Physician Office Visits by Children for Well and Problem-focused Care: United States, 2012.

KEY FINDINGS: Data from the National Ambulatory Medical Care Survey, 2012 •Physician office visit rates for well care were lower for school-aged (those aged 6-11 years) children (31 per 100 population) and adolescents aged 12-17 years (29 per 100 population) than for younger children (349 and 74 per 100 population for children under age 1 year and 1-5 years, respectively). •Visit rates for well and problem-focused care were highest for general pediatricians (59 and 173 per 100 population) compared with other primary (7 and 25 per 100 population) and specialty care providers (1 and 24 per 100 population) across all age groups. •Among school-aged and adolescent children, a higher percentage of well-care visits had recommended height, weight, and blood pressure measurements recorded, compared with visits for problem-focused care.

Routine prenatal care visits by provider specialty in the United States, 2009-2010.

KEY FINDINGS: Data from the 2009 and 2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey •At 14.1% of routine prenatal care visits in the United States in 2009-2010, women saw providers whose specialty was not obstetrics and gynecology (ob/gyn). •The percentage of routine prenatal care visits that were made to non-ob/gyn providers was highest (20.5%) among women aged 15-19. •Visits to non-ob/gyn providers accounted for a higher percentage of routine prenatal care visits among women with Medicaid (24.3%) and women with no insurance (23.1%) compared with women with private insurance (7.3%). •The percentage of routine prenatal care visits to non-ob/gyn providers was lower among women in large suburban areas (5.1%) compared with those in urban areas (14.4%) or in small towns or suburbs (22.4%). Early and adequate prenatal care is a Healthy People 2020 objective (1). Previous studies have focused on practice patterns of obstetricians/gynecologists or overall ambulatory care utilization by women (2-5). However, the amount of routine prenatal care delivered by obstetrics and gynecology (ob/gyn) providers and non-ob/gyn providers has not been quantified. Understanding which providers deliver prenatal care may yield valuable information about training and workforce needs. This report quantifies the amount of routine prenatal care delivered by non-ob/gyn providers among women aged 15-54 who were seen in physicians' offices, community health centers, and hospital outpatient departments (OPDs).

National trends in primary cesarean delivery, labor attempts, and labor success, 1990-2010.

OBJECTIVE: The national primary cesarean delivery rate increased until 2004, but after 2004, this rate cannot be tracked using Vital Statistics data. Additionally, it is unknown whether changes in the primary cesarean delivery rate reflect changes in the rate of labor attempts, labor success, or both. Here, using hospital discharge data, we examined national trends in primary cesarean deliveries, labor attempts, and labor success among women without prior cesarean delivery between 1990 and 2010. STUDY DESIGN: This analysis of serial cross-sectional data from the National Hospital Discharge Survey used Joinpoint regression to assess trends over time and logistic regression with marginal effects to identify rates of change over time and adjust for demographic and clinical factors. RESULTS: The primary cesarean delivery rate declined 0.2 percentage points per year (95% confidence interval [CI], 0.1-0.3) between 1990 and 1999, increased 1.0 percentage point per year (95% CI, 0.8-1.2) between 1999 and 2004, and increased 0.3 percentage points (95% CI, 0.1-0.6) per year from 2004 until 2010. Between 1998 and 2005, the rate of labor attempts declined 0.4 percentage points (95% CI, 0.3-0.5) per year. No changes in the labor attempt rate occurred between 2005 and 2010. Labor success rates increased 0.2 percentage points (95% CI, 0.1-0.3) per year between 1990 and 1998 but then declined 0.5 (95% CI, 0.5-0.8) percentage points per year from 1998 to 2010. Adjusted results were similar. CONCLUSION: The primary cesarean delivery rate continued to increase after 2004. Increases in the primary cesarean delivery rate after 2005 were driven by declines in labor success rates.

Provider attitudes toward clinical protocols in obstetrics.

The Johns Hopkins Oxytocin Protocol (JHOP) Survey was distributed to clinical labor and delivery staff to compare obstetrical providers' attitudes toward clinical protocols and the JHOP. Agreement by registered nurses (RNs), physicians in training (PIT), and attending physicians (APs) and certified nurse midwives (CNMs) was assessed with each of 4 attitudinal statements regarding whether clinical protocol and JHOP use result in better practice and are important to ensure patient safety. Odds of agreement with positive statements regarding clinical protocols did not differ significantly among groups. Odds of agreement with JHOP use resulting in better practice also did not differ significantly among provider groups. Odds of agreement with the JHOP being important to ensure patient safety were lower for the AP/CNM group compared with the RN group. Clinical protocol use is generally well received by obstetrical providers; however, differences exist in provider attitudes toward the use of an institutional oxytocin protocol.