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

Accuracy in Reporting of Kentucky Certified Nurse-Midwives as Attendants in Birth Registration Data

INTRODUCTION

Birth certificate data are used nationally to determine health care policy and health care reimbursement and to demonstrate the legitimacy and value of certified nurse-midwives (CNMs) and certified midwives (CMs) in perinatal and neonatal outcomes. However, the validity of birth certificate data is questionable, in part because of the data collection process. These data are particularly crucial for midwife-attended births because the correct birth attendant is not always accurately identified on the birth certificate. The purpose of this project was to examine the actual number of CNM-reported births compared with those recorded by the Kentucky Office of Vital Statistics and to examine the process used by birth registrars to complete the birth certificate.

METHODS

CNMs attending births in hospitals in Kentucky in 2017 logged their birth statistics. These numbers were compared with the 2017 Kentucky Vital Statistics Birth Certificate data of CNM-attended births. Kentucky birth registrars (50%) who work in facilities where CNMs attend births completed a 32-question survey to describe their process of collecting birth certificate data.

RESULTS

The comparison data revealed that CNM-attended births in Kentucky are underrepresented in the state vital statistics by as much as 19.2%. Birth registrars identified barriers to collecting accurate data including lack of training, multiple sources of data, incomplete prenatal records, and absence of systems to help ensure accuracy.

DISCUSSION

CNMs/CMs should keep personal and practice birth logs and routinely compare these with hospital data kept by the birth registrar. The state office of vital statistics and hospitals should target training to specific facilities that have the most inaccurate data. The Improving Midwifery Birth Numbers Initiative through the American College of Nurse-Midwives Division of Research Data Management Section should continue to encourage midwifery students to complete this research in all 50 states.

Nature and scope of certified nurse-midwifery practice: A workforce study

AIMS AND OBJECTIVES

To describe the nature and scope of nurse-midwifery practice in Texas and to determine legislative priorities and practice barriers.

BACKGROUND

Across the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. With a looming shortage of midwives, there is a pressing need to understand midwives' work environment and scope of practice.

DESIGN

Mixed methods research utilising prospective descriptive survey and interview.

METHODS

An online survey was administered to nurse-midwives practicing in the state of Texas (N = 449) with a subset (n = 10) telephone interviewed. Descriptive and inferential statistics and content analysis was performed.

RESULTS

The survey was completed by 141 midwives with eight interviewed. Most were older, Caucasian and held a master's degree. A majority worked full-time, were in clinical practice in larger urban areas and were employed by a hospital or physician group. Care was most commonly provided for Hispanic and White women; approximately a quarter could care for greater numbers of patients. Most did not clinically teach midwifery students. Physician practice agreements were believed unnecessary and prescriptive authority requirements restrictive. Legislative issues were typically followed through the professional organisation or social media sites; most felt a lack of competence to influence health policy decisions. While most were satisfied with current clinical practice, a majority planned a change in the next 3 to 5 years.

CONCLUSIONS

An ageing midwifery workforce, not representative of the race/ethnicity of the populations served, is underutilised with practice requirements that limit provision of services. Health policy changes are needed to ensure unrestricted practice.

RELEVANCE TO CLINICAL PRACTICE

Robust midwifery workforce data are needed as well as a midwifery board which tracks availability and accessibility of midwives. Educators should consider training models promoting long-term service in underserved areas, and development of skills crucial for impacting health policy change.

Considering disparities: How do nurse practitioner regulatory policies, access to care, and health outcomes vary across four states?

BACKGROUND

Health disparities persist among morbidity and mortality rates in the United States. Contributing significantly to these disparities are the ability to pay for health care (largely, access to health insurance) and access to, and capacity of, the primary care health workforce.

PURPOSE

This article examines key determinants of health (DOH) including demographics, public and regulatory policies, health workforce capacity, and primary health outcomes of four states of the United States. The context of this study is the potential association among health care disparities and myriad DOH, among them, the restrictive nurse practitioner (NP) scope of practice (SOP) regulatory environment, which are documented to influence access to care and health outcomes.

METHODS

This descriptive study explores current NP SOP regulations, access to primary care, and health outcomes of key chronic disease indicators-diabetes, hypertension, and obesity in Alabama, Colorado, Mississippi, and Utah. These states represent both the greatest disparity in chronic disease health outcomes (obesity, diabetes, and hypertension) and the greatest difference in modernization of their NP SOP laws. The Affordable Care Act has greatly expanded access to health care. However, it is estimated that 23 million Americans, 7% of its total population, will remain uninsured by 2019.

DISCUSSION

Restrictive and inconsistent NP SOP policies may continue to contribute to health workforce capacity and population health disparities across the country, with particular concern for primary care indicators. The study findings bring into question whether states with more restrictive NP SOP regulations impact access to primary care, which may in turn influence population health outcomes. These findings suggest the need for further research. NPs are essential for meeting the increasing demands of primary care in the United States, and quality-of-care indicator research supports their use.

Trends in Practice Patterns and Perspectives of Colorado Certified Nurse-Midwives

Healthcare resources are stretched perilously thin and the demand for primary healthcare services has never been greater. Despite this demand for service, relatively little is known about the practice environment of primary healthcare providers, particularly certified nurse-midwives (CNMs), where workforce surveys frequently include these specialists within the broader nurse practitioner category. A distinct professional discipline, nurse-midwives are one type of primary care provider recommended to enhance access to services. The objective of this study was to understand the nature of the nurse-midwifery practice environment in the state of Colorado. Online survey of Colorado CNMs (N = 328) found little ethnic/racial diversity and an aging workforce, with most providing care in an urban, hospital/medical center environment. Several key legislative issues were identified though respondents felt ill prepared to engage in legislative change. Overall, CNMs were optimistic about the future of midwifery and were largely satisfied with their practice.