The focus of this program grant is maintaining a balance between the cost of health care and quality of health care. Using randomized clinical trials in three patient groups, the program project proposes to compare cost of health care and quality of care, as reflected in patient outcomes, between patients discharged routinely from hospitals and patients discharged early using a model of nurse specialist transitional followup care. Cost of care measures include initial hospitalization, rehospitalization, physician services, and for the early discharge group, nurse specialist services and time lost from employment by family members during the period of early discharge. Patient outcomes common across groups include morbidity (infection, acute care visits, rehospitalization), anxiety, depression, hostility, self esteem, and satisfaction with care. Each study includes additional patient outcomes important to that population. The three study groups include women with unplanned cesarean birth, childbearing diabetics, and woman post hysterectomy surgery. These groups are important for the study because these events affect large numbers of women annually; each group is beginning to experience earlier discharge as a result of cost containment efforts; these groups are representative of many groups in need of transitional care rather than longterm care. The purpose of the core grant is to: provide an administrative structure and function which will facilitate the research of the program; analyze patient outcomes across groups; conduct the analysis of cost of care within and across groups; classify interventions used by nurse specialists in transitional followup across groups. Date analysis will include chi-square, analysis of variance with repeated measures, and two-way analysis of variance. Comparisons of patient outcomes and cost of care within and across groups will increase knowledge of: outcomes of patient's discharge earlier; safety and efficacy of early discharge with nurse specialist home followup substituting for a portion of hospitalization. Categorization of nursing interventions will provide a profile of the types of interventions used by nurse specialists in early discharge and followup.
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