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Objective: To assess key birth outcomes in an alternative maternity care model, midwifery-based birth center care. Data Sources: The American Association of Birth Centers Perinatal Data Registry and birth certificate files, using national data collected from 2009 to 2019. Study Design: This observational cohort study compared key clinical birth outcomes of women at low risk for perinatal complications, comparing those who received care in the midwifery-based birth center model versus hospital-based usual care. Linear regression analysis was used to assess key clinical outcomes in the midwifery-based group as compared with hospital-based usual care. The hospital-based group was selected using nearest neighbor matching, and the primary linear regressions were weighted using propensity score weights (PSWs). The key clinical outcomes considered were cesarean delivery, low birth weight, neonatal intensive care unit admission, breastfeeding, and neonatal death. We performed sensitivity analyses using inverse probability weights and entropy balancing weights. We also assessed the remaining role of omitted variable bias using a bounding methodology. Data Collection: Women aged 16-45 with low-risk pregnancies, defined as a singleton fetus and no record of hypertension or cesarean section, were included. The sample was selected for records that overlapped in each year and state. Counties were included if there were at least 50 midwifery-based birth center births and 300 total births. After matching, the sample size of the birth center cohort was 85,842 and the hospital-based cohort was 261,439. Principal Findings: Women receiving midwifery-based birth center care experienced lower rates of cesarean section (-12.2 percentage points, p < 0.001), low birth weight (-3.2 percentage points, p < 0.001), NICU admission (-5.5 percentage points, p < 0.001), neonatal death (-0.1 percentage points, p < 0.001), and higher rates of breastfeeding (9.3 percentage points, p < 0.001). Conclusions: This analysis supports midwifery-based birth center care as a high-quality model that delivers optimal outcomes for low-risk maternal/newborn dyads. KEYWORDS birth center, community birth, low-risk birth, maternity care models, midwifery-led birth center, propensity score weighting What is known on this topic * The United States has the worst maternal outcomes of any high-income country, and improving the maternity care system is challenging given the divergent needs of those with high-risk versus low-risk pregnancies. * The midwifery-based birth center model of maternity care centers midwifery principles, with birth occurring in a nonmedicalized environment, and evidence from outside the United States supports improved outcomes for low-risk pregnancies. * Research conducted in the United States on this model of maternity care, typically conducted using either birth certificate data or perinatal data registries, has resulted in conflicting results regarding clinical outcomes. What this study adds * This study used robust statistical methods, a perinatal data registry, and birth certificate data to evaluate a national sample of US births managed in the midwifery-based birth center model. * The use of these data sources allowed for evaluation of the full model of midwifery-based birth center care, beyond simply place of birth or birth attendant. * This analysis found that women and their neonates at low risk for perinatal complications who received care in the midwifery-based birth center model experienced improved outcomes., 1 | INTRODUCTION The United States has the worst maternal outcomes of any wealthy country, despite spending more per childbirth episode than any other nation in the world. (1,2) Like [...]

Delivering financial planning services and helping to protect your clients' best interest includes risk management planning. Smoothing Out Life's Bumps in the Road Life insurance options protect our clients when [...]

Objective: To evaluate whether Medicare's Hospital Readmissions Reduction Pro-gram (HRRP) is associated with increased observation stay use. Data Sources and Study Setting: A nationally representative sample of fee-for-service Medicare claims, January 2009-September 2016. Study Design: Using a difference-in-difference (DID) design, we modeled changes in observation stays as a proportion of total hospitalizations, separately comparing the initial (acute myocardial infarction, pneumonia, heart failure) and subsequent (chronic obstructive pulmonary disease) target conditions with a control group of nontarget conditions. Each model used 3 time periods: baseline (15 months before program announcement), an intervening period between announcement and implementation, and a 2-year post-implementation period, with specific dates defined by HRRP policies. Data Collection/Extraction Methods: We derived a 20% random sample of all hospitalizations for beneficiaries continuously enrolled for 12 months before hospitalization (N = 7,162,189). Principal Findings: Observation stays increased similarly for the initial HRRP target and nontarget conditions in the intervening period (0.01% points per month [95% CI -0.01, 0.3]). Post-implementation, observation stays increased significantly more for target versus nontarget conditions, but the difference is quite small (0.02% points per month [95% CI 0.002,0.04]). Results for the COPD analysis were statistically insignificant in both policy periods. Conclusions: The increase in observation stays is likely due to other factors, including audit activity and clinical advances. KEYWORDS difference-in-differences, hospital readmissions reduction program, inpatient, Medicare, observation stays, recovery audit contractors What is known on this topic * Observation stays have increased significantly over the last 15 years. * Observation stays are excluded from the numerator and denominator of readmissions measures. * Medicare's Hospital Readmissions Reduction Program (HRRP) may incentivize hospitals to substitute observation stays for inpatient readmissions, although evidence of this is mixed. What this study adds * Ours is the first study to examine how hospitals may have responded to the HRRP by using observation stays in lieu of both index admissions and readmissions. * Using quasi-experimental methods, we find that the HRRP was not meaningfully associated with differential increases in the use of observation stays for target versus nontarget conditions. * The increase in observation stays is more likely the result of advances in clinical care and hospitals taking steps to avoid payment audits., 1 | INTRODUCTION Medicare's Hospital Readmissions Reduction Program (HRRP) has been controversial since its announcement. One ongoing concern is whether the HRRP incentivizes hospitals to use observation stays to avoid [...]

CPAs across America likely perform elements of financial planning without giving themselves credit. With little additional effort, CPAs can transform their clients' lives. My experience shows that the obvious often [...]

Through technical assistance and distribution of funds to State and local governments, the Federal Highway Administration is responsible for ensuring that America's roads and highways continue to be among the [...]

PERHAPS IT'S BECAUSE we're in a period of negative year-over-year comps (seven consecutive quarters for Home Depot and six for Lowe's) following the historic sales gains of the past few [...]

It's a picture you may have seen before: a large white robot with a cute teddy bear face cradling a smiling woman in its arms. Images of Robear, a prototype [...]

Software isn't new to manufacturing, but as technical capabilities have evolved and matured, it's becoming increasingly entrenched in processes that directly affect product quality. This means that quality professionals need [...]

Objective: To examine the relationship between federally qualified health center (FQHC) use and hospital-based care among individuals dually enrolled in Medicare and Medicaid. Data Sources: Data were obtained from 2012 to 2018 Medicare claims. Study Design: We modeled hospital-based care as a function of FQHC use, person-level factors, a Medicare prospective payment system (PPS) indicator, and ZIP code fixed effects. Outcomes included emergency department (ED) visits (overall and non-emergent), observation stays, hospitalizations (overall and for ambulatory care sensitive conditions), and 30-day unplanned returns. We stratified all models on the basis of eligibility and rurality. Data Extraction Methods: Our sample included individuals dually enrolled in Medicare and Medicaid for at least two full consecutive years, residing in a primary care service area with an FQHC. We excluded individuals without primary care visits, who died, or had end-stage renal disease. Principal Findings: After the Medicare PPS was introduced, FQHC use in rural counties was associated with fewer ED and nonemergent ED visits per 100 person-years among both age-eligible (-14.8 [-17.5, -12.1]; -6.6 [-7.5, -5.6]) and disability-eligible duals (-11.3 [-14.4, -8.3]; -6 [-7.4, -4.6]) as well as a lower probability of observation stays (-0.8 pp age-eligible; -0.4 pp disability-eligible) and unplanned returns (-2.1 pp age-eligible; -1.9 pp disability-eligible). In urban counties, FQHC use was associated with more ED and nonemergent ED visits per 100 person-years (10.6 [8.4, 12.8]; 4.0 [2.6, 5.4]) among disability-eligible duals (a decrease of more than 60% compared with the pre-PPS period) and increases in the probability of hospitalization (1.1 pp age-eligible; 0.8 pp disability-eligible) and ACS hospitalization (0.5 pp age-eligible; 0.3 pp disability-eligible) (a decrease of roughly 50% compared with the pre-PPS period). Conclusions: FQHC use is associated with reductions in hospital-based care among dual enrollees after introduction of the Medicare PPS. Further research is needed to understand how FQHCs can tailor care to best serve this complex population. KEYWORDS aged, community health centers, disabled persons, hospitalization, Medicaid, Medicare, primary health care What is known on this topic * Individuals dually enrolled in Medicare and Medicaid are a high-cost, high-need population. * Improving access to primary care may reduce the use of costly and potentially avoidable hospital-based care, but prior studies have excluded dual enrollees, used aggregated data, focused on just a few states, and failed to consider the full spectrum of hospital-based care. * Health centers provide improved access to primary care for certain populations, but there are little data on the use of health centers by dual enrollees. What this study adds * Dually-enrolled individuals who use health centers for their primary care had significantly less hospital-based care after implementation of the Medicare prospective payment system. * Greater reliance on health centers is associated with larger reductions in the use of hospital-based care. * Many dual enrollees are likely to benefit from receiving care at a health center., 1 | INTRODUCTION In 2018, over 12 million Medicare beneficiaries were also enrolled in Medicaid. (1) These dual enrollees have disproportionately high medical spending and substantial health needs. (2) Dual [...]

Mother Nature provides breathtaking vistas, but can also bring us some nasty surprises, especially at a time when the climate is changing and affecting storm frequency and intensity. Many of [...]

Deflated by her job layoff in 2020, Brennan Coker has reinvented herself as a self-supporting, TikTok influencer who preaches in her videos against food waste while dicing and pickling overripe [...]

ON A RECENT TRIP to the West Coast for our HR Training Roundtable group's annual meeting, my trusty iPhone decided to die the day before the meeting started. It was [...]

If your client is a business owner with five or more employees who does not have a retirement plan, has not registered with the state of California and has received [...]

A high-performance sensor is not needed to detect the list of missed targets for the widespread adoption of self-driving cars. General Motors once promised autonomous vehicles (avs) in abundance by [...]

If there is one word to describe how giving to nonprofits increased by $18.6 billion during the depths of a global pandemic in 2021, that word is 'flexible.' Another word [...]

TEN YEARS AGO, my friend's wife made $2 million selling girl's headbands online. When I asked them how they did it, my friend said, 'Dave, in the digital world, [selling] [...]

When the U.S. Securities & Exchange Commission (SEC) settled actions in September 2020 against Interface, Inc., and Fulton Financial Corporation for 'violations that resulted in the improper reporting of quarterly [...]

In addition to yearly internal audit requirements, the Commander, Navy Reserve Force (CNRF) had to rise quickly to the challenge of preparing for the Department of Navy's (DoN's) first ever [...]

Well-designed, well-managed rental housing contributes to the quality of life of people for whom homeownership may be out of reach, but who desire the stability and security of a good [...]

'Members of this channel look to our association to bring them together so we can continue to lean on and learn from each other.' A couple of months ago I [...]

Cybercrimes are on the rise, and so is Arkansas businesses' need for skilled talent to help identify, protect, detect, respond to and recover from potential breaches and attacks. In the [...]

This qualitative study examines the experiences of COVID-19 job loss by individuals from minimal-resource communities. Six participants were interviewed regarding their experience with becoming unemployed during the global pandemic. In [...]

A published nonprofit management scholar from Texas is a new faculty face this year on the Rutgers University-Camden campus in New Jersey while Georgia Southern University in Statesboro, Ga., is [...]

Since the first Lotus car was built in 1948, the company has been a beacon in the automotive industry for the design and manufacture of high-performance cars born out of [...]

Byline: Ian Wright One of the criticisms of Rishi Sunak is that he is a detail jockey - that he becomes completely focused on the minutiae of policy, missing the [...]

More than 150 children were awaiting being matched with someone from Dig Brothers Big Sisters of Butler County at the start of last month --the result of a sluggish return [...]

CARE USA look a calculated risk three years ago, ending its front-end premium program of sending return address labels to prospective donors and instead focused on mission-based donor acquisition. Catholic [...]

growing Lip, I often visited my father's childhood home in South Bend, Indiana. When I was 5 years old, I would hear my grandparents discuss how much contempt they had [...]

As a child, I was a big fan of the animated TV series, The Jetsons. As those of you who watched the show know, the Jetsons were a futuristic family [...]

In Help Wanted (Norton, Mar.; reviewed on p. 48), Waldman follows a team of workers at a big-box store in Upstate New York. What drew you to the subject? It [...]

I may as well have solemnly sworn I was up to no good when, just over ten years ago, as a high school student, I downloaded a soundbite onto my [...]

Oral solids are cost-effective, easy to manufacture and patient-friendly, making them the most common dosage form in the pharmaceutical industry. In addition, advances in drug delivery technology, such as targeted [...]