Examination of perinatal care processes and outcomes of childbearing medicaid beneficiaries reported within the 2012-2014 American Association of Birth Centers Perinatal Data Registry

The purpose of this dissertation study was to describe selected processes and outcomes variables for Medicaid beneficiaries enrolled and giving birth with American Association of Birth Centers Center for Medicare and Medicaid Innovation Strong Start sites between 2012 and 2014. The goal was to examine the relationships between selected care processes and outcomes of childbearing Medicaid beneficiaries to inform research, practice, and policy. Processes of care and the outcomes of Medicaid beneficiaries receiving care within the model exceeded national quality benchmarks, demonstrated resistance to unwarranted variation, and led to increases in effective care and preference sensitive variations. Supply-sensitive variations were demonstrated within the sample of Strong Start sites with the elective hospitalization of healthy, medically-low-risk women leading to significantly more cesarean sections than women choosing home or birth center admission in labor. The dissertation contributes to scientific knowledge and supports expansion of the model among Medicaid beneficiaries nationwide.