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Mortality Trends Diverge

While pregnancy-related deaths dropped around the world, the official number increased early in this decade among U.S. women, according to two reports. Worldwide pregnancy-related deaths dropped by a third during 1990–2008, from 546,000 to 358,000, according to the latest maternal mortality report from the United Nations and the World Bank. “Countries where women are facing a high risk of death during pregnancy or childbirth are taking measures that are proving effective; they are training more midwives, and strengthening hospitals and health [centers] to assist pregnant women,” Dr. Margaret Chan, Director-General of the U.N.'s World Health Organization, said in a statement. In the United States, increased reporting of pregnancy deaths put the number of women dying of maternal causes at 495 in 2003 and 540 in 2004, the Centers for Disease Control and Prevention reported. The U.S. figures translate to 12 deaths per 100,000 live births in 2003 and 13 deaths per 100,000 in 2004. In contrast, the worldwide report said that the 2008 rate of maternal death was 290 per 100,000 live births in developing parts of the world. The U.S. increase “largely reflects the use by an increasing number of states of a separate item on the death certificate indicating pregnancy status of the decedent,” according to the CDC report. It acknowledged that an increasing number of cesarean sections and maternal obesity could be partly to blame.

Pregnancy Prevention Funded

The Department of Health and Human Services has granted $155 million to states, nonprofit organizations, schools, and universities to support teen pregnancy prevention programs that have been tested and proved effective, the agency said. “This investment will help bring evidence-based initiatives to more communities across the country while also testing new approaches so we can expand our toolkit of effective interventions,” HHS Secretary Kathleen Sebelius said in a statement. About $100 million will come from the existing Teen Pregnancy Prevention program, and the rest is from the new Affordable Care Act and the Personal Responsibility Education Program it created.

Planned Parenthood Case Moves On

A criminal case against a Kansas City, Kan., Planned Parenthood clinic is moving forward, after the state's Supreme Court refused to dismiss charges that the clinic conducted illegal late-term abortions and falsified records. The criminal complaint, filed in 2007 by the state's district attorney, includes 23 felonies and 84 misdemeanors, the Kansas City Star reported. The clinic is alleged to have done late-term abortions without finding that they were medically necessary. Planned Parenthood has denied all charges. The district attorney at the time, Phill Kline, had earlier as the state's attorney general launched an investigation into Wichita abortion provider Dr. George Tiller as well as the Kansas City Planned Parenthood clinic. Dr. Tiller went on trial in March 2009 and was acquitted of all charges. He was shot to death 2 months later by an antiabortion activist.

Productivity, Ownership Linked

Billable work per patient appears to be increasing only at physician groups under the “private practice model,” but expenses have also grown, according to a Medical Group Management Association study. Over the past 5 years, relative value units per patient rose by 13% at private medical practices but declined nearly 18% at practices owned by hospitals or integrated delivery systems, analysts found. Meanwhile, operating costs for private practices increased by nearly 2% last year, in contrast to a slight decline for practices owned by the larger entities. MGMA attributed part of the increase in expenses for private practices to the cost of implementing electronic health record systems. “In the private practice model, EHR incentives have provided a catalyst for practices to purchase systems and deploy electronic health records, therefore increasing the practice's information technology expenditures,” Kenneth Hertz, a principal with MGMA Health Care Consulting Group, said in a statement.

Nursing Expansion Called For

Nurses' roles and responsibilities should change significantly to meet the increased demand for care created by health care reform, according to an Institute of Medicine report that immediately drew criticism from the American Medical Association. The report urged removal of regulatory and institutional obstacles to nurses taking on additional patient-care duties. To handle these new responsibilities, nurses should receive higher levels of training through an improved education system, including a new residency program and additional opportunities for lifelong learning, the institute report said. The AMA took issue with the report's call to expand nurses' scope of practice, saying that nurse practitioners don't have nearly the amount of training and clinical experience that doctors do. “With a shortage of both nurses and physicians, increasing the responsibility of nurses is not the answer to the physician shortage,” AMA board member Dr. Rebecca J. Patchin said in a statement.

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