Hospital Charges at Birth and Frequency of Rehospitalizations and Acute Care Visits over the First Year of Life

The proportion of preterm and low-birth-weight infants has been growing steadily for two decades. Most of the more than $10 billion spent on neonatal care in the United States in 2003 was spent on the 12.3% of infants who were born preterm. Research has shown higher initial hospital costs and a higher rate of acute care visits and rehospitalization for preterm and low-birth-weight infants, but only a limited number of studies of the cost of prematurity that follow infants through the first year of life have been conducted. This study is a secondary analysis of data on a subset of infants drawn from a randomized clinical trial that examined health outcomes and health care costs in women with high-risk pregnancies and their infants. For the current study, a sample of 84 singleton infants was chosen. Forty-three infants (51 %) were full term (37 weeks’ gestation or more) and 41 (49%) were born preterm (less than 37 weeks’ gestation). Fifty-five infants (65.5%) were born at normal birth weights (2,500 g or greater), 24 (28.5%) were born at low birth weights (1,501 to 2,499 g), and five (6%) were born at very low birth weights (less than 1,500 g). Data on the initial hospital charges and the rates of rehospitalization and acute care visits in the first year of life in relation to gestational age and birth weight were collected. The results clearly demonstrated that the charges for initial hospitalizations increased as birth weights and gestational ages decreased. Low-birth-weight infants were less likely to have unscheduled acute care visits than normal-birth-weight infants. Interventions to improve prenatal care targeted to women at high risk for delivering preterm or low-birth-weight infants would reduce health care costs and improve health outcomes of infants as well

Lessons Learned from Testing the Quality Cost Model of Advanced Practice Nursing (APN) Transitional Care

Purpose To describe the development, testing, modification, and results of the Quality Cost Model of Advanced Practice Nurses (APNs) Transitional Care on patient outcomes and health care costs in the United States over 22 years, and to delineate what has been learned for nursing education, practice, and further research. Organizing Construct The Quality Cost Model of APN Transitional Care. Methods Review of published results of seven randomized clinical trials with very low birth-weight (VLBW) infants; women with unplanned cesarean births, high risk pregnancies, and hysterectomy surgery; elders with cardiac medical and surgical diagnoses and common diagnostic related groups (DRGs); and women with high risk pregnancies in which half of physician prenatal care was substituted with APN care. Ongoing work with the model is linking the process of APN care with the outcomes and costs of care. Findings APN intervention has consistently resulted in improved patient outcomes and reduced health care costs across groups. Groups with APN providers were rehospitalized for less time at less cost, reflecting early detection and intervention. Optimal number and timing of postdischarge home visits and telephone contacts by the APNs and patterns of rehospitalizations and acute care visits varied by group. Conclusions To keep people well over time, APNs must have depth of knowledge and excellent clinical and interpersonal skills that are the hallmark of specialist practice, an in-depth understanding of systems and how to work within them, and sufficient patient contact to effect positive outcomes at low cost

Issues in the application of research to practice

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/88183/1/ketefian-issues_application_research_practice.pd

The experiences of pregnant women at an advanced maternal age: an integrative review

Abstract OBJECTIVE To identify in the literature how the experiences of women age 35 or above are described in terms of pregnancy. METHOD Integrative review based on MEDLINE/PubMed, CINAHL, LILACS, and SciELO databases, with no time period constraint. RESULTS Eighteen studies that dealt with the experiences of pregnant women at an advanced maternal age were selected and analyzed. The studies evidenced four theme categories: the search for information, which pointed to a deficit of information supplied by health care professionals; perceiving the risks, which pointed to women's concerns about their own health and their children's; the ideal moment for motherhood, with different reasons for postponing it; and adjusting to a new routine, showing a concern regarding changes in daily life. CONCLUSION From the results, it was possible to understand that other factors, in addition to those that include risks, are present in the experiences of older pregnant women and point to a need to involve such aspects in nursing care to create comprehensive strategies that are aligned with these women's needs

Insatisfação corporal em gestantes: uma revisão integrativa da literatura

Resumo A imagem corporal de gestantes deve ser alvo de atenção por parte dos profissionais, tendo em vista a promoção da saúde materna infantil. O objetivo da presente revisão integrativa foi analisar a literatura sobre imagem e insatisfação corporal em gestantes. Foram buscados artigos nas bases de dados Scopus, PubMed, BVS e PsycINFO utilizando o cruzamento de “pregnancy” com as palavras-chave: “body image” e “body dissatisfaction”. Após a adoção dos critérios de inclusão e exclusão foram analisados 40 estudos. Estes apontam dados inconclusivos quanto à insatisfação corporal durante a gestação. Presença de sintomas depressivos, baixa autoestima, atitude alimentar inadequada e ganho de peso fora dos limites recomendados têm sido associados a uma imagem corporal negativa. Contradições nos achados podem estar relacionados às diferenças nos instrumentos utilizados para mensurar a imagem corporal. Pelo possível impacto de uma imagem corporal negativa durante a gestação na saúde materna e infantil, são recomendadas novas investigações, em especial o desenvolvimento de um instrumento avaliativo de imagem corporal específico para gestantes