If efforts to provide quality health care services at reasonable costs are to succeed, it is essential to empirically document the health care problems of patient groups, provider interventions to address these health problems, and the number and time of provider contacts needed to achieve optimal patient outcomes. This is especially true for high risk patient groups. Pregnant women at high risk of delivering low birth weight infants are one such group. The purposes of this study are to: 1) descdbe health problems and advanced practice nurse (APN) interventions for women during and following high risk pregnancy from one randomized controlled trial; 2) compare health problems and APN interventions between 2 randomized controlled trials delivering care to high risk pregnant women; and 3) begin to establish links between health problems, APN interventions, APN time and number of contacts with maternal and infant outcomes and health care costs for women with high risk pregnancies. The proposed study is an analysis of the APN interaction logs (interactions between the APN and the women during and following pregnancy that were recorded almost verbatim at the time of care delivery) and a secondary analysis of outcome data generated from 2 randomized controlled trials that tested a model of APN transitional care to women with high risk pregnancies. In one trial, the intervention group received APN prenatal care added to physician care. In the second trial in the intervention group, half of physician prenatal care delivered in the clinic was substituted with APN prenatal care delivered in the women's homes. In the proposed study, APN interaction logs will be analyzed using the Omaha classification system to document health problems and APN interventions. Patient outcome variables (morbidity, satisfaction with care, affect, and health care costs) will be used to link outcomes with health problems, APN interventions (practices), APN time and contacts, and patient characteristics. Data analysis wil include descriptive statistics and inferential statistics (chi-square, t-tests, and oneway ANOVAs). Study findings will be important to those who provide and pay for health care in the nation, for education of health care providers, and for further research.
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