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Objectives: To observe gestational diabetes mellitus (GDM) prevalence among participants receiving enhanced prenatal care through one of three care models: Birth Centers, Group Prenatal Care, and Maternity Care Homes. Materials and Methods: This study draws upon data collected from 2014 to 2017 as part of the Strong Start II evaluation and includes data from nearly 46,000 women enrolled across 27 awardees with more than 200 sites throughout the United States. Descriptive and statistical analyses utilized data from participant surveys completed upon entry to the program and a limited chart review. Results: A total of 6.3% of Strong Start participants developed GDM during their pregnancy. Rates varied significantly and substantially by model. After adjusting for participant risk factors, we find that Birth Center participants of all races and ethnicities experienced significantly lower rates of GDM than women of the same race/ethnicity in Maternity Care Homes. Conclusions: The lower rates of gestational diabetes among women receiving Birth Center prenatal care suggest the need for further investigation of how prenatal care approaches can reduce GDM and address health disparities. more...

This study assessed the perceptions and actions of rural hospital nurse executives with regard to patient safety and quality improvement (QI). A national sample of rural hospital nurse executives (n = 300) completed a survey measuring 4 domains related to patient safety and QI: (a) patient "Safety Culture," (b) adequacy of QI "Resources," (c) "Barriers" related to QI, and (d) "Nurse Leader Engagement" in activities supporting QI. Perceptions of Safety Culture were strong but 47% of the Resources needed to carry out QI were inadequate, 29% of Barriers were moderate to major, and 25% of Nurse Leader Engagement activities were performed infrequently. Nurse Leader Engagement in quality-related activities was less frequent among nurses in isolated and small rural town hospitals compared with large rural city hospitals. To further QI, rural nurse executives may need to use their communications and actions to raise the visibility of QI. more...

The Centers for Medicare & Medicaid Services (CMS) operates the Quality Improvement Organization (QIO) Program to ensure and improve the quality of health care for Medicare beneficiaries. This report presents the results of an independent evaluation of the ninth scope of work, QIO Program, conducted by Mathematica during 2008–2011. Using innovative quasi-experimental methods, the evaluation found that QIO’s work led to improvement in 4 of the 12 targeted measures of quality evaluated. In addition, more than three-fourths of the hospitals and nursing homes in a national survey with QIO contacts said the contacts themselves or resources the QIO staff provided led to changes that improved patient care. more...

The Centers for Medicare & Medicaid Services (CMS) operates the Quality Improvement Organization (QIO) Program to ensure and improve the quality of health care for Medicare beneficiaries. This report presents the results of an independent evaluation of the ninth scope of work, QIO Program, conducted by Mathematica during 2008–2011. Using innovative quasi-experimental methods, the evaluation found that QIO’s work led to improvement in 4 of the 12 targeted measures of quality evaluated. In addition, more than three-fourths of the hospitals and nursing homes in a national survey with QIO contacts said the contacts themselves or resources the QIO staff provided led to changes that improved patient care. more...