College of Graduate Studies: Theses & Dissertations
Term of Award
Spring 2026
Degree Name
Doctor of Public Health (Dr.P.H.)
Document Type and Release Option
Dissertation (open access)
Copyright Statement / License for Reuse
This work is licensed under a Creative Commons Attribution 4.0 License.
Department
College of Public Health
Committee Chair
Bettye Apenteng
Committee Member 1
Samuel Opoku
Committee Member 2
Linda Kimsey
Abstract
Despite having an advanced U.S. healthcare system, childbirth remains risky in the US, especially for socially vulnerable populations. Medicaid covers a large portion of births and is equipped to implement large-scale interventions to improve maternity care and patient outcomes. Two studies were conducted to (a) examine the relationship between organizational factors in U.S. hospitals and adverse clinical outcomes among Medicaid-insured maternity patients, and (b) analyze state-level Medicaid bundled payment models for maternity care. Guided by the Donabedian Quality of Care Model, Study One used logistic regression on data from the 2018-2020 National Inpatient Sample to explore how hospital organizational factors affect adverse outcomes among Medicaid-insured maternity patients, focusing on postpartum hemorrhage and sepsis. Results showed that structural factors, including private ownership, large size, and urban location, are significant factors for postpartum hemorrhage with a lesser effect on puerperal sepsis. Study Two analyzed state Medicaid bundled payment models in eight states, six of which are active. These models, in place from 2012 to 2024, included coverage for 60 days postpartum, linkage of services to payment, monitoring of labor and delivery outcomes, inclusion of high-risk maternity patients, exclusion of non-maternity care, patient education and care coordination, and quality improvement and assurance efforts. Together, these studies add to the growing body of research on strategies to prevent adverse maternal health outcomes and enhance the quality of maternity care, emphasizing the need for continued research on and practice focused on system- and organizational-level interventions to improve maternal health.
OCLC Number
1588662263
Catalog Permalink
https://galileo-georgiasouthern.primo.exlibrisgroup.com/permalink/01GALI_GASOUTH/c9nn09/alma9916659742702950
Recommended Citation
Browder, Tamaya S., "Maternal Healthcare in the United States: An Exploration of the Organizational and Political Determinants of Maternal Healthcare Quality and Outcomes" (2026). College of Graduate Studies: Theses & Dissertations. 3142.
https://digitalcommons.georgiasouthern.edu/etd/3142
Research Data and Supplementary Material
No
Included in
Health Policy Commons, Health Services Research Commons, Maternal and Child Health Commons, Women's Health Commons
