A Scoping Review of Certified Nurse‐Midwife and Certified Midwife Care in the United States: Assessing Outcomes Across Six Patient Care Domains
这篇范围综述评估了美国认证护士助产士和认证助产士护理在医疗质量六个领域（安全、有效、以患者为中心、及时、高效、公平）中的结果，发现其与医生护理相比结果相当或更优，尤其在安全和有效性方面，但整合仍受限制。
Policy Points Certified nurse-midwife (CNM)/certified midwife (CM) care is associated with outcomes that are comparable or improved compared to physician care across multiple domains of health care quality, especially safety and effectiveness. CNM/CM care is consistently associated with lower rates of intrapartum interventions and improved birth outcomes and patient satisfaction. Integration of CNM/CM care remains limited across many US health systems due to scope of practice restrictions and institutional policies. Growing, diversifying, and integrating CNM/CM care offers a critical pathway to advancing health care quality, equity, and efficiency in the United States and addressing the alarming rise in adverse perinatal and sexual and reproductive health outcomes. CONTEXT: The alarming rise in US maternal mortality and disparities in perinatal, sexual, and reproductive health outcomes underscores the urgent need for effective, equitable, and evidence-based models of care. Care provided by certified nurse-midwives (CNMs) and certified midwives (CMs) has played a critical role in addressing these disparities, yet a comprehensive synthesis of its impact across health care quality domains is lacking. METHODS: A scoping review methodology following PRISMA-ScR guidelines was used to assess the association of CNM/CM care and perinatal, sexual, and reproductive health outcomes through the lens of the Institute of Medicine's six domains of health care quality: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. This review included United States-based studies published since 2012 identified via PubMed and CINAHL. Studies were screened for relevance to the six domains and CNM/CM care. Data were extracted into a spreadsheet, grouped by domains, and analyzed using narrative synthesis. FINDINGS: A total of 66 studies met inclusion criteria. Within the safety, effectiveness, and patient-centeredness domains, CNM/CM care was associated with similar or improved perinatal, sexual, and reproductive health outcomes compared to physician care, including lower rates of cesarean birth, fewer interventions, improved neonatal outcomes, greater patient satisfaction, and reduced health care costs. CNM/CM care also demonstrated potential in mitigating racial and geographic maternal health disparities, though scope of practice restrictions and institutional policies limited CNM/CM integration. Despite this evidence, gaps remain in understanding the influence of CNM/CM care on health care quality as it relates to efficiency, timeliness, and equity. CONCLUSIONS: These findings highlight the importance of expanding CNM/CM integration within the United States' health care system to improve care delivery and associated health outcomes, reduce health disparities, and advance health equity. Future studies should incorporate standardized outcome measures and explore the role of CNM/CM care within collaborative models to enhance perinatal care quality and accessibility.