Trends in prenatal cares settings: association with medical liability

Coco, Andrew S.; Cohen, Donna; Horst, Michael A.; Gambler, Angela S.
January 2009
BMC Public Health;2009, Vol. 9 Issue 1, p257
Academic Journal
Background: Medical liability concerns centered around maternity care have widespread public health implications, as restrictions in physician scope of practice may threaten quality of and access to care in the current climate. The purpose of this study was to examine national trends in prenatal care settings based on medical liability climate. Methods: Analysis of prenatal visits in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1997 to 2004 (N = 21,454). To assess changes in rates of prenatal visits over time, we used the linear trend test. Multivariate logistic regression modeling was developed to determine characteristics associated with visits made to hospital outpatient departments. Results: In regions of the country with high medical liability (N = 11,673), the relative number, or proportion, of all prenatal visits occurring in hospital outpatient departments increased from 11.8% in 1997-1998 to 19.4% in 2003-2004 (p < .001 for trend); the trend for complicated obstetrical visits (N = 3,275) was more pronounced, where the proportion of prenatal visits occurring in hospital outpatient departments almost doubled from 22.7% in 1997-1998 to 41.6% in 2003-2004 (p = .004 for trend). This increase did not occur in regions of the country with low medical liability (N = 9,781) where the proportion of visits occurring in hospital outpatient departments decreased from 13.3% in 1997-1998 to 9.0% in 2003-2004. Conclusion: There has been a shift in prenatal care from obstetrician's offices to safety net settings in regions of the country with high medical liability. These findings provide strong indirect evidence that the medical liability crisis is affecting patterns of obstetric practice and ultimately patient access to care.


Related Articles

  • Development and Psychometric Testing of the Prenatal Breast-feeding Self-efficacy Scale. Wells, Kristen J.; Thompson, Nancy J.; Kloeblen-Tarver, Amy S. // American Journal of Health Behavior;Mar/Apr2006, Vol. 30 Issue 2, p177 

    Objective: To develop and evaluate the psychometric properties of a scale measuring prenatal breast-feeding self-efficacy. Methods: A 20-item scale was administered to a sample of 279 low-income pregnant women. Results: Results from this study provide evidence for internal consistency...

  • Indochinese Refugee Fertility Rates and Pregnancy Risk Factors, Oregon. Hopkins, David D.; Clarke, Nancy G. // American Journal of Public Health;Nov83, Vol. 73 Issue 11, p1307 

    Matching 471 Oregon birth certificates with official Indochinese arrival lists reveals a fertility rate of 126.7, 1.8 times the US rate of 68.5. Greater maternal and infant risk rates were noted, particularly for Hmong. Data indicate improvements in obtaining prenatal care and in reducing the...

  • Quality of prenatal care questionnaire: instrument development and testing. Heaman, Maureen I.; Sword, Wendy A.; Akhtar-Danesh, Noori; Bradford, Amanda; Tough, Suzanne; Janssen, Patricia A.; Young, David C.; Kingston, Dawn A.; Hutton, Eileen K.; Helewa, Michael E. // BMC Pregnancy & Childbirth;2014, Vol. 14 Issue 1, p1 

    Background Utilization indices exist to measure quantity of prenatal care, but currently there is no published instrument to assess quality of prenatal care. The purpose of this study was to develop and test a new instrument, the Quality of Prenatal Care Questionnaire (QPCQ). Methods Data for...

  • Foreign-Born and US-Born Black Women: Differences in Health Behaviors and Birth Outcomes. Cabral, Howard; Fried, Lise E.; Levenson, Suzette; Amaro, Hortensia; Zuckerman, Barry // American Journal of Public Health;Jan1990, Vol. 80 Issue 1, p70 

    Abstract: We studied health behaviors and birth outcome among 201 foreign-born and 616 US-born Black women receiving prenatal care at Boston City Hospital. Foreign-born women had better pre-pregnancy nutritional status and prenatal health behaviors, and their infants had greater intrauterine...

  • Expediting support for the pregnant mothers to obtain antenatal care at public health facilities in rural areas of Balochistan province, PakistanExpediting support for the pregnant mothers to obtain antenatal care at public health facilities in rural areas of Balochistan province, Pakistan Ghaffar, Abdul; Pongpanich, Sathirakorn; Ghaffar, Najma; Chapman, Robert Sedgwick; Mureed, Sheh // Pakistan Journal of Medical Sciences;May/Jun2015, Vol. 31 Issue 3, p678 

    Objectives: To identify, and compare relative importance of, factors associated with antenatal care (ANC) utilization in rural Balochistan, toward framing a policy to increase such utilization. Methods: This cross sectional study was conducted among 513 pregnant women in Jhal Magsi District,...

  • Percentage of U.S. Women Who Had no Prenatal Care Reached a High in Late 1980s, then Fell Through 1992. Remez, L. // Family Planning Perspectives;Nov/Dec96, Vol. 28 Issue 6, p290 

    This article presents a statistical analysis of American women who had no prenatal care. To determine whether deliveries that were several weeks preterm could have biased the lack of prenatal care-since very early births could effectively "deny" prenatal care to women who delayed seeking it...

  • Análisis del gasto en salud reproductiva en México, 2003. Cahuana-Hurtado, Lucero; Ávila-Burgos, Leticia; Pérez-Núñez, Ricardo; Urube-Zúñiga, Patricia // Revista Panamericana de Salud Publica;Nov2006, Vol. 20 Issue 5, p287 

    Objectives. To estimate reproductive health expenditures in Mexico during 2003; analyze how costs were distributed across the main programs, funding entities, and providers of health goods and services; and evaluate the relationship between reproductive health expenditures and economic...

  • Improving Access to Prenatal Care in Vermont. Carney, Jan K.; Berry, Patricia; Thompson, Ellen B.; Brozicevic, Margaret M. // American Journal of Public Health;Jun96, Vol. 86 Issue 6, p880 

    The article discusses the actions taken to improve prenatal care in Vermont. The Department of Health and others implemented coordinated programs and redirected efforts to increase access to early prenatal care. The entire population is served by the state health agency through local health...

  • A County Consortium for Access to Health Care. Dawson, Peter // American Journal of Public Health;May91, Vol. 81 Issue 5, p655 

    The article reports on the efforts of a public consortium in Boulder County, Colorado to improve access to personal health services through public health agencies. The consortium has facilitated discussion in the community designed to address the shortage of prenatal care. It has sponsored two...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics