A comparative evaluation of collaborative prenatal care

Objective: To evaluate the effectiveness of an advanced-practice nurse-obstetrician collaborative prenatal practice. Methods: A group of 194 consecutively enrolled medically low-risk obstetric patients was identified between January 1, 1994 and December 31, 1994 at Neighborhood Pregnancy Care, a collaborative-practice site. An equal number of medically low-risk patients attending the Louisiana State University obstetric clinic at the Medical Center of Louisiana at New Orleans was selected randomly from among those registering the same month. The two groups were compared on the primary outcome variable, low birth weight. Data were analyzed by chi(2), Fisher exact test, t test, and regression models. Results: We compared 179 collaborative-care and 181 university patients with retrievable information. By univariate analysis, collaborative-care patients more often were teenagers and black, and less likely to be married or employed. Collaborative-care patients had more prenatal visits and were more likely to participate in Medicaid, but less likely to deliver at the Medical Center of Louisiana at New Orleans. Birth weight and gestational age at delivery were greater. Both delivery before 37 weeks (7.3% versus 17.7%, P < .001) and birth weight less than 2500 g (8.9% versus 19.3%, P < .001) were less common. When differences identified at the initial obstetric visit were considered, multivariate weighted logistic regression confirmed the importance of prenatal care at the collaborative-practice program for low birth weight (odds ratio [OR] 0.37; 95% confidence interval [CI] 0.19, 0.71) and preterm delivery (OR 0.36; 95% CI 0.16, 0.78). When all differences were entered, low birth weight remained a significantly less likely occurrence at the collaborative-practice site (OR 0.46; 95% CI 0.23, 0.92). Conclusion: An advanced-practice nurse-obstetrician collaborative practice may be implemented successfully and lead to acceptable perinatal outcomes, as judged by low birth weight and prematurity. (C) 1998 by The American College of Obstetricians and Gynecologists.