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Objectives. We examined disparities in perinatal care, birth outcomes, and infant health between rural American Indian and Alaska Native (AIAN) persons and rural Whites over time. Methods. We compared perinatal and infant health measures for 217064 rural AIAN births and 5032533 rural non-Hispanic White births. Results. Among American Indians and Alaska Natives, unadjusted rates of inadequate prenatal care (1985-1987, 36.3%; 1995-1997, 26.3%) and postneonatal death (1985-1987, 7.1 per 1000; 1995-1997, 4.8 per 1000) improved significantly. However, disparities between American Indians and Alaska Natives and Whites in adjusted odds ratios (AORs) of postneonatal death (1985-1987, AOR = 1.55; 95% confidence interval [Cl] = 1.41, 1.71; 1995-1997, AOR = 1.46; 95% CI = 1.31, 1.64) and adjusted risk ratios (ARRs) of inadequate prenatal care (1985-1987, ARR = 1.67; 95% CI = 1.65, 1.69; 1995-1997, ARR = 1.84; 95% CI = 1.81, 1.87) persisted. Conclusions. Despite significant decreases in inadequate prenatal care and postneonatal death among American Indians and Alaska Natives, additional measures are needed to close persistent health gaps for this group. (Am J Public Health. 2008;99:638-646. doi:10.2105/AJPH.2007.119735) [ABSTRACT FROM AUTHOR]

Objectives. We sought to provide a national profile of rural and urban American Indian/ Alaska Native (AI/AN) maternal and infant health. Methods. In this cross-sectional study of all 1989-1991 singleton AI/AN births to US residents, we compared receipt of an inadequate pattern of prenatal care, low birthweight (< 2500 g), infant mortality, and cause of death for US rural and urban AI/AN and non-AI/AN populations. Results. Receipt of an inadequate pattern of prenatal care was significantly higher for rural than for urban mothers of AI/AN infants (18.1% vs 14.4%, P ≤ .001); rates for both groups were over twice that for Whites (6.8%). Al/AN postneonatal death rates (rural = 6.7 per 1000; urban = 5.4 per 1000) were more than twice that of Whites (2.6 per 1000). Conclusions. Preventable disparities between AI/ANs and Whites in maternal and infant health status persist. (Am J Public Health. 2002;92:1491-1497) [ABSTRACT FROM AUTHOR]

Objectives. Over 80% of US states have implemented expansions in prenatal services for Medicaid-enrolled women, including case management, nutritional and psychosocial counseling, health education, and home visiting. The study evaluated the effect of Washington State's expansion of such services on prenatal care use and low-birthweight rates. Methods. The change in prenatal care use and low-birthweight rates among Washington's Medicaid-enrolled pregnant women before and after initiation of expanded prenatal services was compared with the change in these outcomes in Colorado, a control state. Results. The percentage of expected prenatal visits completed increased significantly, from 84% to 87%, in both states Washington's low-birthweight rate decreased (7.1% to 6.4%, P=12), while Colorado's rate increased slightly (10.4% to 10.6%, P=.74). Washington's improvement was largely due to decrease in low-birthweight rates for medically high-risk women (18.0% to 13.7%, P=.01, for adults, 22.5% to 11.5%, P=.03, for teenagers), especially those with preexisting medical conditions. Conclusions. A statewide Medicaid-sponsored support service and case management program was associated with a decrease in the low-birthweight rate of medically high-risk women. [ABSTRACT FROM AUTHOR]

Objectives. This study examined hospital administrators' experiences with the National Practitioner Data Bank. Methods. One hundred forty-nine rural hospital administrators completed questionnaires assessing their perceptions of the data bank. Results. Nearly 90% of respondents rated the data bank as an important source of information for credentialing. Three percent indicated it had directly affected privileging decisions; 43% and 34%, respectively, believed the costs exceeded or equaled the benefits. Twenty percent reported changes that could decrease disciplinary action reports to the data bank. Conclusions. While the National Practitioner Data Bank is an important source of information to rural hospitals, it may affect few credentialing decisions and motivate behavioral changes that could have a paradoxical effect on quality assurance. [ABSTRACT FROM AUTHOR]

This study examines the professional relationships between midwives and physicians providing obstetrical care in Washington State. Four hundred ninety-six randomly sampled family physicians and obstetrician-gynecologists and 211 certified nurse, licensed, and lay midwives were surveyed to learn more about midwife/physician consulting relationships. Only certified nurse midwives have forged mutually satisfactory relationships with the physician community. Increased hospital-based training and practice opportunities are needed before licensed midwives can improve their professional relationships with physicians. [ABSTRACT FROM AUTHOR]

Objectives. This study sought to determine the rate of emergency department use among the elderly and examined whether that use is reduced if the patient has a principal-care physician. Methods. The Health Care Financing Administration's National Claims History File was used to study emergency department use by Medicare patients older than 65 years in Washington State during 1994. Results. A total of 18.1% of patients had 1 or more emergency department visits during the study year; the rate increased with age and illness severity. Patients with principal-care physicians were much less likely to use the emergency department for every category of disease severity. After case mix, Medicaid eligibility, and rural/urban residence were controlled for, the odds ratio for having any emergency department visit was 0.47 for patients with a generalist principal-care physician and 0.58 for patients with a specialist principal-care physician. Conclusions. The rate of emergency department use among the elderly is substantial, and most visits are for serious medical problems. The presence of a continuous relationship with a physician--regardless of specialty--may reduce emergency department use. (Am d Public Health. 2000;90:97-102) [ABSTRACT FROM AUTHOR]

We investigated the relation of hospital delivery volume and nursery technology level to perinatal outcome in 226, 164 White singleton births in Washington State, 1980-83. Level III facilities (neonatal intensive care unit) were defined by the state licensing commission. We defined the Level II (intermediate) and Level I (normal newborn) facilities using published criteria. Infants under 2000 gm born in Level III facilities had half the risk of perinatal death compared to those born in an Level I or II facility. No significant improvement was noted among level or volume groupings for normal birthweight infants. A loglinear regression model of hospital perinatal death rates showed that when birthweight and maternal risk were controlled, obstetrical volume added minimal explanatory power to level of nursery care. [ABSTRACT FROM AUTHOR]