In-home nursing care for women with high-risk pregnancies: outcomes and cost

Obstet Gynecol. 2001 Jun;97(6):982-7. doi: 10.1016/s0029-7844(01)01360-6.


Objective: To evaluate a program that provides in-home care to women with pregnancies threatened by preterm delivery (including preterm labor, preterm premature rupture of membranes, and multiple gestation) and women with pregnancy-related hypertension.

Methods: Data from hospital discharge summaries were used to compare birth outcomes and cost of care for women in the in-home program and a cohort of women who received in-hospital antenatal care before the new program. Birth outcomes included data for mothers and infants. The sample included 437 women with threatened preterm delivery (n = 228 in-home, n = 209 in-hospital) and 308 with hypertension (n = 155 in-home, n = 153 in-hospital). The cost per woman included all costs of services for mothers and infants.

Results: Women at risk of preterm delivery who received in-home care were half as likely to have their infants in the neonatal intensive care unit more than 48 hours (odds ratio 0.53, 95% confidence interval 0.36, 0.78). On average, their infants weighed more (2732 +/- 716 g versus 2330 +/- 749 g, P <.001) and were 2 weeks older at birth (36.1 +/- 3.1 weeks versus 34.0 +/- 4.0 weeks, P <.001). There was a wide range in the total cost per woman and no significant difference between cohorts. For women with hypertension, there were no significant differences between in-home and in-hospital cohorts in birth outcomes or costs of care per woman.

Conclusion: The program with current admission criteria, staffing, and guidelines for antenatal hospital admission provides safe care to women at similar cost to that of hospitalization.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Canada
  • Cohort Studies
  • Community Health Nursing / economics*
  • Cost-Benefit Analysis
  • Female
  • Health Care Costs
  • Home Care Services / economics
  • Home Care Services / organization & administration*
  • Humans
  • Infant, Newborn
  • Nursing Evaluation Research
  • Nursing Service, Hospital / economics
  • Pregnancy
  • Pregnancy Complications / nursing*
  • Pregnancy Outcome*
  • Pregnancy, High-Risk*
  • Prenatal Care / economics*
  • Prenatal Care / methods*
  • Probability
  • Program Evaluation
  • Reference Values
  • Retrospective Studies