CHDR Funded Pilot Studies

Efficacy and Cost-effectiveness of Nurse Case Management in a Managed Care Prenatal Program

Elizabeth Jordan, DNSc, RNC (JHUSON)

Given the high-risk prenatal health status of many of the women in nurse case management, it is important to understand if prenatal nurse case management improves neonatal outcomes. The objective of this study is to examine the efficacy and cost-effectiveness of nurse case management in a managed care prenatal program.

Clinical and financial databases from a mid-Atlantic Managed Care Organization will be used to examine the impact of prenatal nurse case management and costs of prenatal care based on the neonatal outcomes of birth weight, NICU length of stay, and neonatal hospital costs among a sample of newborns admitted to NICU. A non-experimental/retrospective analysis of medical records of patients enrolled in the managed care organization will be used to conduct the study. The maternity clinical database will include representation from all five regions of the mid-Atlantic state from 2002-2004.

The Structure and Process in Birth Weight Outcome framework will be used to guide this study. The following structure variables will be examined: maternal age, maternal education, and maternal race. The process variables to be examined will be nurse case management and prenatal care costs. Prenatal care initiation, number of prenatal visits, and smoking status will also be included as process variables. The neonatal outcomes to be studied are birth weight, NICU length of stay, and neonatal hospital costs. Medical records from the managed care organization will be linked with a financial database, specifically patient billing and hospital financial databases. The results will be analyzed using multivariate analysis.