SIXTY YEARS OF NURSE MIDWIFERY: PRACTICE-OUTCOME ANALYSI

这项研究的具体目的是：(A)描述人口 接受护士提供的产科护理的妇女- 边疆护理服务(FNS)60年的助产士 (B)比较怀孕的情况 以国家接受的参数为基础的结果 评估产妇保健服务的质量 发病率--死亡率和围产期发病率和死亡率 (C)描述和描述护士助产实践和 他们自1925年以来在FNS的演变。 研究问题包括：(1)FNS的比较是什么 母婴结局与相关县、州和国家 母婴结局以十年为增量，从 1925至1985年？(2)FNS护士- 助产实践和母婴结局。 与护士助产士管理的22,000名分娩有关的信息 将从缩微的医疗记录中提取 从1925年到现在分娩的妇女。 概率样本将由分层随机样本组成 记录的记录。地层将先是年，然后是时间段 对应于病历设计的变化。数量和 数据质量以及数据录入的最佳程序 然后将对每个时间段进行评估。评分员间的可靠性 研究助理的费用也将计算在内。 研究助理将直接从微缩芯片输入数据 将记录传送到计算机。一种无纸化数据录入工具， 使用格式化的“屏幕”出现在监视器上，启用数据 以高效和高效的方式直接记录在计算机上 准确的举止。质量控制措施和清洁 数据集将会出现。 描述性统计将记录护士-助产实践。 将使用S统计进行统计分析 由AT&T贝尔实验室开发的包。 用于比较地点和交付情况的汇总 将以十年为间隔定义，并将比较 年度地区、州和全国基线数据的FNS结果 大致相同的时间段。时间顺序关系 在FNS服务的人群中取得的关键成果 1925年以来的适当社会经济和环境因素 将以图形格式显示。

The specific aims of this study are to: (a) describe the population of women receiving maternity care provided by the nurse- midwives of the Frontier Nursing Service (FNS) in the 60 years since establishment of the service; (b) compare pregnancy outcomes in terms of nationally accepted parameters used to evaluate quality of maternity care as reflected by maternal morbidity - mortality rates and perinatal morbidity and mortality rates; and (c) depict and describe nurse midwifery practices and their evolution at the FNS since 1925. Research questions include: (1) What is the comparison of FNS maternal infant outcomes to relative county, state, and national maternal infant outcomes in ten year increments of time from 1925 to 1985? (2) What is the relationship between FNS nurse- midwifery practices and maternal infant outcomes.? Information related to 22,000 births managed by nurse-midwives at the FNS will b extracted from the microfiched medical records of women delivered in the years 1925 to the present. The probability sample will consist of a stratified random sample of records. Strata will be years and then time periods corresponding to changes in medical record design. Quantity and quality of data, as well as the optimal procedure for data entry will then be assessed for each time period. Interrater reliabilities on research assistants will also be calculated. Research assistants will enter data directly from the microfiched records to the computer. A paperless data entry tool, by which the use of formatted "screens appear on the monitor, enables data to be recorded directly on the computer in an efficient and accurate manner. Quality control measures and cleansing of the data set will occur. Descriptive statistics will document nurse-midwifery practices. Statistical analysis will be performed using the S statistical package developed by AT & T Bell Laboratories. Aggregations for comparisons for site and situation of delivery will be defined in terms of ten year intervals and will compare FNS outcomes to baseline regional, state, and national figures for the same approximate time period. The chronological relationship of key outcomes in the population served by the FNS to appropriate socioeconomic and environmental factors since 1925 will be shown in a graphical format.