title: Evaluating the social and economic impact of community-based prenatal care.
abstract: OBJECTIVE
  This article describes the evaluation and findings of a community-based prenatal care program, Omaha Healthy Start (OHS), designed to reduce local racial disparities in birth outcomes.
  
  
  METHODS
  This evaluative study used a comparative descriptive design, and Targeting Outcomes of Programs was the conceptual framework for evaluation.
  
  
  METHODS
  The evaluation followed 3 groups for 2 years: OHS birth mothers (N=79; N=157); non-OHS participant birth mothers (N=746; N=774); and Douglas County birth mothers (N=7,962; N=7,987).
  
  
  METHODS
  OHS provided case management, home visits, screening, referral, transportation, and health education to participants. Program outcome measures included low birth weight, infant mortality, adequacy of care, trimester of care, and costs of care.
  
  
  RESULTS
  OHS birth outcomes improved during year 2, and there was a 31% cost saving in the average hospital expenditure compared with the nonparticipant groups. Preliminary evaluative analysis indicates that prenatal case management and community outreach can improve birth outcomes for minority women, while producing cost savings.
  
  
  CONCLUSIONS
  Further prospective study is needed to document trends over a longer period of time regarding the relationship between community-based case management programs for minority populations, birth outcomes, and costs of care.
authors.affiliation: College of Nursing and College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA. mecramer@unmc.edu
authors.forename: Mary E
authors.initials: ME
authors.lastname: Cramer
authors.forename: Li-Wu
authors.initials: LW
authors.lastname: Chen
authors.forename: Sara
authors.initials: S
authors.lastname: Roberts
authors.forename: Dorothea
authors.initials: D
authors.lastname: Clute
mesh_terms: D019090:Case Management / Q000191:economics*; D003152:Community Health Nursing / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007231:Infant, Newborn; D008913:Minority Groups; D009329:Nebraska; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology*; D011295:Prenatal Care / Q000191:economics*; D015397:Program Evaluation