Kett Paula M, Guenther Grace A, van Eijk Marieke S, Patterson Davis G, Frogner Bianca K
Center for Health Workforce Studies, University of Washington School of Medicine, Seattle, WA 98195, United States.
Department of Anthropology, College of Arts and Sciences, University of Washington, Seattle, WA 98195, United States.
Health Aff Sch. 2024 Dec 4;2(12):qxae113. doi: 10.1093/haschl/qxae113. eCollection 2024 Dec.
Health centers (sometimes referred to as "federally qualified health centers") can play an important role in addressing perinatal inequities. However, there is limited information on how different staffing models in health centers contribute to perinatal outcomes, including the availability of certified nurse midwives (CNMs). Using 2011-2021 Uniform Data System files, we examined 4 staffing models in 1385 health centers: those with no CNMs or obstetricians-gynecologists (OBs) ("non-CNM/OB"), CNM-only, OB-only, and both CNMs and OBs ("CNM/OB"). We predicted adjusted low birthweight (LBW) rates across these staffing types using a generalized linear model approach, adjusting for both time and center fixed effects as well as relevant patient, staffing, organizational, and community characteristics. We found that CNM-only health centers had the lowest LBW rates across all staffing models (7.6%) and non-CNM/OB centers had the highest (10.1%). Among Black births, LBW rates ranged from 10.1% (CNM-only) to 13.5% (non-CNM/OB). Findings indicate the importance of building and supporting the CNM workforce and ensuring adequate staffing at health centers, particularly as part of a comprehensive approach to addressing inequities in perinatal outcomes including addressing the scope of practice of CNMs, as more CNM-staff health centers were in areas with independent scope of practice.
健康中心（有时也被称为“联邦合格健康中心”）在解决围产期不平等问题方面可以发挥重要作用。然而，关于健康中心不同的人员配置模式如何影响围产期结局，包括认证护士助产士（CNM）的可获得性，相关信息有限。利用2011 - 2021年统一数据系统文件，我们研究了1385家健康中心的4种人员配置模式：没有CNM或妇产科医生（OB）的（“无CNM/OB”）、仅有CNM的、仅有OB的，以及同时有CNM和OB的（“CNM/OB”）。我们使用广义线性模型方法预测这些人员配置类型的调整后低出生体重（LBW）率，并对时间和中心固定效应以及相关的患者、人员配置、组织和社区特征进行了调整。我们发现，在所有人员配置模式中，仅有CNM的健康中心LBW率最低（7.6%），无CNM/OB的中心最高（10.1%）。在黑人出生的情况中，LBW率从10.1%（仅有CNM）到13.5%（无CNM/OB）不等。研究结果表明，建立和支持CNM劳动力队伍以及确保健康中心有足够的人员配置非常重要，特别是作为解决围产期结局不平等综合方法的一部分，包括解决CNM的执业范围问题，因为更多有CNM工作人员的健康中心位于执业范围独立的地区。
