Stapleton Susan, Wright Jennifer, Jolles Diana R
American Association of Birth Centers, Perkiomenville, Pennsylvania (Drs Stapleton and Jolles); Commission for the Accreditation of Birth Centers, Kennebunk, Maine (Dr Stapleton); AABC Perinatal Data Registry, Brattleboro, Vermont (Ms Wright); and El Rio Community Health Center, Frontier Nursing University, Tucson, Arizona (Dr Jolles).
J Perinat Neonatal Nurs. 2020 Jan/Mar;34(1):27-37. doi: 10.1097/JPN.0000000000000454.
In 2018, the Center for Medicare and Medicaid Innovation in the United States (US) released report demonstrating birth centers as the appropriate level of care for most Medicaid beneficiaries. A pilot project conducted at 34 American Association of Birth Centers (AABC) Strong Start sites included 553 beneficiaries between 2015 and 2016 to explore client perceptions of high impact components of care. Participants used the AABC client experience of care registry to report knowledge, values, and experiences of care. Data were linked to more than 300 process and outcome measures within the AABC Perinatal Data Registry™. Descriptive statistics, t tests, χ analysis, and analysis of variance were conducted. Participants demonstrated high engagement with care and trust in pregnancy, birth, and parenting. Beneficiaries achieved their preference for vaginal birth (89.9%) and breastfeeding at discharge through 6 weeks postpartum (91.7% and 87.6%). Beneficiaries reported having time for questions, felt listened to, spoken to in a way they understood, being involved in decision making, and treated with respect. There were no variations in experience of care, cesarean birth, or breastfeeding by race. Medicaid beneficiaries receiving prenatal care at AABC Strong Start sites demonstrated high levels of desired engagement and reported receiving respectful, accessible care and high-quality outcomes. More investment and research using client-reported data registries are warranted as the US works to improve the experience of perinatal care nationwide.
2018年，美国医疗保险和医疗补助服务中心创新中心发布报告，表明分娩中心对大多数医疗补助受益人群而言是合适的护理级别。2015年至2016年期间，在美国分娩中心协会（AABC）的34个“强力开端”试点项目点开展了一个试点项目，纳入了553名受益人，以探究客户对高影响力护理要素的看法。参与者使用AABC护理体验登记系统报告护理知识、价值观和体验。数据与AABC围产期数据登记系统™内300多项过程和结果指标相关联。进行了描述性统计、t检验、χ分析和方差分析。参与者对护理表现出高度参与，并对怀孕、分娩和育儿充满信任。受益人实现了阴道分娩的偏好（89.9%），并在产后6周内出院时实现了母乳喂养（91.7%和87.6%）。受益人报告说有时间提问，感觉有人倾听，能以他们理解的方式与之交流，参与决策，并受到尊重。护理体验、剖宫产或母乳喂养在种族方面没有差异。在AABC“强力开端”试点项目点接受产前护理的医疗补助受益人表现出高度的期望参与度，并报告说得到了尊重、便捷的护理和高质量的结果。随着美国努力改善全国围产期护理体验，有必要利用客户报告的数据登记系统进行更多投资和研究。
