141st APHA Annual Meeting

In This section

Role of public health nursing in decreasing unwarranted variations in care to Medicaid beneficiaries

Wednesday, November 6, 2013 : 8:50 AM - 9:10 AM

Diana Jolles, CNM MS , Midwifery, Frontier Nursing University, Corpus Christi, TX
Background: Unwarranted variations in care to Medicaid beneficiaries cause harm, decrease quality and cost taxpayers. The nursing model of health promotion and disease prevention has an important role in the prevention of unwarranted variations and overuse within the beginning of life care continuum. The advanced practice nursing role in resisting unwarranted variation has not been well documented within the literature. Methods: Secondary analysis of a prospective perinatal, advanced practice data registry. In order to control for the warrant of procedure and utilization, the sample is controlled by risk status and includes only medically low-risk pregnancies. Evaluation of unwarranted variation in care is conducted within the sample of low-risk Medicaid beneficiaries only. Eight supply sensitive measures of unwarranted variation documented within the perinatal literature are evaluated within a population of Medicaid beneficiaries receiving care within nurse-midwifery led freestanding birth centers. Results: Medicaid beneficiaries represent 23.7% (n=3,701) of the total sample in data set between 2007 and 2009. High quality perinatal outcomes are demonstrated by the model with a total spontaneous vaginal delivery rate of 96.9% and an exclusive breastfeeding on discharge from birth facility rate of 94.6% far exceeding national benchmarks. The sample achieved congruence with all eight supplies sensitive measures of overuse demonstrating fidelity to evidence based care and appropriate use. Conclusion: This evaluation documents the public health contributions of advanced practice nurses through the preservation and documentation of nurse-midwifery led birth centers. The model demonstrates resistance to unwarranted variations in care.

Learning Areas:
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health or related nursing
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Analyze the framework of “unwarranted variation” applied to Medicare populations within a population of Medicaid beneficiaries. Evaluate the contributions of the midwifery-led, birth center model of care as an innovative public health nursing intervention capable of resisting national trends of overuse and unwarranted variation in care. Evaluate the perinatal quality measures of a sample of Medicaid beneficiaries receiving care within nurse-led models of care. Demonstrate the contribution of advanced practice nursing in public health data registries.

Keywords: Public Health Nursing, Outcomes, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a public health nurse midwife. I began in the National Health Service Corp and have continued throughout my career to serve underserved populations. I am in the dissertation phase of my PhD in Nursing Research at Texas Woman's University. This abstract is my pilot study for my dissertation I have been involved in the development and maintenance of the perinatal data registry.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.