Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Other (Provider Practice), Prenatal Care Access, Non-Traditional Providers

Intervention Description: The intervention in this study was the provision of obstetric care, specifically prenatal care and delivery services, by family physicians (FPs) in a rural county in Alabama. The FPs provided full-time prenatal care and delivery services at a local hospital, with high-risk pregnancies and infants referred to a regional medical center located 38 miles away. The FPs were trained through an obstetrics fellowship and had experience in managing high-risk deliveries. The study examined the impact of the availability of local obstetric services, particularly prenatal care provided by FPs, on infant mortality rates in the county

Intervention Results: The results of the study indicated that the availability of obstetric care, particularly prenatal care and delivery services provided by family physicians (FPs), was associated with lower infant mortality rates in the rural county of Pickens, Alabama. The study found that during the period when both prenatal care and delivery services were provided locally by FPs, the county achieved an infant mortality rate (IMR) that was lower than both the state and national IMRs during the same period. The closure of the local maternity unit coincided with a 50% increase in IMR, while the provision of full-time prenatal care by an FP trained through an obstetrics fellowship, even in the absence of local delivery services, contributed to an 11% decline in IMR compared to a period with no obstetric care available locally . Furthermore, the study observed a significant decrease in IMR in Pickens County between periods when no obstetric services were available and when full prenatal care and delivery services were provided locally by FPs. The results also highlighted the potential impact of FPs providing obstetric care, including lower rates of cesarean deliveries, forceps deliveries, and labor inductions in low-risk pregnancies compared to obstetricians/gynecologists (OB/GYNs), as well as higher rates of spontaneous vaginal deliveries and vaginal deliveries after cesarean. Despite the loss of local delivery services, the provision of full-time prenatal care by an FP trained through an obstetrics fellowship resulted in a decline in IMR, indicating the potential benefit of prenatal care alone in reducing infant mortality . Additionally, the study compared IMR trends in other rural counties with and without obstetric services and observed variations in IMR changes based on the availability of obstetric care. These findings supported the association between the provision of obstetric care, particularly by FPs, and changes in IMR in rural communities .

Conclusion: The study concluded that the availability of obstetric care, particularly prenatal care and delivery services provided by family physicians (FPs), can have a significant impact on infant mortality rates in rural areas. The study found that the provision of full-time prenatal care and delivery services by FPs was associated with lower infant mortality rates in a rural county in Alabama. The study also highlighted the potential impact of FPs providing obstetric care, including lower rates of cesarean deliveries, forceps deliveries, and labor inductions in low-risk pregnancies compared to obstetricians/gynecologists (OB/GYNs), as well as higher rates of spontaneous vaginal deliveries and vaginal deliveries after cesarean. The study suggested that properly trained FPs can have a profound impact on infant mortality in rural areas and that efforts should be made to maintain their competencies in managing high-risk deliveries. The study also emphasized the importance of access to prenatal care in reducing infant mortality rates, even in the absence of local delivery services

Study Design: The study utilized a natural experiment design to investigate the impact of the availability of obstetric services, particularly prenatal care provided by family physicians, on infant mortality in a rural county. The natural experiment involved variations in the availability of obstetric services in Pickens County, Alabama, over different time periods, allowing the researchers to assess the association between the closure and reopening of local obstetric units and changes in infant mortality rates . This design enabled the researchers to examine the potential impact of the availability of local obstetric services on infant mortality in a real-world setting.

Setting: The setting of the study was Pickens County, Alabama, a rural area where obstetric services, including prenatal care, were unavailable for a period of time . This rural setting allowed the researchers to examine the impact of the availability of obstetric care provided by family physicians on infant mortality in a specific geographic area.

Population of Focus: The target audience for this study includes healthcare professionals, policymakers, and researchers interested in maternal and child health, particularly in rural areas. The findings of the study are relevant to family physicians, obstetricians, public health officials, and policymakers involved in improving access to prenatal care and reducing infant mortality in rural communities

Sample Size: The study focused on a specific rural county, Pickens County in Alabama, and did not explicitly mention a sample size. The researchers likely used available data on infant mortality, prenatal care, and obstetric services within the county to conduct their analysis. Therefore, the "sample size" in this context would refer to the population of the county and the available data on births, infant deaths, and prenatal care services within that population.

Age Range: The study focused on infant mortality, which is defined as the number of deaths among infants less than one year of age . Therefore, the age range of interest in this study was from birth to one year of age.

Intervention Components (click on component to see a list of all articles that use that intervention): , Care Coordination, Nurse/Nurse Practitioner, Non-Traditional Providers

Intervention Description: Approximately 20% of school-age children have a vision problem. Screening is an effective way to detect visual impairments, although only if adequate follow-up is available. Here, we evaluate the impact of hiring full-time nurses in four underserved schools on the likelihood of increasing follow-up for treatment after vision screening. First, we compared descriptive screening follow-up data from the intervention schools with that of five matched schools with part-time nurses in San Jose, California, from 2008 to 2012. The intervention schools had around 2800 low-income, minority children each year, and the five comparison schools had around 3445. Secondly, we conducted a qualitative analysis of open-ended survey responses from 129 teachers in the nine participating schools.

Intervention Results: In the final year, 96% of the students screened and referred for possible vision problems in schools with full-time nurses were followed up and examined by a health care provider. Yet, only 67% of students screened in comparison schools were examined.

Conclusion: Teachers in schools with full-time nurses reported that follow-up of vision problems and getting glasses for students was the most beneficial activity performed by the nurses. School nurses can effectively increase medical care coordination and follow-up of vision screening in low-income communities.