Objective. This study examined to what degree patient-centeredness—measured as an underlying ability of obstetrical nurses—influenced Medicaid patients’ satisfaction with care in hospital obstetrical units. Design. Multigroup structural equation modeling design, using three cross-sectional random samples ( each) from the 2003 Press Ganey National Inpatient Database. Setting. Self-administered mail surveys. Participants. 900 Medicaid recipients recently discharged from inpatient hospital obstetrical units across the United States. Methods. Multigroup structural equation modeling was used to test the goodness of fit between a hypothesized model based on the Primary Provider Theory and patients’ ratings of nurses. Results. The model fitted the data well, was stable across three random samples, and was sustained when compared to a competing model. The patient-centeredness of nurses significantly influenced overall patient satisfaction and explained 66% of its variability. When nurses’ patient-centeredness increased by one standard deviation, patients’ satisfaction increased by 0.80 standard deviation. Conclusion. This study offers a novel approach to the measurement of the patient-centeredness of nurses and a paradigm for increasing it and its influence on Medicaid patients’ satisfaction in hospital obstetrical units. 1. Introduction Although rates of maternal mortality are low in the United States [US], evidence is accumulating that the country’s rates of maternal morbidity during labor and delivery are high [1] and rates of severe obstetric complications are increasing (e.g., hypertension [2], pulmonary embolism [3]). In addition, it is well known that the US ranks behind most other developed countries in its rates of adverse birth outcomes, such as low birth weight [4], preterm birth [5–7], and infant mortality [4]. Persistent racial and socioeconomic disparities in adverse birth outcomes [8] and maternal morbidity [9] and mortality [10] also have been well documented. Obstetrical (OB) units in hospitals can be crucial points of intervention to prevent the negative consequences of maternal morbidity and especially conditions that give rise to early labor and delivery, such as hypertensive disorders. As in other healthcare settings, the provider-patient relationship in the OB unit is a central locus of communication, understanding, and delivery of care [11]. If women do not receive adequate information or care during their stay in an OB unit, it could be detrimental for their own health as well as the health of their infants. High-quality care is,
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