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.

项目概要/摘要 意义：与同等发展水平的国家相比，美国的情况要糟糕得多 围产期健康结果的代价要大得多。增加孕产妇护理人员的数量， 尤其是助产士，是改善美国围产期健康结果的拟议解决方案。 以助产士为主导的产前、分娩和产后护理的特点是加强教育和 支持孕妇和产妇，强调从产前到产后的持续护理 产后期以及技术和程序的有限使用。与医生主导的护理相比， 助产士在临产和分娩过程中使用较少的医疗干预措施，并产生类似或改进的结果 围产期健康结果，特别是低收入人群。然而，许多国家层面的政策却阻碍了 将助产士纳入现有卫生系统。增加助产服务的可及性可以改善 美国的围产期健康。 具体目标：拟议项目将 (1) 评估助产士之间报销公平的影响 和医生了解助产士接生的比例，(2) 评估围产期的患病率 反事实情景中的发病率，即获得助产服务的机会增加 10%、20% 和 50%， (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 医疗补助参与者的怀孕参与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）来自期刊的立法更新 向助产士提供医疗补助报销历史信息的执业护士； (2) 全国 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 广义双重差分法，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费率向助产士提供报销，并提供助产士主导的服务 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和 应用 g 公式来确定如果能够避免的围产期发病率 总人口（目标 2）和医疗补助参与者（目标 3）的助产护理有所增加。 奖学金信息：申请人为妇幼健康与流行病学博士生 北卡罗来纳大学教堂山分校，以及卡罗莱纳州 NICHD 资助的 T32 培训项目的博士前实习生 人口中心。通过围产期健康、流行病学和卫生政策、支持和 来自多学科导师团队的指导以及北卡罗来纳大学教堂山分校的协作研究环境， 拟议的培训计划将以西蒙斯女士之前的研究经验为基础。培训将有助于 西蒙斯女士成功完成了她的论文工作，并实现了成为一名 成功的独立研究员，拥有卫生政策和围产期健康方面的专业知识。