HUP official seeking to provide care options

In the future, pregnant women may have the choice to receive more care at home instead of in the hospital if their water breaks early.

Director of the Advanced Practice Nurse Program at the Hospital of the University of Pennsylvania Lynn Stringer has written a proposal to demonstrate that home care for women with preterm premature rupture of membranes -- or women whose waters break before their due date -- is medically and economically preferable.

Additionally, Stringer hopes to reduce hospitals' financial costs. Typically, hospitals lose about a quarter million dollars each year due to insurance companies denying payment during the patients' observational care. In Fiscal Year 2001, HUP lost about $146,000.

The grant -- entitled "Home Care for Women with Preterm PROM-Outcomes and Cost" -- was submitted to the National Institute for Nursing Research, a component of the National Institutes of Health. If received, the Institute will award Stringer and her team around $100,000 to conduct research over a couple of years.

The research proposal stemmed from Stringer's area of study -- "the use of ultrasound for high-risk pregnant women" -- and also the mass loss of hospital revenues.

"This study is about providing home care by advanced practiced nurses for when these women are discharged home" from the hospital, Nursing Professor and Co-Principal Grant Investigator Linda Brown said. "We have certain things that need to be done for these women, one of which includes the use of ultrasound in the home so that we can actually take a peak at that baby."

And with the recent portability of ultrasound equipment, it is more feasible for nurses to take care of pregnant women at home.

As of now, women with preterm PROM are admitted to the hospital to make sure that no infections have developed and to check if labor has begun. Typically, the woman is kept from 24 to 48 hours to ensure that she and the baby are stable.

However, if physicians decide that the woman needs to stay in the hospital for observational care after 48 hours, the insurance companies will not pay for the rest of her hospital stay.

Insurance companies claim that if pregnant women are deemed stable, they are healthy enough to leave the hospital and be monitored from home.

"The insurers' view is that the patients aren't getting any special care in the hospital," said Stringer, who serves as the research team's principal grant investigator. "The way we practice medical care is that it's not standard of care to send these women home... but in other parts of the world like Canada they care for women who rupture membranes early in the home."

Currently, nurses are not able to provide home care because it has not been proven that it works or is safe, which is exactly what Stringer said her research will try to prove.

"We can't send these women home because we've never demonstrated that it's safe," Stringer said. "So right now we don't have a choice but to care for women in the hospital."

"We really believe that [the mother and baby] are going to do better in the home," she added, noting that in the past, nurses with Masters degrees have been able to care for women with other pregnancy complications at home with better outcomes.

Caring for the mother at home is psychologically beneficial and cost efficient, according to Stringer.

"One of the main reasons women deliver early is stress," she said. "And when women are at home they feel less stressed because they're in a comfortable environment."

In turn, women are able to keep the baby in the womb longer -- the safest place for it to be, according to medical experts -- which reduces the time spent in the costly neo-natal intensive care unit.

Please note All comments are eligible for publication in The Daily Pennsylvanian.