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The role of midwives in a transforming health care system
Transcript of The role of midwives in a transforming health care system
MANA Region 1 Conference
March 3, 2013 Health care is becoming... Health care is becoming... more patient-centered. more connected. Thank you! Amy Romano, MSN, CNM
www.optimalcareinchildbirth.com http://www.ehealth.va.gov/MHVBlueButton.asp Shared Decision
Making patient experience patient-centered research breaking down data silos investment in EHRs Health care is becoming... more team-based http://www.flickr.com/photos/usarmyafrica/5169700174/sizes/z/in/photostream/ Why? Midwifery is... connected woman-centered http://www.flickr.com/photos/chrisandjenni/147355845/ team-based "ambulatory practice" "non-physician providers" "patient engagement" INNOVATIVE mobile and social poor outcomes
chronic disease poorly coordinated care
practice variation and lack of informed decision making waste and inefficiencies
perverse incentives chronic disease
prevention of preterm birth and LBW
optimal gut colonization
prevention of breast cancer, heart disease, obesity Midwives and the Triple Aim population health "Midwife-led care confers benefits and shows no adverse outcomes. It should be the norm for women classified at low and high risk of complications." - Hatem 2008 outcomes "women assigned to group care were significantly less likely to have preterm births compared with those in standard care...Effects were strengthened for African-American women." - Ickovics 2007 disparities experience of care source: ACNM http://www.flickr.com/photos/differentview/6157264842/sizes/z/in/photostream/ per-capita cost high cost of cesareans
Commercial $18,329 vs $27,866
Medicaid $9,131 vs $13,590 concentration in facility fees
59-66% of total payments covered facility fees rising costs 50% increase in last decade 4-fold increase in out-of-pocket (-Truven Health Analytics 2013) A lot of it is not really working... Regarding EHRs
"We’ve not achieved the productivity and quality benefits that are unquestionably there for the taking,” - Arthur Kellerman, RAND Study Author
Regarding Patient-Centered Medical Homes
"In our study...we found no association between PCMH processes and patient experience." - Martsolf 2012
Regarding Shared Decision Making
"Barriers to shared decision making included overworked physicians, insufficient provider training, and clinical information systems incapable of prompting or tracking patients through the decision-making process." - Friedman 2013 "Disruptive Innovation" "The task of building a truly patient-centric health care system brings with it a transfer of power that will uproot the established order from the exam room to the boardroom." - Michael Millenson
"The only way to make health care cost a lot less money is to do it better. Way better. For everyone." - Joe Flower http://www.flickr.com/photos/45128746 $3.5 billion $27 billion http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-gawande-harvard-medical-school-commencement-address.html#ixzz2MTVnyz8q "We’re all specialists now—even primary-care doctors. A structure that prioritizes the independence of all those specialists will have enormous difficulty achieving great care."
- Atul Gawande whole-person care
personal clinician provides first contact, continuous, comprehensive care
care is coordinated or integrated across the health care system
team-based care positive deviance = high quality, high-value care DISRUPTIVE DEVIANT Key Recommendations: keep being disruptive, positive deviants - we're good at that!
shore up care coordination and teamwork practices
collect, track, and report data
build toward a high-quality, integrated, midwife-led primary maternity care system References: Friedberg, M. W., Van Busum, K., Wexler, R., Bowen, M., & Schneider, E. C. (2013). A demonstration of shared decision making in primary care highlights barriers to adoption and potential remedies. Health Affairs (Project Hope), 32(2), 268-275. doi: 10.1377/hlthaff.2012.1084; 10.1377/hlthaff.2012.1084
Hatem, M., Sandall, J., Devane, D., Soltani, H., & Gates, S. (2008). Midwife-led versus other models of care for childbearing women. Cochrane Database of Systematic Reviews (Online), (4)(4), CD004667. doi: 10.1002/14651858.CD004667.pub2
Ickovics, J. R., Kershaw, T. S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H., & Rising, S. S. (2007). Group prenatal care and perinatal outcomes: A randomized controlled trial. Obstetrics and Gynecology, 110(2), 330-339. doi: 10.1097/01.AOG.0000275284.24298.23
Kellermann, A. L., & Jones, S. S. (2013). What it will take to achieve the as-yet-unfulfilled promises of health information technology. Health Affairs (Project Hope), 32(1), 63-68. doi: 10.1377/hlthaff.2012.0693; 10.1377/hlthaff.2012.0693
Martsolf, G. R., Alexander, J. A., Shi, Y., Casalino, L. P., Rittenhouse, D. R., Scanlon, D. P., & Shortell, S. M. (2012). The patient-centered medical home and patient experience. Health Services Research, 47(6), 2273-2295. doi: 10.1111/j.1475-6773.2012.01429.x; 10.1111/j.1475-6773.2012.01429.x
Millenson, M.Not in my name: Patient-centeredness means sharing power, health affairs blog. Retrieved March 1, 2013, from http://healthaffairs.org/blog/2013/02/26/not-in-my-name-real-patient-centeredness-means-sharing-power/
Truven Health Analytics. (2013). The cost of having a baby in the united states. (). Ann Arbor, MI: Truven Health Analytics.