Enough is Enough!

Medicaid and state regulation of nurse-midwives: the challenge of data retrieval

This article discusses one of four findings of a larger descriptive correlational health policy study, the purpose of which was to investigate relationships among state regulation of nurse-midwifery practice, utilization of certified nurse-midwives (CNM) for Medicaid funded prenatal care, and maternal newborn outcomes. The larger study showed that use of accurate data about CNM practice and subsequent health care outcomes creates a challenge for researchers because of the paucity of data related to services provided by CNMs. Barriers to adequate data collection related to CNM services, specifically those funded by Medicaid, preclude legitimate conclusions about subsequent health care policy. Methods of workforce data collection need to be addressed by health care and health policy groups to facilitate further investigation of the relationships among state regulation of CNM practice, utilization of CNMs for Medicaid-funded prenatal care and maternal newborn outcomes as they affect access to care for vulnerable populations.

Application of the Kessner and Kotelchuck prenatal care adequacy indices in a preterm birth population

OBJECTIVES

Healthy People 2010 goals to eliminate racial and ethnic health disparities that persist in the utilization of prenatal care (PNC) highlight the importance of measuring PNC as a variable in maternal and infant health outcomes research. These disparities are significantly correlated to adverse infant outcomes in preterm birth (PTB), a leading cause of infant mortality and life-long morbidity. Currently the most extensively used PNC adequacy indices (Kessner and Kotelchuck) were developed to measure outcomes in populations consisting mostly of full-term births. It is unclear whether these PNC adequacy indices are reliable when pregnancy is truncated due to PTB (<37 weeks). This paper compares and demonstrates how they can be applied in a specific PTB cohort.

DESIGN AND SAMPLE

This secondary analysis of a nested case-control study compares Kessner and Kotelchuck adequacy scores of 367 mothers of PTB infants.

RESULTS

There were significant differences in the rating of PNC inadequacy ( p<.001) depending on the PNC adequacy index used.

CONCLUSION

Critical evaluation is warranted before using these PNC adequacy indices in future public health nursing and PTB research.