How to improve access to midwifery care and prevent perinatal morbidities

如何改善助产护理的可及性并预防围产期疾病

• 批准号: 10536207
• 负责人: Elizabeth Simmons
• 金额: $ 3.59万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2026-08-14
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10536207
• 关键词: Birth; Birth Certificates; Caring; Cesarean section; Childbirth; Country; Data; Data Analyses; Development; Discipline of obstetrics; Education; Environment; Epidemiology; Epidural Analgesia; Fellowship; Funding; Future; Goals; Health; Health Policy; Health system; Healthcare Systems; Hemorrhage; Hospitals; Hypertension; Improve Access; Induced Labor; Infection; Information Systems; Intervention; Journals; Justice; Licensure; Life; Link; Low Income Population; Low income; Maternal and Child Health; Measures; Medicaid; Medical; Mentors; Methodology; Methods; Midwife; Midwifery; Mission; Mothers; National Institute of Child Health and Human Development; Neonatal; Nurse Practitioners; Outcome; Patients; Physicians; Physiological Processes; Policies; Population; Positioning Attribute; Postpartum Period; Pregnancy; Pregnant Women; Prenatal care; Prevalence; Procedures; Process; Public Health; Reproductive Health; Research; Research Personnel; Resources; Risk; Secure; Services; Source; Technology; Touch sensation; Training; Training Programs; Trauma; United States; United States National Institutes of Health; Universities; Update; Vital Statistics; Woman; Work; base; care costs; care delivery; care providers; cost; disability; doctoral student; experience; fetal; improved; longitudinal dataset; multidisciplinary; perinatal health; perinatal morbidity; perinatal outcomes; postpartum care; pre-doctoral; pregnant; prenatal; prevent; skills

PROJET SUMMARY/ABSTRACT Significance: Compared to countries at similar development levels, the United States suffers from far worse perinatal health outcomes at a much greater cost. Increasing the number of maternity care providers, especially midwives, is a proposed solution to improve perinatal health outcomes in the United States. Midwifery-led prenatal, labor and delivery, and postpartum care is characterized by increased education and support for pregnant and laboring mothers, an emphasis on continuation of care from the prenatal to postpartum periods, and limited use of technology and procedures. Compared with physician-led care, midwives utilize fewer medical interventions during labor and delivery and produce similar or improved perinatal health outcomes, particularly for low-income populations. However, many state-level policies prevent integration of midwives into the existing health system. Increasing access to midwifery care could improve perinatal health in the United States. Specific Aims: The proposed project will (1) evaluate the impact of reimbursement equity between midwives and physicians on the proportion of deliveries conducted by a midwife, (2) assess prevalence of perinatal morbidities in counterfactual scenarios where access to midwifery care is increased by 10%, 20%, and 50%, and (3) estimate prevalence of perinatal morbidities in a hypothetical intervention where all low-risk pregnancies among Medicaid enrollees engage in midwifery-led prenatal care. Approach: The proposed analysis will utilize data from three sources: (1) Legislative Updates from the journal the Nurse Practitioner that provide historical information on Medicaid reimbursement to midwives; (2) National Vital Statistics Data; and (3) data from the Pregnancy to Early Life Longitudinal Data System. Using a generalized difference-in-difference approach, Aim 1 will assess the association between state implementation of Medicaid policies that reimburse midwives at the same rate as physicians and access to midwifery-led delivery care. Aims 2 and 3 will utilize a causal inference framework for observational data analysis and application of the g-formula to determine the number of perinatal morbidities that could be averted if access to midwifery care were increased among the total population (Aim 2), and among Medicaid Enrollees (Aim 3). Fellowship information: The applicant is a PhD student in Maternal and Child Health and Epidemiology at UNC Chapel Hill, and a predoctoral trainee on the NICHD-funded T32 training program at the Carolina Population Center. Through coursework on perinatal health, epidemiology and health policy, support and guidance from a multidisciplinary team of mentors, and UNC Chapel Hill’s collaborative research environment, the proposed training plan will build on Ms. Simmons’ previous research experience. The training will assist Ms. Simmons in successfully completing her dissertation work, and achieving her long-term goal of becoming a successful independent researcher with expertise on health policy and perinatal health.

Projet摘要/摘要 意义：与相似发展水平的国家相比，美国遭受的遭受更大的痛苦 围产期健康结果的成本要大得多。增加产妇护理提供者的数量， 尤其是助产士，是提出改善美国围产期健康状况的建议解决方案。 由助产士领导的产前，劳动和分娩以及产后护理的特征是教育增加和 支持怀孕和劳动母亲，强调继续从产前护理到 产后时期，技术和程序的使用有限。与身体领导的护理相比 助产士在劳动和分娩过程中使用的医疗干预措施较少，并产生相似或改进的 围产期健康结果，特别是对于低收入人群。但是，许多州级政策阻止 将助产士整合到现有的卫生系统中。增加获得助产士护理的机会可以改善 美国围产期健康。 具体目的：拟议的项目将（1）评估助产士之间报销公平的影响 和医师在助产士进行的分娩比例中，（2）围产期的评估率 在反事实场景中，获得助产士护理的疾病率增加了10％，20％和50％ （3）在所有低风险 医疗补助招生的怀孕从事助产士主导的产前护理。 方法：拟议的分析将利用来自三个来源的数据：（1）期刊的立法更新 提供有关助产士的医疗补助报销历史信息的护士从业者； （2）国家 重要统计数据； （3）从怀孕到早期纵向数据系统的数据。使用 广义差异差异方法，AIM 1将评估国家实施之间的关联 以与医生相同的速度偿还助产士的医疗补助政策，并获得助产士为主导 送货护理。目标2和3将利用因果推理框架进行观察数据分析和 如果访问可能会避免的围产期病毒数量，则应用G形式的应用 在总人口中，助产士护理增加（AIM 2）以及医疗补助注册（AIM 3）。 奖学金信息：申请人是孕产妇和儿童健康和流行病学的博士生 UNC Chapel Hill，以及卡罗来纳州NICHD资助的T32培训计划中的一名占主导地位的实习生 人口中心。通过围产期健康，流行病学和健康政策，支持和 多学科导师团队的指导，UNC教堂山的合作研究环境， 拟议的培训计划将基于西蒙斯女士以前的研究经验。培训将有助于 西蒙斯女士成功完成了她的论文工作，并实现了她成为一个的长期目标 成功的独立研究人员拥有卫生政策和围产期健康专业知识。