Clinical, psychosocial, and economic effects of antenatal day care for three medical complications of pregnancy: a randomised controlled trial of 395 women.
BACKGROUND
Day care is increasingly being used for complications of pregnancy, but there is little published evidence on its efficacy. We assessed the clinical, psychosocial, and economic effects of day care for three pregnancy complications in a randomised trial of day care versus standard care on an antenatal ward.


METHODS
395 women were randomly assigned day (263) or ward (132) care in a ratio of two to one, stratified for major diagnostic categories (non-proteinuric hypertension, proteinuric hypertension, and preterm premature rupture of membranes). The research hypothesis was that for these disorders, as an alternative to admission, antenatal day care will reduce specified interventions and investigations, result in no differences in clinical outcome, lead to greater satisfaction and psychological wellbeing, and be more cost-effective. Data were collected through case-note review, self-report questionnaires (response rates 81.0% or higher) and via the hospital's financial system. Analysis was by intention to treat.


RESULTS
All participants were included in the analyses. There were no differences between the groups in antenatal tests or investigations or intrapartum interventions. The total duration of antenatal care episodes was shorter in the day-care group than in the ward group (median 17 [IQR 5-9] vs 57 [35-123] h; p=0.001). Overall stay was also significantly shorter in the day-care group (mean 7.22 [SE 0.31] vs 8.53 [0.44]; p=0.014). The median number of care episodes was three (range one to 14) in the day-care group and two (one to nine) in the ward group (p=0.01). There were no statistically or clinically significant differences in maternal or perinatal outcomes. The day-care group reported greater satisfaction, with no evidence of unintended psychosocial sequelae. There was no significant difference in either average cost per patient or average cost per day of care.


CONCLUSIONS
Since clinical outcomes and costs are similar, adoption by maternity services of a policy providing specified women with the choice between admission and day-unit care seems appropriate.
Turnbull
Deborah A
DA
Department of General Practice, Women's and Children's Hospital, Adelaide, Australia. deborah.turnbull@adelaide.edu.au
Wilkinson
Chris
C
Gerard
Karen
K
Shanahan
Marian
M
Ryan
Philip
P
Griffith
Elizabeth C
EC
Kruzins
Gillian
G
Stamp
Georgina E
GE
D000328:Adult; D002755:Choice Behavior; D003362:Cost-Benefit Analysis; D003631:Day Care, Medical / Q000191:economics / Q000379:methods* / Q000523:psychology; D017050:Episode of Care; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000523:psychology / Q000628:therapy; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007231:Infant, Newborn; D009775:Obstetrics and Gynecology Department, Hospital / Q000191:economics; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D011225:Pre-Eclampsia / Q000191:economics / Q000523:psychology / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000523:psychology / Q000628:therapy*; D011295:Prenatal Care / Q000191:economics / Q000379:methods*