Identifying Elements of Business Case Model for Certified Nurse Midwifery led Birth Center Care in the U.S. (2015)

Undergraduates: Esita Patel, n/a n/a n/a n/a

Faculty Advisor: Cheryl Giscombe
Department: Nursing

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Childbirth has been repeatedly cited as the leading cause of hospitalizations and source of hospital costs in the United States. Despite evidence suggesting that the certified nurse midwife-(CNM) led free standing birth center (FSBC) care model provides safe, effective care, with less resource utilization and costs, and increased patient satisfaction for low risk births, less than 0.5% of births in the U.S. occur through this model. The absence of a formal business case that demonstrates a financial return on investment for models shown to improve health care, such as the CNM-led FSBC care model in the US, is often cited as a reason for not implementing quality improving innovations in health care. Currently, guidelines to assist in the analysis of the business case for establishing and operating a free standing birth center are unavailable. This study aims to identify elements of the business case for the CNM-led FSBC model. A systematic literature review of the CNM-led FSBC model in the U.S was conducted. Semi-structured interviews were also conducted with FSBC representatives and CNMs. Results of the review and interviews were collectively analyzed to identify elements necessary, including financial factors involved in initial investments, cash inflows, and cash outflows, to consider when developing a business case for CNM-led FSBCs. This information may allow stakeholders to better understand factors necessary to consider when starting and/or operating a CNM-led FSBC.