美国杜拉计划及其成果:全面审查以告知州级政策
Gabriela Alvarado1, Dana Schultz1, Nipher Malika1
1The RAND Corporation, Santa Monica, California.
概括
美国的孕产妇健康状况不佳. 虽然杜拉护理看起来很有前途,并且正在被医疗补助计划所采用,但其有效性的证据有限,需要进一步研究以实现最佳实施.
科学领域:
- 孕产妇健康 孕产妇健康
- 公共卫生政策 公共卫生政策
- 医疗保健服务研究 医疗服务研究
背景情况:
- 与其他工业化国家相比,美国在孕产妇健康方面面临重大挑战.
- 新出现的证据表明,杜拉护理可以改善母亲和婴儿的结果.
- 国家医疗补助计划越来越多地将杜拉护理纳入其服务中.
研究的目的:
- 进行对美国杜拉计划及其结果的范围审查.
- 为国家政策制定者提供信息,考虑与杜拉护理相关的法律和计划.
- 为了描述当前的杜拉护理文学风景.
主要方法:
- 学术数据库和灰色文献的范围审查.
- 包括标准适用于740个已识别的记录,其中100个符合标准.
- 在2012年1月1日至2022年3月10日期间进行的文献搜索.
主要成果:
- 结果数据主要是临床的,尽管doulas不是临床提供者.
- 有限的证据表明,杜拉护理与分娩人员和婴儿的改善临床结果之间存在关联.
- 杜拉劳动力的多样性,公平性和支付模式仍未得到充分探索,可获得定性数据.
结论:
- 决策者必须承认证据的局限性,即杜拉护理只关注临床结果和成本节约.
- 关于杜拉护理的影响存在相互矛盾的结论,需要进一步研究.
- 让杜拉参与补偿讨论和开发改进的指标对于成功实施和理解孕产妇健康结果至关重要.
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