A cost-effectiveness analysis of three staffing models for the delivery of low-risk prenatal care.

Abstract

BACKGROUND. Health care costs are increasing at more than twice the rate of inflation, thus, public officials are seeking safe and economic methods to deliver quality prenatal care to poor pregnant women. This study was undertaken to determine the relationship between the cost and effectiveness of three prenatal clinic staffing models: physician based, mixed staffing, and clinical nurse specialist with physicians available for consultation. METHODS. Maternal and neonatal physiological outcome data were obtained from the hospital clinical records of 156 women attending these clinics. The women were then interviewed concerning their satisfaction with their prenatal care clinic. The financial officer from each clinic provided data on the clinic staffing costs and hours of service. RESULTS. There were no differences in outcomes for the maternal-neonatal physiological variables, although newborn admission to the Neonatal Intensive Care Unit (NICU) approached significance among the clinics. The clinic staffed by clinical nurse specialists had the greatest client satisfaction and the lowest cost per visit. CONCLUSIONS. The use of clinical nurse specialists might substantially reduce the cost of providing prenatal care while maintaining quality, and might thereby save valuable resources.

Meeting Health Care Needs of a Vulnerable Population: Perceived Barriers

“…These concerns are congruent with findings from other research (Graveley & Littlefield, 1992;Olivo, Freda, Piening, & Henderson, 1994;Welch, 1996) in which it has been found that women prefer female providers who they find more understanding and knowledgeable, especially in regard to women's problems. For many low-income women and children, the health care system itself can be perceived as a barrier, as access to health care can be foiled by inflexible office hours that do not accommodate working mothers and school-age children (Ahmed & Maurana, 1999;Salganicoff & Wyn, 1999), and having to spend more than the usual time waiting at clinics is a common dissatisfaction (Riportella-Muller et al, 1996;Salganicoff & Wyn, 1999;Stevenson et al, 1994).…”

“…There is ample support for nurse managed clinics with numerous reports documenting cost effectiveness and client satisfaction with primary health care received from NPs, nurse midwives, and advanced practice nurses (Bear & Bowers, 1998;Brown & Grimes, 1995;Chang et al, 1999;Graveley & Littlefield, 1992;Ramsey, Edwards, Lenz, Odom, & Brown, 1993).…”

Comprehensive measurement of maternal satisfaction: The modified Mason Survey

“…Similarly, 20 references to the measurement of maternal satisfaction were identified and included in the analysis: Astbury et al , 1994; 13 Bramadat and Driedger, 1993; 14 Brown and Lumley, 1994; 15 Cottrell and Grubbs, 1994; 16 Drew et al , 1989; 17 Flint et al , 1989; 18 Giles et al , 1992; 19 Graveley and Littlefield, 1992; 20 Green et al , 1990; 21 Hambly, 1997; 22 Higgins et al , 1994; 23 Hornberger et al 1996; 24 Jacoby, 1987; 25 Kenny et al , 1993; 26 Matthews, 1991; 27 Righard et al , 1993; 28 Rowley et al , 1995; 29 Seguin et al , 1989; 30 Small et al , 1992; 31 and Waldenstrom and Nilsson, 1993 32 …”

Interspecialty differences in the obstetric care of low-risk women.

“…Of the 9470 charts examined by the abstractors, 4431 (46.8%) met the eligibility criteria (Table 1); random-number tables were used to randomly select 11 charts from each provider's practice for inclusion in the study. Providers who had fewer than 11 eligible charts during the study year had all their eligible charts abstracted.…”