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Table of Contents
CHECKLIST 3
1. Is there a well-defined objective? 4
2. Is the regression discontinuity design valid? 5
3. Is the index score smooth at the cut-off point? 7
4. Is the cut-off unique to the program being evaluated? 8
5. Is the RDD fuzzy or sharp? 8
6. Is the discontinuity a valid instrument to control for non-compliers? 9
7. Is the selection on observables balanced? 10
8. Were sensitivity analyses performed to characterize uncertainty? 10
9. Are there limitations of the study? 12
10. Are the results generalizable? 13
Conclusion 14
REFERENCES 15
APPENDIX 18
Douglas Almond and Joseph J. Doyle Jr (2011) “After midnight: a regression discontinuity design in length of
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With increasing costs of healthcare in the 1990s (Sekhri, 2000), health maintenance organizations (HMOs) under pressure to provide cost-effective care denied reimbursement for hospital stays longer that 1 midnight for uncomplicated vaginal deliveries (Hospital Stay for Healthy Term Newborns, 2004).
As the percentage of vaginal births with stays under 2 days doubled between 1990 and 1995 (figure 1), there was evidence of increasing hospital re-admission rates for neonatal jaundice resulting from early discharges (Maisels and Kring, 1998). The California Newborns’ and Mothers’ Health Act of 1997 (NMHA), which went into effect on 26 August 1997, mandated insurance coverage of a minimum of 48-hours for hospital births (Evans, Garthwaite and Wei, 2008).
Figure 1: U.S. births with fewer than 2 days in hospital: 1970 -2004
Source: National Center for Health Statistics (NCHS)
(Almond and Doyle, 2011; page 6, figure 1)
Figure 2: Percentage of newborns discharged early from vaginal deliveries without complications in California 1995-2000
(Evans, Garthwaite and Wei, 2008; fig. 1, page 852)
Since all hospital-based deliveries are covered either by private health insurance or Medicaid (figure 2), post partum care is reimbursed by a predetermined number of midnights. Therefore, for newborns born 5 minutes before midnight, their length of stay determined by the first midnight would start immediately after birth. On the other hand,
The medical industrial complex (MIC) holds many influences in the care of women, especially poor marginalized women. MIC is simply a platform of the network among corporations that supply health care services and products to make money. Oparah and Bonaparte explain how the individual’s ability to pay determines the quality of care they receive (Oparah & Bonaparte, 2015, pg. 4). In relations to birthing, hospitals aren’t a place for an intimate connection between a woman that’s about to give birth and their newborns. It’s more of a time efficiency center where doctors (mainly white men) would purposely perform cesarean deliveries to not only save time, but to make a
While, as previously stated, the Affordable Healthcare Act is expected to increase medical coverage to include an additional 30 million people, it has become clear that just because the coverage was expanded does not mean an expansion of actual care. With the enactment of the ACA, congress unleashed what can be called a “tsunami” of newly insured patients, flooding a delivery system that was already stressed and barely hanging on. The
In the Perinatal area, another measurement used is that of the number of mothers who had elective vaginal deliveries or elective cesarean sections at equal to and greater than 37 weeks gestation to less than 39 weeks gestation. An elective delivery is defined as the delivery of a
Childbirth is one of the greatest privileges on the earth anyone could have and we, as women, should feel proud to be major contributors for it. Thus, a mother has to play a key role in aiding the healthcare workers to mitigate the health crisis associated with childbirth by performing her duties faithfully. One such associated health crisis is “Premature (preterm) birth” which occurs when the baby is born too early, before 37 weeks of gestational period (CDC, 2015). The rate of preterm birth ranges from 5% to 18% of babies born across 184 countries (WHO, 2015).
According to Healthy People 2020, "Improving the well-being of mothers, infants, and children, is an important public health goal for the United States. Their well-being determines the health of the next generation and can help predict future public health challenges for families, communities, and the health care system" (Healthy People 2020, 2015). Infant mortality is defined as the death of an infant before his or her first birthday, while fetal mortality is defined as the intrauterine death of a fetus at any gestational age (MMRW, 2013 and MacDorman, Kirmeyer & Wilson, 2012). In the United States an estimated 13,000 fetal deaths occurred ≥ 28 weeks gestation making up 28% of all perinatal deaths in 2006, the latest year with available national data (Lee,
The writer explained there could be no concern for fetal or maternal health during the delivery although some obstetricians tended to induce labor in all diabetic mothers to protect babies and mothers. Moreover, labor progress was supposedly assessed by old-fashioned methods, which resulted in performing unnecessary obstetrical practices. Intervention was imposed in cases of inaccurately labeled slow or abnormal labors and failures to progress. It is common practice that a primary cesarean generally produces subsequent surgical deliveries. The author realized that cesareans were performed because of insufficient data on laboring women’s
The main benefit associated with this policy is that health insurance companies will typically pay for delivery and care carried out by a nurse midwife in the hospital that is compliant with these laws. Large companies, such as Blue Cross and Blue Shield of Alabama, will not pay for any midwife outside of the hospital, even if she had a permit by the state. The other benefit is that in the event that some emergency was to occur before, during, or after delivery, a trained physician and advanced technology are readily available to take over.
Pregnant mothers are viewed as a business made for doctors and hospitals as insurances typically cover infant birth and hospital bills. As Patricia Burkhardt, Clinical Associate Professor, NYU Midwifery Program could not speak the truth any better, she states, “Hospitals are a business. They want those beds filled and emptied. They don’t want women hanging around the labor room.”
Although nurse midwives do complete the task of aiding in the delivery of newborns, “they also provide health care and wellness care to women, which may include family planning, gynecological checkups, and prenatal care” (nurse.org). Nurse midwives also assist along with physicians during c-sectional births. Certified Nurse Midwives or CNMs are advanced nurse practitioners; however, nurse midwives must earn an advanced degree, a special certification, and training in order to practice midwife duties. CNMs offer similar care to that of an OB/GYN doctor; therefore they make different financial earnings. “Nursing Economics, found that when midwives work in collaboration with physicians, the birth is less likely to end in a C-section” (nurse.org). If less c- sections are performed in hospitals, it could help lower the medical costs due to paying for medication during the labor and delivery, of a natural vaginal birth. To illustrate, nurse midwives should be more prevalent in hospitals, in order to lower the financial status of medical
According to “Human Sexuality: Diversity in Contemporary America,” women and couples planning the birth of a child have decisions to make in variety of areas: place of birth, birth attendant(s), medication, preparedness classes, circumcision, breast feeding, etc. The “childbirth market” has responded to consumer concerns, so its’ important for prospective consumers to fully understand their options. With that being said, a woman has the choice to birth her child either at a hospital or at home. There are several differences when it comes to hospital births and non-hospital births.
Also in the year 2008, despite declining to 4.2 million total births from a high of 4.7 million births in 2007, most of these (67%) were delivered vaginally, and the majority of vaginal deliveries (84%) occurred without complications or serious procedures in hospital births.
In the case of the CNM who delivered a 35 week breeched infant, several factors need
The cost of the health care industry has always been rising since the early 1980s. It has been a growing concern in both the industry and society. Massachusetts General Hospital (MGH) is no exception. Even though the average length of stay (LOS) for the patients in MGH has been declining (Exhibit 10), it is still the highest compared to their competitors (Exhibit 6). Besides the cost, there is no uniformity of process and standardization across different facilities and departments of the hospital. MGH lacks communication and coordination between the facilities.
Vaginal birth after caesarean (VBAC) is the name used for identifying the method of giving birth vaginally after previously delivering at least one baby through a caesarean section (CS). A trial of labour (TOL) is the term used to describe the process of attempting a VBAC. An elected repeat caesarean (ERC) is the other option for women who have had a caesarean in the past. The rates of women choosing to deliver by means of an ERC has been increasing in many countries, this is typically due to the common assumption that there are too many risks for the baby and mother (Knight, Gurol-Urganci, Van Der Meulen, Mahmood, Richmond, Dougall, & Cromwell, 2013). The success rate of VBAC lies in the range of 56 - 80%, a reasonably high success rate, however, the repeat caesarean birth rate has increased to 83% in Australia (Knight et al., 2013). It is essential to inform women of the contraindications, success criteria, risks, benefits, information on uterine rupture and the role of the midwife in relation to considering attempting a VBAC (Hayman, 2014). This information forms the basis of an antenatal class (Appendix 1) that provides the necessary information to women who are considering attempting a VBAC and can therefore enable them to make their own decision regarding the mode of birth.
While some women who received no prenatal care had normal, uncomplicated births, others did not. Most of the women who did not receive adequate prenatal care gave birth to an underweight and underdeveloped infant. Among the benefits of early, comprehensive prenatal care are decreased risk of preterm deliveries and low birth weight (LBW)-both major predictors of infant morbidity and mortality. (Dixon, Cobb, Clarke, 2000). Preterm deliveries, deliveries prior to 37 weeks of gestation, have risen. Since the studies in 1987, which showed the rate of preterm deliveries as 6.9% of births, the 1997 rate shows an increase to 7.5%. Low birth weight, defined as an infant weighing less than 2500 grams (5lbs. 5oz) is often preceded by preterm delivery. Low