Identification and case management in an HMO of patients at risk of preterm labor.
We carried out a study of pregnant patients in a health maintenance organization to identify and provide case management of women at risk of preterm labor and to determine important risk factors for preterm labor in a managed care population. Data were collected on 794 women who completed an initial prenatal care visit at HealthAmerica of Pittsburgh between July 15, 1994, and March 31, 1995, and delivered at a local Pittsburgh hospital. The patients were assessed during an initial call to schedule their first prenatal visit and also at the 8- to 15-week and 24- to 28-week prenatal visits. Patients scoring 10 or higher on the risk assessment form were referred to a nurse case manager who provided education and support. Results of a logistic regression analysis suggest that the risk assessment tool was effective in identifying women at risk for preterm labor. "Physical/stressful work", as assessed by the patient, history of a prior preterm birth, and multiple gestation were all statistically significant predictors of preterm birth. Further research is needed to confirm the finding that physical or stressful work is a significant predictor of preterm births and to determine which aspects of the work may increase the patient's risk. This study was based on 8 months of data; however, additional program implementation is needed to evaluate fully the potential long-term benefits of the program.
Lear
D
D
University of Pittsburgh, PA 15261, USA.
Schall
L C
LC
Marsh
G M
GM
Liu
K S
KS
Yao
Y
Y
D019090:Case Management; D005260:Female; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006801:Humans; D007752:Obstetric Labor, Premature; D010414:Pennsylvania; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods / Q000458:organization & administration*; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors