Urban Institute, Washington, District of Columbia.
Center for Medicare and Medicaid Innovation, Baltimore, Maryland.
Birth. 2019 Jun;46(2):244-252. doi: 10.1111/birt.12431. Epub 2019 May 13.
Medicaid pays for approximately half of United States births, yet little research has explored Medicaid beneficiaries' perspectives on their maternity care. Typical maternity care in the United States has been criticized as too medically focused while insufficiently addressing psychosocial risks and patient education. Enhanced care strives for a more holistic approach.
The perspectives of participants in the Strong Start for Mothers and Newborns II initiative, which provided enhanced prenatal care to women covered by Medicaid or the Children's Health Insurance Program (CHIP) during pregnancy through Birth Centers, Group Prenatal Care, and Maternity Care Homes, are evaluated. Strong Start intended to improve care quality and birth outcomes while lowering costs. We analyzed data from 133 focus groups with 951 pregnant or postpartum women who participated in Strong Start from 2013 to 2017.
The majority of focus group participants said that Strong Start's enhanced care offered numerous important benefits over typical maternity care, including considerably more focus on women's psychosocial risk factors and need for education. They praised increased support; nutrition, breastfeeding, and family planning education; community referrals; longer time with practitioners; and involvement of partners in their care. Maternity Care Home participants, however, occasionally voiced concerns over lack of practitioner continuity and short clinical appointments, whereas Group Prenatal Care participants sometimes said they could not attend visits because of lack of childcare.
Medicaid and CHIP beneficiaries reported positive experiences with Strong Start care. If more Medicaid practitioners could adopt aspects of the prenatal care approaches that women praised most, it is likely that women's risk factors could be more effectively addressed and their overall care experiences could be improved.
医疗补助计划为美国约一半的分娩提供资金，但几乎没有研究探讨医疗补助受益人的产妇护理观点。美国典型的产妇护理受到批评，认为其过于注重医学，而对心理社会风险和患者教育关注不足。强化护理则力求采用更全面的方法。
评估参与“母亲和新生儿强壮开端 II 倡议”（Strong Start for Mothers and Newborns II initiative）的参与者的观点。该倡议通过生育中心、小组产前护理和产妇护理之家，为参加医疗补助计划或儿童健康保险计划（Children's Health Insurance Program，CHIP）的妇女在怀孕期间提供强化产前护理。Strong Start 旨在提高护理质量和分娩结果，同时降低成本。我们分析了 2013 年至 2017 年期间，共有 951 名参加 Strong Start 的孕妇或产后妇女参加的 133 个焦点小组的数据。
大多数焦点小组参与者表示，与典型的产妇护理相比，Strong Start 的强化护理提供了许多重要的益处，包括更注重妇女的心理社会风险因素和教育需求。他们称赞增加了支持、营养、母乳喂养和计划生育教育、社区转介、与从业者相处的时间更长以及伴侣参与其护理。然而，产妇护理之家的参与者偶尔对从业者连续性和短期临床预约表示担忧，而小组产前护理的参与者有时则表示由于缺乏儿童保育，他们无法参加预约。
医疗补助计划和 CHIP 受益人称 Strong Start 护理的体验积极。如果更多的医疗补助计划从业者能够采用妇女最称赞的产前护理方法的某些方面，那么妇女的风险因素可能会得到更有效地解决，她们的整体护理体验可能会得到改善。
