title: A randomized trial of nurse specialist home care for women with high-risk pregnancies: outcomes and costs.
abstract: OBJECTIVE
  To examine prenatal, maternal, and infant outcomes and costs through 1 year after delivery using a model of prenatal care for women at high risk of delivering low-birth-weight infants in which half of the prenatal care was provided in women's homes by nurse specialists with master's degrees.
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  A sample of 173 women (and 194 infants) with high-risk pregnancies (gestational or pregestational diabetes mellitus, chronic hypertension, preterm labor, or high risk of preterm labor) were randomly assigned to the intervention group (85 women and 94 infants) or the control group (88 women and 100 infants). Control women received usual prenatal care. Intervention women received half of their prenatal care in their homes, with teaching, counseling, telephone outreach, daily telephone availability, and a postpartum home visit by nurse specialists with physician backup.
  
  
  RESULTS
  For the full sample, mean maternal age was 27 years; 85.5% of women were single mothers, 36.4% had less than a high school education, 93.6% were African American, and 93.6% had public health insurance, with no differences between groups on these variables. The intervention group had lower fetal/infant mortality vs the control group (2 vs 9), 11 fewer preterm infants, more twin pregnancies carried to term (77.7% vs 33.3%), fewer prenatal hospitalizations (41 vs 49), fewer infant rehospitalizations (18 vs 24), and a savings of more than 750 total hospital days and $2,496,145 [corrected].
  
  
  CONCLUSIONS
  This model of care provides a reasoned solution to improving pregnancy and infant outcomes while reducing healthcare costs.
authors.affiliation: Case Western Reserve University School of Nursing, Cleveland, OH, USA. d.brooten@theresearchateam.com
authors.forename: D
authors.initials: D
authors.lastname: Brooten
authors.forename: J M
authors.initials: JM
authors.lastname: Youngblut
authors.forename: L
authors.initials: L
authors.lastname: Brown
authors.forename: S A
authors.initials: SA
authors.lastname: Finkler
authors.forename: D F
authors.initials: DF
authors.lastname: Neff
authors.forename: E
authors.initials: E
authors.lastname: Madigan
mesh_terms: D000328:Adult; D005260:Female; D017048:Health Care Costs; D006699:Home Care Services / Q000191:economics; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007231:Infant, Newborn; D017146:Models, Organizational; D009720:Nurse Clinicians / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D015143:Philadelphia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000191:economics / Q000453:epidemiology; D018566:Pregnancy, High-Risk; D011295:Prenatal Care / Q000191:economics / Q000458:organization & administration*; D000078329:Workforce