Bridging the gaps in care: Perspectives of obstetric service delivery providers on alternative models of care outside Metropolitan Atlanta, Georgia Open Access

Pinto, Meredith Lee (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/ht24wk11f?locale=en
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Abstract

Background: A workforce study conducted in 2011 by the Georgia Infant and Maternal Health Research Group (GIMHRG) found that 52% of Primary Care Service Areas outside metropolitan Atlanta Georgia had an overburdening or complete lack of obstetric care. In response, GMIHRG collaborated with the Georgia Obstetrical and Gynecological Society (GOGS), the Georgia Department of Public Health, and the March of Dimes Foundation to identify the challenges that service providers face while delivering care and to describe essential components of new models of care that might be implemented. Proposed models of care include rotating physicians into shortage areas; incorporating certified nurse midwives, obstetricians, and maternal fetal medicine specialists into a tiered model; using a hospitalist model of care; and adapting mobile clinics.

Methods: We conducted 46 qualitative in-depth interviews with obstetricians, maternal-fetal medicine specialists, certified nurse midwives, and Georgia maternal and child health leaders. Stakeholders were recruited using a snowball method. Interviews were digitally recorded, transcribed verbatim and analyzed using MAXQDA software. We used a grounded theory approach to identify challenges providers face and to assess new obstetric service models that would to address these barriers in Georgia.

Results: Service delivery providers face significant financial barriers, including low Medicaid reimbursement, high cost of medical malpractice insurance, and high percentage of self-pay patients. Furthermore, the gaps within in the Maternal Care System include patient's late initiation into prenatal care and a lack of collaboration between stakeholder populations. Essential components of effective models of care include patient continuity of care, efficient use of resources, and risk appropriate care.

Discussion: Our analysis revealed that an ideal service delivery system would include closer collaboration among different stakeholder populations, decentralization of services, increased continuity of care, decreased time to care, and increase reimbursement rates that align with incentives for risk appropriate care. These findings should serve as the foundation for policy makers and program managers as they endeavor to resolve the obstetric provider shortage in Georgia. Incorporating these findings into Georgia's maternal and child health programming will improve maternal and infant health outcomes.

Table of Contents

Table of Contents
Chapter 1: Introduction.................................................1
Project Rational...........................................................1
Purpose statement and research question........................2
Specific Research Question............................................3
Significance statement..................................................3
Chapter 2: Comprehensive Review of the Literature...........4
The Georgia Obstetric System........................................4
Benefits of Prenatal Care..............................................4
Current State of Obstetrics in Georgia.............................5
Models of Care............................................................9
Chapter 3: Manuscript.................................................17
Contributions of the Student.........................................18
Abstract....................................................................19
Introduction...............................................................20
Methods....................................................................24
Results.....................................................................29
Discussion.................................................................40
Chapter 4: Public Health Implications.............................45
Bibliography..............................................................48
Appendix 1: IRB Approval............................................50
Appendix 2: Letter of Endorsement................................51
Appendix 3: Proposed Models of Obstetric Care................52
Appendix 4: Interview Guides........................................54
Appendix 5: Code book................................................65
Appendix 6: Georgia's Maternal Care System...................71

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