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Improving Pregnancy Outcome and Reducing Avoidable Clinical Resource Utilization Through Telephonic Perinatal Care Coordination

Little, Mary RN; Saul, Gwen D. RN; Testa, Karen BSN, RN; Gaziano, Cecilie PhD, MA, BSJ


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 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.

Mary Little, RN, is a Perinatal Case Manager for the ROSEBUD program at ING Re. She graduated from Arthur B. Ancker Memorial School of Nursing in St. Paul, MN, and has over 25 years of experience in perinatal nursing. She worked for 15 years with a high-risk pregnant Medicaid population at an inner-city hospital.

Gwen D. Saul, RN, is a Perinatal Case Manager for the ROSEBUD program at ING Re. She graduated from Methodist-Kahler School of Nursing, Rochester, MN. She has over 24 years of experience working with obstetrical, pediatric, and medical-surgical patients in the clinic and hospital setting. Gwen has worked as a high-risk obstetrical case manager for 8 years.

Karen Testa, BSN, RN, is a High-risk Perinatal Nurse Case Manager and quality assurance lead for the ROSEBUD program at ING Re. She received her bachelor of science degree in nursing from The College of St. Benedict. Her experience includes obstetrics and at-risk infants in a variety of settings including hospital, clinic, and home care.

Cecilie Gaziano, PhD, MA, BSJ, is a Social Science Consultant at Research Solutions, Inc. She received a master’s degree in science writing and a doctorate in mass communication theory and methodology from the University of Minnesota. Her experience includes health communication issues, customer satisfaction surveys, and data analysis of twins in utero.

Note: The reader is referred to the article “The Influence of Telephonic Nursing Care Coordination on Patient Satisfaction in a Predominantly Low-income, High-risk Pregnancy Population” (Lippincott’s Case Management, January/February 2002;7[1]) which discusses the ROSEBUD® program and its effects on patient satisfaction.

Address correspondence and reprint requests to: Mary Little, RN, Perinatal Nurse Consultant, ROSEBUD Program, ING Re, Group Life, Accident and Health Reinsurance, 20 Washington Avenue South, Minneapolis, MN 55401 (e-mail:

© 2002 Lippincott Williams & Wilkins, Inc.