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: 10740840
• 负责人: Elizabeth Simmons
• 金额: $ 3.82万
• 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/10740840
• 关键词: Birth; Birth Certificates; Caring; Cesarean section; Childbirth; Country; Data; Data Analyses; Development; Discipline of obstetrics; Education; Environment; Epidemiology; Epidural Analgesia; Equity; Fellowship; Funding; Future; Goals; Health; Health Policy; Health system; Healthcare Systems; Hemorrhage; Hospitals; Hypertension; Improve Access; Induced Labor; Infection; Information Systems; Intervention; Journals; Justice; Licensing; 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; Postdoctoral Fellow; 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; access restrictions; 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.

项目总结/摘要 意义：与发展水平相近的国家相比，美国遭受的苦难要严重得多 围产期健康结果的成本要高得多。增加产妇护理提供者的数量， 特别是助产士，是一个拟议的解决方案，以改善围产期健康结果在美国。 助产士主导的产前、分娩和产后护理的特点是教育和 支持孕妇和分娩母亲，强调从产前到产后的持续护理， 产后时期，以及有限的技术和程序的使用。与医生主导的护理相比， 助产士在分娩和分娩期间使用更少的医疗干预，并产生类似或更好的结果 围产期健康结果，特别是低收入人群。然而，许多国家的政策阻止了 将助产士纳入现有的卫生系统。增加获得助产护理的机会可以改善 美国的围产期健康。 具体目标：拟议项目将（1）评估助产士之间补偿公平的影响 （2）评估由助产士接生的比例，（3）评估围产期死亡率， 在反事实的情况下，获得助产护理的机会增加了10%，20%和50%， 和（3）在假设的干预措施中估计围产期发病率，其中所有低风险 参加医疗补助计划的孕妇参加助产士引导的产前护理。 方法：拟议的分析将利用来自三个来源的数据：（1）期刊上的《立法最新情况》 向助产士提供医疗补助报销历史信息的执业护士;（2）国家 生命统计数据;（3）来自妊娠至生命早期纵向数据系统的数据。使用 广义差异中的差异方法，目标1将评估国家实施之间的关联 医疗补助政策，以与医生相同的速度偿还助产士，并获得助产士主导的 分娩护理目标2和3将利用因果推理框架进行观测数据分析， 应用g-公式确定如果获得 助产护理在总人口（目标2）和医疗补助登记者（目标3）中有所增加。 奖学金信息：申请人是一名博士生，在孕产妇和儿童健康和流行病学， 查佩尔山，以及卡罗莱纳NICHD资助的T32培训项目的博士前实习生 人口中心。通过关于围产期健康、流行病学和卫生政策的课程， 来自多学科导师团队的指导，以及查佩尔山的合作研究环境， 拟议中的培训计划将以西蒙斯女士以前的研究经验为基础。培训将有助于 女士西蒙斯成功地完成了她的论文工作，并实现了她的长期目标，成为一个 具有卫生政策和围产期健康专门知识的成功的独立研究员。