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McRae DN, Muhajarine N, Janssen PA. Improving birth outcomes for women who are substance using or have mental illness: a Canadian cohort study comparing antenatal midwifery and physician models of care for women of low socioeconomic position. BMC Pregnancy Childbirth 2019; 19:279. [PMID: 31387532 PMCID: PMC6683351 DOI: 10.1186/s12884-019-2428-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/25/2019] [Indexed: 11/18/2022] Open
Abstract
Background Some observational studies have shown improved birth outcomes for women of low socioeconomic position (SEP) receiving antenatal midwifery versus physician care. To understand for whom and under what circumstances midwifery care is associated with better birth outcomes we examined whether psychosocial risk including substance use, mental illness, social assistance, residence in a neighbourhood of low/moderate SEP, and teen maternal age modified the association between model of care (midwifery versus physician) and small-for-gestational-age (SGA) or preterm birth (PTB) for women of low SEP. Methods For this retrospective cohort study, maternity data from the British Columbia Perinatal Data Registry were linked with Medical Services Plan billing data. We report adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for SGA birth (< the 10th percentile) and PTB (< 37 weeks’ completed gestation). For tests of interaction between antenatal models of care and psychosocial risk, p-values < 0.10 were considered statistically significant. Women were eligible for inclusion if they were residents of British Columbia, Canada, carried a singleton fetus, had low to moderate medical/obstetric risk, birthed between April 1, 2008 and Dec. 31, 2012, and received a health insurance subsidy (n = 33,937). Results Midwifery versus obstetrician patients had lower odds of PTB. The difference was 31% larger among substance users (aOR 0.24, 95% CI: 0.11–0.54) compared to non-substance users (aOR 0.55, 95% CI: 0.45–0.68). Additionally, there was a 34% statistically significant absolute difference in odds of PTB for midwifery versus obstetrician patients with both mental illness and substance use (aOR 0.18, 95% CI: 0.06–0.55) compared to women with neither mental illness nor substance use (aOR 0.52, 95% CI: 0.41–.66). Results demonstrated a consistent association between midwifery versus physician care and lower odds of SGA, yet effects were not statistically significantly different for women with higher or lower psychosocial risk. Conclusion Among low SEP women in British Columbia, Canada, antenatal midwifery compared to obstetrician care was associated with reduced odds of PTB. Odds were lower among women with substance use, and mental illness and substance use, than among women without these risk factors. Electronic supplementary material The online version of this article (10.1186/s12884-019-2428-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daphne N McRae
- Department of Community Health and Epidemiology, University of Saskatchewan, Box 7 Health Science Building 107 Wiggins Road, Saskatoon SK, S7N 5E5, Canada.
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, University of Saskatchewan, Box 7 Health Science Building 107 Wiggins Road, Saskatoon SK, S7N 5E5, Canada
| | - Patricia A Janssen
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver BC, V6T 1Z3, Canada
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McRae DN, Janssen PA, Vedam S, Mayhew M, Mpofu D, Teucher U, Muhajarine N. Reduced prevalence of small-for-gestational-age and preterm birth for women of low socioeconomic position: a population-based cohort study comparing antenatal midwifery and physician models of care. BMJ Open 2018; 8:e022220. [PMID: 30282682 PMCID: PMC6169769 DOI: 10.1136/bmjopen-2018-022220] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Our aim was to investigate if antenatal midwifery care was associated with lower odds of small-for-gestational-age (SGA) birth, preterm birth (PTB) or low birth weight (LBW) compared with general practitioner (GP) or obstetrician (OB) models of care for women of low socioeconomic position. SETTING This population-level, retrospective cohort study used province-wide maternity, medical billing and demographic data from British Columbia, Canada. PARTICIPANTS Our study included 57 872 pregnant women, with low socioeconomic position, who: were residents of British Columbia, Canada, carried a singleton fetus, had low to moderate medical/obstetric risk, delivered between 2005 and 2012 and received medical insurance premium assistance. PRIMARY AND SECONDARY OUTCOME MEASURES We report rates, adjusted ORs (aOR), and 95% CIs for the primary outcome, SGA birth (<the 10th percentile), and secondary outcomes, PTB (<37 weeks' completed gestation) and LBW (<2500 g). RESULTS Our sample included 4705 midwifery patients, 45 114 GP patients and 8053 OB patients. Odds of SGA birth were reduced for patients receiving antenatal midwifery versus GP (aOR 0.71, 95% CI 0.62 to 0.82) or OB care (aOR 0.59, 95% CI 0.50 to 0.69). Odds of PTB were lower for antenatal midwifery versus GP (aOR 0.74, 95% CI 0.63 to 0.86) or OB patients (aOR 0.53, 95% CI 0.45 to 0.62). Odds of LBW were reduced for midwifery versus GP (aOR 0.66, 95% CI 0.53 to 0.82) or OB patients (aOR 0.43, 95% CI 0.34 to 0.54). CONCLUSION Antenatal midwifery care in British Columbia, Canada, was associated with lower odds of SGA birth, PTB and LBW, for women of low socioeconomic position, compared with physician models of care. Results support the development of policy to ensure antenatal midwifery care is available and accessible for women of low socioeconomic position. Future research is needed to determine the underlying mechanisms linking midwifery care to better birth outcomes for women of low socioeconomic position.
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Affiliation(s)
- Daphne N McRae
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia A Janssen
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saraswathi Vedam
- Birth Place Lab, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maureen Mayhew
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Deborah Mpofu
- Saskatoon City Hospital, Saskatoon Health Region, Saskatoon, Saskatchewan, Canada
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ulrich Teucher
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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McRae DN, Muhajarine N, Stoll K, Mayhew M, Vedam S, Mpofu D, Janssen PA. Is model of care associated with infant birth outcomes among vulnerable women? A scoping review of midwifery-led versus physician-led care. SSM Popul Health 2016; 2:182-193. [PMID: 29349139 PMCID: PMC5757823 DOI: 10.1016/j.ssmph.2016.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/17/2015] [Accepted: 01/11/2016] [Indexed: 11/15/2022] Open
Abstract
This scoping review investigates if, over the last 25 years in high resource countries, midwives' patients of low socioeconomic position (SEP) were at more or less risk of adverse infant birth outcomes compared to physicians' patients. Reviewers identified 917 records in a search of 12 databases, grey literature, and citation lists. Thirty-one full documents were assessed and nine studies met inclusion criteria. Eight studies were assessed as moderate in quality; one study was given a weak rating. Of the moderate quality studies, the majority found no statistical difference in outcomes according to model of care for preterm birth, low or very low birth weight, or NICU admission. No study reported a statistically significant difference for small for gestational age birth (2 studies), or mean or low Apgar score (4 studies). However, one study found a reduced risk of preterm birth (AOR=0.70, p<0.01), and heavier mean infant birth weight (3325 g vs. 3282 g, p<0.01) for midwifery patients. Another study reported lower risk of low (RR=0.59, 95% CI: 0.46, 0.73) and very low birthweight (RR=0.44, 95% CI: 0.23, 0.85) for midwifery care. And, a third study reported a decrease in stays (1-3 days) in NICU (Adjusted Risk Difference=-1.8, 95% CI: -3.9, 0.2) for midwifery patients, though no overall difference in NICU admission of any duration. Other studies reported significant differences favoring midwifery care for mean birth weight (3598 g vs. 3407.3 g, p<0.05; 3233 g vs. 3089 g, p<0.05; 2 studies) and very low birth weight (OR=0.35, 95% CI:0.1, 0.9), for sub-groups within the larger study populations. This scoping review documented heterogeneity in study designs and analytical methods, inconsistent findings, moderate methodological quality, and lack of currency. There is a need for new studies to definitively establish if and how a midwifery-led model of care influences birth outcomes for women of low SEP.
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Affiliation(s)
- Daphne N. McRae
- Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Rd., Saskatoon, Sask., Canada S7N 5E5
| | - Nazeem Muhajarine
- Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Rd., Saskatoon, Sask., Canada S7N 5E5
| | - Kathrin Stoll
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - Maureen Mayhew
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - Saraswathi Vedam
- UBC Midwifery, University of British Columbia, Suite 320-5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3
| | - Deborah Mpofu
- Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Rd., Saskatoon, Sask., Canada S7N 5E5
- Saskatoon Health Region, 701 Queen St., Saskatoon, Sask., Canada S7K 0M7
| | - Patricia A. Janssen
- UBC Midwifery, University of British Columbia, Suite 320-5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3
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Oliveira ORC, Santana MG, Santos FS, Conceição FD, Sardinha FLC, Veiga GV, Tavares do Carmo MG. Composition of fatty acids in the maternal and umbilical cord plasma of adolescent and adult mothers: relationship with anthropometric parameters of newborn. Lipids Health Dis 2012; 11:157. [PMID: 23153394 PMCID: PMC3551641 DOI: 10.1186/1476-511x-11-157] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 11/08/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Considering the importance of long chain polyunsaturated fatty acids to fetal development and the lack of studies that have compared the status of fatty acids between adolescents and adults mothers, the purpose of this study was to evaluate the composition of fatty acids in maternal and umbilical cord plasma from adolescent and adults mothers. METHODS Forty pregnant adolescents and forty pregnant adults were selected to assess the distribution profile of fatty acids in the maternal and umbilical cord plasma. Quantification of fatty acids in the total lipids of the sample groups was performed through the use of gas-liquid chromatography. RESULTS The maternal and umbilical cord plasma of the adolescents showed a greater concentration of AA than did that of the adults (P < 0.05). However, a greater percentage of EPA was found in the umbilical cord plasma of the adults (P < 0.05). DHA in the plasma of the adolescent mothers correlated positively to birth weight and head circumference. CONCLUSIONS This suggests that in situations of greater nutritional risk, as in adolescent pregnancy, n-3PUFA concentrations have a greater influence on the proper development of newborns. Moreover, variations in fatty acid concentrations in the maternal and cord plasma of adolescents and adults may indicate that pregnancy affects the LC-PUFA status of adults and adolescents in distinct ways.
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Affiliation(s)
- Olívia RC Oliveira
- Nutritional Biochemical Laboratory, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michelle G Santana
- Nutritional Biochemical Laboratory, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávia S Santos
- Nutritional Biochemical Laboratory, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Felipe D Conceição
- Nutritional Biochemical Laboratory, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fátima LC Sardinha
- Nutritional Biochemical Laboratory, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Glória V Veiga
- Department of Social and Applied Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria G Tavares do Carmo
- Nutritional Biochemical Laboratory, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto de Nutrição Josué de Castro, UFRJ – Laboratório de Bioquímica Nutricional, Av. Brigadeiro Trompowski, s/n - CCS, Bloco J, 2° andar, Cidade Universitária, Ilha do Fundão, Cep.: 21941-590, Rio de Janeiro, Brazil
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Sonenberg A. Medicaid and state regulation of nurse-midwives: the challenge of data retrieval. Policy Polit Nurs Pract 2011; 11:253-9. [PMID: 21531961 DOI: 10.1177/1527154411398137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Andrea Sonenberg
- Pace University, Lienhard School of Nursing, 861 Bedford Road, Pleasantville, NY 10570, USA.
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Abstract
A systematic literature review of research on midwifery care of poor and vulnerable women from 1925 to 2003, which included topics studied, research methods used, and special issues and implications for future research, was performed; 44 studies published between 1955 and 2003 were identified. The majority were retrospective, descriptive studies. Outcomes examined included prenatal care visits, vaginal versus operative births, labor interventions, maternal and neonatal mortality and morbidity, birth weight, and cost-effectiveness. Studies showed that midwives predominantly serve vulnerable women who are young, poor, immigrants, or members of racial and ethnic minorities. Preterm birth prevention is emerging as a midwifery research focus. Health system changes are making it more difficult to provide effective care and counseling to disadvantaged women, especially in managed care settings. Extensive evidence documents excellent outcomes of midwifery care for the poor in urban and rural settings over the past three quarters of a century. Future research should include more intervention studies and use both qualitative and quantitative methods to investigate midwifery processes of care and the process-outcome connection. The research focus should broaden beyond childbirth to include gynecology, family planning, and primary care issues. Health disparities, cultural studies, obstetric interventions, and poor women's experiences of childbirth and midwifery care are important topics for future research.
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Affiliation(s)
- Jeanne Raisler
- University of Michigan School of Nursing, Ann Arbor, MI 48109, USA.
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Bloch JR, Dawley K, Suplee PD. Application of the Kessner and Kotelchuck prenatal care adequacy indices in a preterm birth population. Public Health Nurs 2009; 26:449-59. [PMID: 19706128 DOI: 10.1111/j.1525-1446.2009.00803.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Joan Rosen Bloch
- College of Nursing & Health Professions, Drexel University, 245 N.15th Street, MS 1030, Philadelphia, PA 19102, USA.
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Cragin L, Kennedy HP. Linking obstetric and midwifery practice with optimal outcomes. J Obstet Gynecol Neonatal Nurs 2006; 35:779-85. [PMID: 17105644 DOI: 10.1111/j.1552-6909.2006.00106.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To compare midwifery and medical care practices and measure optimal perinatal outcomes using a new clinimetric instrument. DESIGN Prospective descriptive cohort design. SETTING A large, inner city obstetric service with medical and midwifery services. PARTICIPANTS Three hundred seventy-five of 400 consecutively enrolled patients were participated (25 excluded due to extreme risk status or missing data); 92% were of minority race/ethnicity and 54% had less than a high school education. Of the 375 patients, 179 received physician care and 196 received nurse-midwife care. MAIN OUTCOME MEASURES The Optimality Index-US was measured. Health record data were extracted and scored using the Optimality Index-US to summarize the optimality of processes and outcomes of care as well as the woman's preexisting health status. RESULTS Midwifery patients had more optimal care processes (less use of technology and intervention) with no difference in neonatal outcomes, even when preexisting risk was taken into account. CONCLUSION Even among moderate-risk patients, the midwifery model of care with its limited use of interventions can produce outcomes equivalent to or better than those of the biomedical model.
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Affiliation(s)
- Leslie Cragin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA 94110, USA.
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Gama SGND, Szwarcwald CL, Sabroza AR, Castelo Branco V, Leal MDC. Fatores associados à assistência pré-natal precária em uma amostra de puérperas adolescentes em maternidades do Município do Rio de Janeiro, 1999-2000. CAD SAUDE PUBLICA 2004; 20 Suppl 1:S101-11. [PMID: 16636740 DOI: 10.1590/s0102-311x2004000700011] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Caracterizou-se o perfil das gestantes com pré-natal precário, segundo variáveis sócio-demográficas, história reprodutiva da mãe, apoio familiar, satisfação com a gestação e comportamentos de risco durante a gravidez. Foram entrevistadas 1.967 adolescentes no pós-parto imediato de maternidades públicas, conveniadas com o SUS e particulares no Município do Rio de Janeiro. A variável dependente foi o número de consultas de pré-natal (0-3; 4-6; 7 e mais). A análise estatística testou a hipótese de homogeneidade de proporções mediante análises bi e multivariada, com o uso de regressão logística multinomial, cuja categoria de referência da variável-resposta foi a realização de > 7 consultas. Foram encontradas maiores proporções de 0-3 consultas nos grupos de mães com grau de escolaridade < 4ª série do ensino fundamental; que não têm água encanada; não vivem com o pai do bebê; tiveram nascidos vivos anteriores; não ficaram satisfeitas com a gestação; não tiveram apoio do pai do bebê; tentaram interromper a gestação e as que fumaram, beberam e/ou usaram drogas durante a gestação. Pode-se concluir que as mães com piores condições de vida e comportamentos de risco na gravidez foram as que mais ficaram à margem da assistência pré-natal.
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Affiliation(s)
- Silvana Granado Nogueira da Gama
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
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Fox MH, Foster CH. The role of early newborn discharge legislation in influencing policy development: understanding the Kansas experience. JOURNAL OF HEALTH & SOCIAL POLICY 2003; 16:55-74. [PMID: 12943332 DOI: 10.1300/j045v16n04_03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Early newborn discharge legislation began a movement in health policy towards incremental changes in how medical consumers receive services. While well intentioned, these initiatives may undermine national efforts to address problems through more comprehensive reform, while stifling smaller efforts to address the problems locally. This paper discusses early newborn discharge legislation in Kansas: its origins, apparent impact, and implications. Findings from a hospital survey and two-year follow-up suggest a minimal effect of the legislation on health services in the state. Though acute hospital care appeared to replace home-based programs in many hospitals we spoke with, the more longstanding impact of the legislation seems to have been its precedent in how health policy is now made.
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Affiliation(s)
- Michael H Fox
- Department of Health Policy and Management, Research and Training Center on Independent Living, University of Kansas, 4089 Dole Center, Lawrence, Kansas 66045, USA.
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