A randomized trial of nurse specialist home care for women with high-risk pregnancies: Outcomes and costs

Objective: To examine prenatal, maternal, and infant outcomes and costs thr ough 1 year after delivery using a model of prenatal care for women at high risk of delivering low-birthweight infants in which half of the prenatal c are was provided in women's homes by nurse specialists with master's degree s. Study Design: Randomized clinical trial. Patients and Methods: A sample of 173 women (and 194 infants) with high-ris k pregnancies (gestational or pregestational diabetes mellitus, chronic hyp ertension, preterm labor, or high risk of preterm labor) were randomly assi gned to the intervention group (85 women and 94 infants) or the control gro up (88 women and 100 infants). Control women received usual prenatal care. Intervention women received half of their prenatal care in their homes, wit h teaching, counseling, telephone outreach, daily telephone availability, a nd a postpartum home visit by nurse specialists with physician backup. Results: For the full sample, mean maternal age was 27 years; 85.5% of wome n were single mothers, 36.4% had less than a high school education, 93.6% w ere African American, and 93.6% had public health insurance, with no differ ences between groups on these variables. The intervention group had lower f etal/infant mortality vs the control group (2 vs 9), 11 fewer preterm infan ts, more twin pregnancies carried to term (77.7% vs 33.3%), fewer prenatal hospitalizations (41 vs 49), fewer infant rehospitalizations (18 vs 24), an d a savings of more than 750 total hospital days and $2,880,000. Conclusion: This model of care provides a reasoned solution to improving pr egnancy and infant outcomes while reducing healthcare costs.