Persely
authors.forename: A
authors.initials: A
authors.lastname: Swank
authors.forename: D
authors.initials: D
authors.lastname: Robbins
mesh_terms: D000328:Adult; D000359:Aftercare / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006699:Home Care Services / Q000458:organization & administration; D006760:Hospitalization / Q000191:economics; D006801:Humans; D006973:Hypertension / Q000451:nursing; D007231:Infant, Newborn; D016389:Maternal-Child Nursing / Q000191:economics; D009720:Nurse Clinicians / Q000458:organization & administration*; D010351:Patient Discharge; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000451:nursing; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000451:nursing; D018566:Pregnancy, High-Risk; D013997:Time Factors; D016896:Treatment Outcome