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 or ganization to identify and provide case management of women at risk of preterm labor and to determine important risk factors for preterm lab or in a managed care population. Data were collected on 794 women who completed an initial prenatal care visit at HealthAmerica of Pittsburg h 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 t he risk assessment form were referred to a nurse case manager who prov ided education and support, Results of a logistic regression analysis suggest that the risk assessment tool was effective in identifying wom en at risk for preterm labor. ''Physical/stressful work,'' as assessed by the patient, history of a prior preterm birth, and multiple gestat ion were all statistically significant predictors of preterm birth. Fu rther research is needed to confirm the finding that physical or stres sful work is a significant predictor of preterm births and to determin e which aspects of the work may increase the patient's risk. This stud y was based on 8 months of data; however, additional program implement ation is needed to evaluate fully the potential long-term benefits of the program.