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Evaluating the Social and Economic Impact of Community-Based Prenatal Care


Mary E. Cramer, 985330 Nebraska Medical Center, Omaha, NE 68198-5330. E-mail:


ABSTRACT Objective: This article describes the evaluation and findings of a community-based prenatal care program, Omaha Healthy Start (OHS), designed to reduce local racial disparities in birth outcomes.

Design: This evaluative study used a comparative descriptive design, and Targeting Outcomes of Programs® was the conceptual framework for evaluation.

Sample: The evaluation followed 3 groups for 2 years: OHS birth mothers (N=79; N=157); non-OHS participant birth mothers (N=746; N=774); and Douglas County birth mothers (N=7,962; N=7,987).

Measurement: OHS provided case management, home visits, screening, referral, transportation, and health education to participants. Program outcome measures included low birth weight, infant mortality, adequacy of care, trimester of care, and costs of care.

Results: OHS birth outcomes improved during year 2, and there was a 31% cost saving in the average hospital expenditure compared with the nonparticipant groups. Preliminary evaluative analysis indicates that prenatal case management and community outreach can improve birth outcomes for minority women, while producing cost savings.

Conclusions: Further prospective study is needed to document trends over a longer period of time regarding the relationship between community-based case management programs for minority populations, birth outcomes, and costs of care.