Contextual and Policy Influences on the Implementation of Prenatal Care Coordination.

Prenatal Care Coordination (PNCC) is a Medicaid fee-for-service that provides reimbursement for supportive services to mothers and infants at high risk of adverse outcomes. Services include health education, care coordination, referral to needed services, and social support. Currently, the implement...

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Publicado en:Policy, Politics & Nursing Practice Vol. 24; no. 3; pp. 187 - 198
Autores principales: Greene, Madelyne Z., Gillespie, Kate H., L. Dyer, Rachel
Formato: research tables/charts Journal Article
Publicado: Sage Publications Inc. Aug2023
Acceso en línea:Ver este registro en EBSCOhost
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      dt: Aug2023
      vid: 24
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      pub: Sage Publications Inc.
      place: Thousand Oaks, California
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        atl: Contextual and Policy Influences on the Implementation of Prenatal Care Coordination.
      aug:
        au:
          Greene, Madelyne Z.
          Gillespie, Kate H.
          L. Dyer, Rachel
        affil: School of Nursing, 5228University of Wisconsin-Madison, Madison, WI, USA
      sug:
        subj:
          Prenatal Care
          Medicaid
          Health Policy
          Health Education
          Continuity of Patient Care
          Support, Social
          Human
          Qualitative Studies
          Descriptive Research
          Thematic Analysis
          Semi-Structured Interview
          Program Implementation
          Maternal Health Services
          Insurance, Health, Reimbursement
          Public Health
          Implementation Science
          Registered Nurses
          Funding Source
      ab: Prenatal Care Coordination (PNCC) is a Medicaid fee-for-service that provides reimbursement for supportive services to mothers and infants at high risk of adverse outcomes. Services include health education, care coordination, referral to needed services, and social support. Currently, the implementation of PNCC programs is highly variable. We aimed to identify and describe the contextual factors that influence implementation of PNCC. Using a qualitative descriptive approach and theoretical reflexive thematic analysis techniques, we conducted observation and semistructured interviews with all PNCC staff at two PNCC sites in Wisconsin, representing diversity in region and patient population. We thematically analyzed interview data to examine how contextual factors influenced program implementation with the Consolidated Framework for Implementation Research as a sensitizing model. Observational field notes were used to triangulate interview data. Overall, participants endorsed the goals of PNCC and believed in its potential. However, participants asserted that the external policy context limited their impact. In response, they developed local strategies to combat barriers and work toward better outcomes. Our findings support the need to study the implementation of perinatal public and community health interventions and consider "health in all policies." Several changes would maximize PNCC's impact on maternal health: increased collaboration among policy stakeholders would reduce barriers; increased reimbursement would enable PNCC providers to better meet the complex needs of clients; and expansions in postpartum Medicaid coverage would extend the PNCC eligibility period. Nurses who provide PNCC have unique insights that should be leveraged to inform maternal–child health policy.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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