Distribution and Adequacy of Delivery Care Providers in the United States 公开
Vanderlaan, Jennifer (2012)
Abstract
Obstetrician benchmarks have been used to measure maternity care workforce adequacy in the United States since 1981. These measures are not precise enough to capture evolving differences in non-physician workforce, nor do they allow for regional differences in fertility rates. Using GIS technology to compare the distribution of areas with adequate workforce reveals differences between obstetrician to population measures and obstetrician equivalent to birth measures. Using a measure of adequacy that includes a count of midwives reveals associations between policies regulating midwifery practice and proportion of areas with adequate delivery workforce.
Table of Contents
Table of Figures
Part One: Introduction 1
Introduction and Rationale 1
Problem Statement 6
Purpose Statement 12
Research Questions 13
Significance Statement 13
Definition of Terms 14
Chapter Two: Literature Review 15
Delivery Care Provider Workforce Benchmarking 15
Obstetricians 16
Family Practice Physicians 20
Midwives 21
Geographic Studies. 25
Summary of Current Problem and Relevance 26
Chapter Three: Methodology 28
Introduction 28
Population and Sample 28
Research Design 30
Procedures 31
Limitations and Delimitations 32
Chapter Three: Results 33
Findings 33
Distribution of Delivery Care Providers at the County Level 33
Adequacy of the workforce at the County Level 38
Distribution of Delivery Care Providers at the Health Service Area Level 46
Adequacy of the workforce at the Health Service Area Level 50
Association of state midwifery policy with adequacy of the workforce 55
Other Findings 61
Summary 62
Chapter Five: Discussion 62
Chapter Six: Implications/Recommendations 65
Appendix A: Summary of Direct Entry Midwifery Laws with Sources for Direct Entry Midwifery Data 67
Appendix B: Summary of Midwifery Written Practice Agreement Laws by State(ACNM, 2011) 70
Appendix C: Difference between Obstetrician to Population and Obstetrician to D Measures of Adequacy 72
References 73
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