BackgroundVariations in care for pregnant women have been reported to affect pregnancy outcomes.MethodsThis study examined data for all 3136 Medicaid beneficiaries enrolled at American Association of Birth Centers (AABC) Center for Medicare and Medicaid Innovation Strong Start sites who gave birth between 2012 and 2014. Using the AABC Perinatal Data Registry, descriptive statistics were used to evaluate socio‐behavioral and medical risks, and core perinatal quality outcomes. Next, the 2082 patients coded as low medical risk on admission in labor were analyzed for effective care and preference sensitive care variations. Finally, using binary logistic regression, the associations between selected care processes and cesarean delivery were explored.ResultsMedicaid beneficiaries enrolled at AABC sites had diverse socio‐behavioral and medical risk profiles and exceeded quality benchmarks for induction, episiotomy, cesarean, and breastfeeding. Among medically low‐risk women, the model demonstrated effective care variations including 82% attendance at prenatal education classes, 99% receiving midwifery‐led prenatal care, and 84% with midwifery‐ attended birth. Patient preferences were adhered to with 83% of women achieving birth at their preferred site of birth, and 95% of women using their preferred infant feeding method. Elective hospitalization in labor was associated with a 4‐times greater risk of cesarean birth among medically low‐risk childbearing Medicaid beneficiaries.ConclusionsThe birth center model demonstrates the capability to achieve the triple aims of improved population health, patient experience, and value.

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Interdisciplinary healthcare teams have become the new model for patient care delivery in today's complex healthcare environment of increased specialization and disciplinarity of healthcare providers. Research to support the efficacy of this model has been problematic because of poorly conceptualized interdisciplinary teams as well as methodological problems conducting the research. Findings from organizational studies and healthcare interdisciplinary research can be integrated into a theory-based model to design an educational workshop to develop team members. Development of team members is proposed as a means to enhance collaboration among team members and therefore reduce the risk of team failure.

Racial and gender disparities in health are well documented in health science literature. Racial minorities and women are known to receive disproportionately poorer quality of health care when compared to non-Hispanic Whites. It is unknown why women and particular racial and ethnic minorities are more susceptible to experience disparities in patient care. Moreover, with pain being the most common complaint for those entering the healthcare system, gaps in understanding the potential relationship between the nurse provider's gender and/or race and ethnicity and pain management deserve exploration. A systematic literature review has been conducted to explore the current state of knowledge related to providers, health disparities, and pain. Much of the research to date has focused on the provider-patient relationship to health disparities in pain management. Further research is needed to examine how provider-patient interactions may influence patient outcomes, satisfaction, adherence and disparities in health.

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