在获得证书的护士助产士的全职执业权限下,健康结果和提供者选择
Lauren Hoehn-Velasco1, Diana R Jolles2, Alicia Plemmons3
1Department of Economics, Andrew Young School of Policy Studies, Georgia State University, United States of America.
Journal of health economics
|October 1, 2023
概括
经过认证的护士助产士 (CNMs/CMs) 的全职执业权限对产科和死亡率结果的影响最小. 然而,它增加了CNM/CM辅助分娩的1%,这表明这些提供商的使用率更高.
科学领域:
- 孕产妇健康 孕产妇健康
- 医疗保健服务研究 医疗服务研究
- 公共卫生政策 公共卫生政策
背景情况:
- 完全执业权限允许非医生提供者独立管理患者护理.
- 认证护士助产士 (CNMs/CMs) 是产妇护理的关键提供者.
- 了解扩大实践权威的影响对于医疗保健政策至关重要.
研究的目的:
- 评估CNMs/CMs的全面实践权威对产科和死亡结果的影响.
- 评估使用CNMs/CMs与分娩医生之间的变化.
- 探索驱动 CNM/CM 协助交付所观察到的任何变化的潜在机制.
主要方法:
- 对2008-2019年美国出生和死亡证明记录的分析.
- 在全面实践权威实施之前和之后的结果和交付出席率的比较.
- 检查影响CNM/CM劳动力供应和报告准确性的因素.
主要成果:
- 对CNMs/CMs的全面实践权限对产科结果,产妇死亡率和新生儿死亡率的影响微不足道.
- 报告的CNM/CM辅助分娩增加了1%,医生辅助分娩相应减少.
- 在CNM/CM辅助分娩的增加反映了现有提供商的利用率增加,而不仅仅是改善报告或劳动力供应变化.
结论:
- 授予CNMs/CMs的完全实践权限不会显著改变关键的孕产妇和新生儿健康结果.
- 对CNMs/CMs的扩大实践权限导致其用于分娩的使用量略有增加.
- 政策变化使CNMs/CMs能够独立实践,主要是轮班出勤,而不是广泛影响健康指标.
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