Revolutionizing prenatal care: new evidence-based prenatal care delivery models

Much of prenatal care is based on tradition and expert opinion rather than on sound scientific evidence. With the increased emphasis on providing evidence-based prenatal care, new research-based models are emerging. This article describes two new models of prenatal care delivery and the evidence supporting them. A model of reduced-frequency prenatal visits is adapted from the U.S. Department of Health and Human Services (HHS) Expert Panel on Prenatal Care (1989) recommendations that healthy, pregnant women who are at low risk for pregnancy complications may attend fewer visits without negative consequences. Another emerging model of group prenatal care, CenteringPregnancy, integrates group support with prenatal care. It is important that healthcare providers are aware of these models in order to offer the highest quality, evidence-based care to pregnant women.     

The quest for new innovative care delivery models

In response to growing nurse shortages and heightened attention to patient quality, many healthcare organizational leaders are developing and testing new care delivery models. These models strive to improve patient quality and satisfaction by engaging nurses and other healthcare professionals in different roles across the continuum of care. In this article, the authors profile 5 new care delivery models from their current work sponsored by the Robert Wood Johnson Foundation. In addition, the authors identify common elements underlying the success of the models.     

Continuity of care. Balancing care of elders between health care settings

Continuing care planning and balancing care of elders are crucial components of health care today. The most sweeping change that has come with the advent of prospective pricing for the acute care setting is in the financing of health care for the aged and disabled. Prospective pricing, which uses the diagnosis-related group system, is the method chosen by federal agencies to restrain Medicare costs. For almost two decades, the hospital has been the reservoir for the impaired elderly who could not be returned home or to the community without support services. The system now encourages shortened hospital stays. Continuing care planning is the key to balancing the care of the elder through the process of discharge planning. We must assure patients and families that their needs will be met in the community when the patient is discharged. Balancing care of elders between health care settings through discharge planning is identified in three simple words: A Complex Process. As health care professionals, we must be ready to accept this challenge.     

Continuity of care. A teaching model

Recent changes in health care mandate innovative approaches to teaching. Rehabilitation as part of the continuum of disability motivated the "continuity of care model." This model permits the presentation of rehabilitation in its global sense: from onset of injury through re-integration into the community. This report describes a curriculum for physical medicine and rehabilitation residents that comprises a three-phase approach to rehabilitation: acute care, inpatient rehabilitation and community re-entry. The curriculum is adaptable for medical students. A secondary benefit of the project for the resident is a better understanding of relevant cost benefit/cost effective concepts in the delivery of quality services. The close interaction of residents with community agencies permits these agencies to gain a better understanding of the medical needs of disabled people.     

Continuity of care after discharge from ICU

Patients and their relatives may feel unsupported in general wards and the community after the high level of care received in ICUs. Some general nurses may not have enough experience to deal with the high-dependency needs of patients discharged from ICUs to ward care. It is recommended that a follow-up nurse assess the needs of ICU patients and ensure provision has been made for their return to the community.     

Continuity of care practices and substance use disorder patients' engagement in continuing care

BACKGROUND: Substance use disorder (SUD) patients who engage in more continuing care have better outcomes, but information on practices associated with greater patient engagement and retention in continuing care remains elusive. OBJECTIVES: The objectives of this study were to determine if staff's continuity of care practices predict patients' engagement in continuing care in the 6 months after discharge from intensive SUD treatment and to determine if the impact of continuity of care practices on patients' engagement in continuing care differs for patients treated in inpatient/residential versus outpatient programs. RESEARCH DESIGN: Staff in 28 Veterans Affairs (VA) intensive SUD treatment programs with varying continuity of care practices provided data on 878 patients' alcohol and drug problems at treatment entry. At discharge, staff provided data on patients' motivation, treatment intensity, and on the continuity of care practices they used with each patient. VA administrative databases supplied data on patients' subsequent engagement in continuing care. Mixed-effects modeling was used to examine predictors of patients' engagement in care. RESULTS: Patients in outpatient programs who received more continuity of care engaged in continuing care significantly longer. More highly motivated outpatients, those with fewer alcohol problems at treatment entry, and patients who used VA services in the year before treatment also remained in continuing care longer. These findings did not hold for patients treated in inpatient/residential programs. CONCLUSIONS: Continuity of care practices predicted engagement in continuing care only for patients treated in outpatient SUD programs. More research is needed to identify effective continuity of care practices for patients treated in inpatient/residential programs.