title: University hospital-based prenatal care decreases the rate of preterm delivery and costs, when compared to managed care.
abstract: OBJECTIVE
  Our purpose was to compare the rate of recurrent preterm delivery and the combined costs of mother/infant care for patients with a history of preterm delivery cared for in an inner city hospital house staff (HS) clinic versus an inner city managed care organization (MCO).
  
  
  METHODS
  A retrospective cohort study was conducted. The groups consisted of 96 patients with a history of preterm delivery who were cared for by the HS clinic and 164 patients cared for in a neighborhood MCO. All patients with a history of previous preterm delivery who delivered at the Johns Hopkins Hospital between 1 January 1994 and 31 December 1996 were included in the study. The groups were examined regarding source of prenatal care for the subsequent pregnancy (HS vs. MCO), baseline demographics, intensity of prenatal care, maternal and neonatal outcomes and total cost of the provision of care.
  
  
  RESULTS
  There were no differences in baseline demographics between the groups. There was a higher rate of recurrent prematurity for patients cared for by the MCO (HS, 24% vs. MCO, 36%, p = 0.04). Mean total mother/infant costs were also higher in the MCO group ($13565) when compared to the HS group ($9082), (p = 0.02).
  
  
  CONCLUSIONS
  While some MCOs may provide cost savings for some low-risk populations, our study demonstrates that this health-care delivery system resulted in greater total expenditures for patients with a history of preterm delivery.
authors.affiliation: The Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, Baltimore, Maryland 21287-1228, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Bienstock
authors.forename: S H
authors.initials: SH
authors.lastname: Ural
authors.forename: K
authors.initials: K
authors.lastname: Blakemore
authors.forename: E K
authors.initials: EK
authors.lastname: Pressman
mesh_terms: D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D015331:Cohort Studies; D018588:Fee-for-Service Plans / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000191:economics; D006786:Hospitals, Urban / Q000191:economics; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008329:Managed Care Programs / Q000191:economics*; D007752:Obstetric Labor, Premature / Q000191:economics* / Q000453:epidemiology*; D010044:Outpatient Clinics, Hospital / Q000191:economics*; D010343:Patient Admission / Q000191:economics; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000191:economics* / Q000458:organization & administration; D012189:Retrospective Studies