Teen-focused care versus adult-focused care for the high-risk pregnant adolescent: An outcomes evaluation

The purpose of this retrospective, matched-case comparison study was to com pare outcomes and cost-effectiveness of comprehensive, interdisciplinary te en-centered prenatal care clinics (Young Women's Clinic & Teen Pregnancy an d Parenting Clinic) with "traditional" adult-centered obstetric services (U niversity of Washington Medical Center & Group Health Cooperative) in a uni versity medical center and a staff-model HMO. The sample (n = 106) included 27 index teens from Young Women's Clinic and matched cases from the other three clinics, matched on nine risk variables. Findings showed that teen-cl inic clients missed fewer appointments (0.96 vs. 2.29, p < 0.05), were more likely to be enrolled in the supplemental Medicaid program First Steps (p < 0.001) and WIC (p < 0.01), were more likely to have vaginal deliveries (9 0% vs. 75%, p < 0.05) and higher birth weight infants (3330 vs. 3084 g, p < 0.05), and were more likely to attend 2-week (p < 0.001) and 6-week postpa rtum exams (p < 0.05). Postpartum data were missing for the majority of adu lt-clinic subjects; teen-clinic postpartum outcomes included high contracep tion rates (87.5%), breastfeeding (62%), school return postpartum (63%), an d long-term follow-up. Costs were lower for teen clinics based on outcomes; cost savings related to preterm labor were similar.