A competency based approach to comprehensive pregnancy care

This paper assesses the quality and cost of a pregnancy care program based on explicit and achieved patient competencies. By using the USPHS Content o f Prenatal Care (1989), key psychosocial/education elements of perinatal ca re were identified. The goal was a process of patient education that is com petency based, integrated, and outcome oriented. Psychosocial assessment, p atient education tools, criterion-based length of postpartum stay, and home nursing follow-up were implemented as part of a Comprehensive Pregnancy Pr ogram (CPP). Case-control and cohort survey methodology were used to evalua te outcome. There was a significant decrease in hospital length of stay for mothers and newborns after implementation of the CPP. Post-discharge mater nal emergency room visits and/or readmits did not increase. Differences in newborn emergency room visits and/or readmits were non-significant. There w as a marked reduction in hospital costs for mothers and newborns. Patient s atisfaction remained high. Core competencies forming the basis of education al and assessment programs allow the focus of care to be optimal outcome, a nd provide a useful template against which to measure prenatal, intrapartum , and postpartum care.