Comparison of a Collaborative Nurse System and a Tertiary Medical System of Perinatal Care for Rural Women

Abstract

The study was a retrospective program evaluation, using a matched comparison design, to determine differences in the quality of care provided to patients from twelve rural east central Georgia counties. The 377 subjects were poor, predominantly African-American, Medicaid-insured women who received perinatal care in a collaborative nurse system of care and a tertiary medical system of care. Matching factors were race, age group, gravidity, entry into care, and medical risks at entry into care. Components of existing data sets were combined into a data base. Brooten’s (1986) cost quality evaluation model guided the selection of the dependent variables. The matched design created confounding that must be considered in interpreting the findings; some women with unique constellations of risks were unable to be matched to controls, and more than half of the 131 matched sets were not straight-forward and had to be adjudicated by and expert panel. The distribution of birth weight in the two groups was not different . low birth weight rates in the two groups were 14.5 and 14.2 for the Jefferson County and the tertiary groups, respectively ; very low birth weight rates were .76 and 3.25, respectively. One neonatal death occurred in the Jefferson County group and four in the tertiary group. There were 3 sexually transmitted diseases at delivery in the Jefferson County group, compared to 28 in the tertiary group. Infant stays in the intermediate and/or intensive care nurseries required 103 hospital days in the Jefferson County group and 493 days in the tertiary group. Twenty-one of 65 (32%) matched sets with ill infants had more than one infant with possible morbidity or death. The differences in very low birth weight infants, neonatal death outcomes, infant stays in intermediate and intensive care nurseries, and sexually transmitted diseases at delivery give support for further evaluation of the effectiveness of utilizing a model of comprehensive perinatal nursing in a community-tertiary partnership. This collaborative system may deliver care that achieves uniquely improved health outcomes for rural women.