A Randomized Trial of Early Discharge and Nurse Specialist Transitional Follow Up Care of High Risk Childbearing Women

In a randomised clinical trial, quality of health care as reflected in patient outcomes and cost of health care was compared between two groups of high-risk childbearing women: women diagnosed with diabetes or hypertension in pregnancy. The control group was discharged routinely from the hospital. The intervention group was discharged early using a model of clinical nurse specialist transitional follow-up care. During pregnancy, the intervention group had significantly fewer rehospitalisations than the control group. For infants of diabetic women enrolled in the study during their pregnancy, low birth weight was three times more prevalent in the control group than in the intervention group. The postpartum hospital charges for the intervention group were also significantly less than for the control group. The mean total hospital charges for the intervention group were 44 percent less than for the control group. The mean cost of the clinical specialist follow-up care was two percent of the total hospital charges for the control group. A net savings of $13,327 was realised for each mother-infant dyad discharged early from the hospital.