Improving pregnancy outcome and reducing avoidable clinical resource utilization through telephonic perinatal care coordination.

The effects of telephonic nursing case management and standard care in a low-income, high-risk pregnancy population, controlling for gestational age at referral and risk factors (medical, demographic, and behavioral) were compared. The hypothesis was that a program of telephonic perinatal nursing care coordination and case management would increase mean gestational ages and mean birth weights and would reduce clinical resource utilization, compared with standard nursing care. The methods focused on a telephonic model developed during the past 16 years that included risk assessment, patient education, coordination of care for home services and clinic appointments, coordination of interventions requested by care providers, and patient advocacy. The patient population, primarily of minority cultural and racial backgrounds, obtained prenatal care from two large obstetric clinics and delivered at a level-3 tertiary care center. They were randomly assigned to treatment (N = 61) and control (N = 50) conditions. Interpreters were used for any contacts with non-English-speaking patients. The results demonstrated increased mean birth weights for the treatment group when intervening variables were controlled. Mean gestational age at delivery was not significantly different between groups. Telephonic case management saved an average of 501.31 dollars per patient in inpatient and outpatient costs combined. In the treatment group, for every dollar spent on case management costs, the savings were 4.08 dollars.

The influence of telephonic nursing care coordination on patient satisfaction in a predominantly low-income, high-risk pregnancy population.

The effect of telephonic nursing case management on patient satisfaction in a predominantly non-Caucasian low-income, high-risk pregnancy population was studied. Patient satisfaction of care was significantly higher for treatment group participants than for controls on 9 of 10 items measuring satisfaction. The satisfaction score of the treatment patients, constructed by summing scores for each item, averaged 8 points higher than the control group's score. Demographics made little difference. Telephonic case management was the strongest predictor of satisfaction in a multiple regression analysis. Satisfaction was unrelated to mode of delivery, infant birth weight, or gestational age. The satisfaction levels of treatment patients were high, whether or not they had outpatient charges. Participants rated the program highly for the nurses' ability to answer questions, overall program experience, the opportunity to ask the nurses questions, health teachings and instructions received, and confidence in the nurse coordinating their care or their child's care.