(1198) A Comparison Between Provider Density and Severe Maternal Morbidity Rates: A Georgia State Review

Georgia’s (GA) maternal morbidity & mortality rate is among the highest in the country. GA also has one of the highest rates of maternity deserts, defined as counties without obstetric care providers. Increasing the rates of non-physician providers, including certified nurse midwives (CNM), nurse practitioners (NP), advanced practice nurses (APRN), & physician assistants (PA) has been proposed to address the physician provider shortage. We analyzed the change in non-physician & physician provider density in relation to severe maternal morbidity (SMM) rates in GA from 2011 to 2020.

Study Design:

 
We conducted a population-based cohort study utilizing GA Birth Certificate Data from 2011-2020 (n=1,278,299). SMM included admission to intensive care, unplanned hysterectomy, eclampsia, & maternal blood transfusion. Changes in provider density for non-physician & physician providers were calculated & compared with changes in SMM rates overall & stratified by rural residence.

Results:

Between 2011-2020, non-physician provider density increased significantly [CNM (60.3%), NP (164.4%), APRN (151.1%), & PA (62.3%)] (Table 1). This increase of >50% in non-physician providers was seen in both rural and non-rural settings. While overall physician density increased by 12.8%, physician density in rural settings declined by 5% (Table 1). The SMM rate per 10,000 births increased from 42.2 in 2011 to 65.2 in 2020, indicating a 54.5% increase. There was no significant difference between changes in non-physician provider density & SMM rate (p=0.91) or changes in physician provider density & SMM rate (p=0.61).

Conclusion:

Our data demonstrate significant increases in CNM, NP, APRN, & PA rates across GA, including rural settings. While physician density in rural settings decreased, further efforts to provide directive education regarding maternal health in pregnancy to existing non-physician providers could help optimize care quality and access. Leveraging the opportunity to train non-physician providers in rural settings could help stratify care needs & facilitate transfer to higher level facilities when necessary.