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Lui B, Khusid E, Tangel VE, Jiang SY, Abramovitz SE, Oxford CM, White RS. Disparities in postpartum readmission by patient- and hospital-level social risk factors in the United States: a retrospective multistate analysis, 2015-2020. Int J Obstet Anesth 2024; 59:103998. [PMID: 38719764 DOI: 10.1016/j.ijoa.2024.103998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Postpartum readmission is an area of focus for improving obstetric care and reducing costs. We examined disparities in all-cause 30-day postpartum readmission by patient- and hospital-level factors in the United States. METHODS We conducted a retrospective cohort study using 2015-2020 records from the State Inpatient Databases from four states. Generalized linear mixed models were constructed to estimate the effects of individual patient- and hospital-level factors on adjusted odds of 30-day readmission after controlling for confounders. Stratified analyses by delivery and anesthesia type (New York only) and interaction models were performed. RESULTS Black mothers were more likely than White mothers to be readmitted within 30-days postpartum (aOR 1.57, 95% CI 1.52 to 1.61). Mothers with public insurance had increased odds of readmission compared with those with private insurance (Medicare: aOR 2.13, 95% CI 1.95 to 2.32; Medicaid: aOR 1.14, 95% CI 1.11 to 1.17). Compared with mothers in the lowest income quartile, those in the highest quartile experienced a 14% lower odds of readmission (aOR 0.86, 95% CI 0.83 to 0.89). There were no significant associations between hospital-level characteristics and readmission. Black mothers were more likely to be readmitted regardless of delivery type and most combinations of delivery and anesthesia type. Black mothers from the highest income quartile were more likely to be readmitted than White mothers from the lowest income quartile. CONCLUSION Substantial disparities in 30-day postpartum readmissions by patient-level social factors were observed, particularly amongst Black mothers. Action is needed to address and mitigate disparities in postpartum readmission.
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Affiliation(s)
- B Lui
- Weill Cornell Medical College, Weill Cornell Medicine, New York, NY, USA
| | - E Khusid
- Weill Cornell Medical College, Weill Cornell Medicine, New York, NY, USA
| | - V E Tangel
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - S Y Jiang
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - S E Abramovitz
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - C M Oxford
- Department of Maternal and Fetal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - R S White
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
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Rosario N, Kiles TM, M Jewell T, Wollen J. Racial and ethnic harm in patient care is a patient safety issue. Res Social Adm Pharm 2024; 20:670-677. [PMID: 38670882 DOI: 10.1016/j.sapharm.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024]
Abstract
Health equity and antiracism can contribute to enhanced patient safety in healthcare settings. The Oath of the Pharmacist states, "I will promote inclusion, embrace diversity, and advocate for justice to advance health equity." Part of this commitment means upholding these principles in patient care settings. Racial and ethnic harm negatively impact patient safety. Racial and ethnic harm are reviewed in the context of social learning theory, critical race theory, and medical and scientific racism. Pharmacists and healthcare systems must actively prevent and mitigate racial and ethnic harm to patients from personal and organizational levels to create a culture of safety. Part of this strategy involves acknowledging when you have contributed to patient harm, issuing a genuine apology, and offering to mend or re-establish trust between racially and ethnically minoritized patients and the pharmacist or the health system to contribute to patient safety. These strategies may help create a culturally safe space for racially and ethnically marginalized patients in the healthcare system.
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Affiliation(s)
- Natalie Rosario
- Pharmacy Practice and Translational Research Health 2 University of Houston College of Pharmacy, 4349, Martin Luther King Boulevard, Houston, TX, USA.
| | - Tyler Marie Kiles
- Pharmacy Practice, University of Texas at Austin College of Pharmacy, 2409 University Avenue, Austin, TX, 78712, USA.
| | - T'Bony M Jewell
- Division of Pharmacy Practice, Raabe College of Pharmacy - Ohio Northern University, 525 South Main Street, Ada, OH, 45810, USA.
| | - Joshua Wollen
- Pharmacy Practice and Translational Research Health 2 University of Houston College of Pharmacy, 4349, Martin Luther King Boulevard, Houston, TX, USA.
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Speer JE, Conley Q. Examining the pedagogical practices that support cultural proficiency development in graduate health science students. BMC MEDICAL EDUCATION 2024; 24:130. [PMID: 38336750 PMCID: PMC10858479 DOI: 10.1186/s12909-024-05097-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Health disparities are often a function of systemic discrimination and healthcare providers' biases. In recognition of this, health science programs have begun to offer training to foster cultural proficiency (CP) in future professionals. However, there is not yet consensus about the best ways to integrate CP into didactic and clinical education, and little is known about the role of clinical rotations in fostering CP. METHODS Here, a mixed-methods approach was used to survey students (n = 131) from a private all-graduate level osteopathic health sciences university to gain insight into the training approaches students encountered related to CP and how these may vary as a function of academic progression. The research survey included instruments designed to quantify students' implicit associations, beliefs, and experiences related to the CP training they encountered through the use of validated instruments, including Implicit Association Tests and the Ethnocultural Empathy Inventory, and custom-designed questions. RESULTS The data revealed that most students (73%) had received CP training during graduate school which primarily occurred via discussions, lectures, and readings; however, the duration and students' perception of the training varied substantially (e.g., training range = 1-100 hours). In addition, while students largely indicated that they valued CP and sought to provide empathetic care to their patients, they also expressed personal understandings of CP that often fell short of advocacy and addressing personal and societal biases. The results further suggested that clinical rotations may help students attenuate implicit biases but did not appear to be synergistic with pre-clinical courses in fostering other CP knowledge, skills, and attitudes. CONCLUSIONS These findings highlight the need to utilize evidence-based pedagogical practices to design intentional, integrated, and holistic CP training throughout health science programs that employ an intersectional lens and empowers learners to serve as advocates for their patients and address systemic challenges.
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Affiliation(s)
- Julie E Speer
- Teaching & Learning Center, A.T. Still University, 5835 E. Still Circle, Mesa, AZ, 85206, USA.
| | - Quincy Conley
- Teaching & Learning Center, A.T. Still University, 5835 E. Still Circle, Mesa, AZ, 85206, USA
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Zuber MJ, Miller A, Poehling KA. Influenza Vaccination in Pregnancy-Rolling Up Sleeves for Pregnant Persons and Infants. JAMA Pediatr 2024; 178:115-116. [PMID: 38109106 DOI: 10.1001/jamapediatrics.2023.5630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Affiliation(s)
- Matthew J Zuber
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Vaccines at the Extremes of Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - April Miller
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Katherine A Poehling
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Vaccines at the Extremes of Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Innovation Quarter, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Bisson C, Dautel S, Mueller A, Britt R, Patel E, Suresh S, Tsigas E, Rana S. Patient and provider perception of home blood pressure monitoring kits. Pregnancy Hypertens 2023; 34:33-38. [PMID: 37783091 DOI: 10.1016/j.preghy.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Pregnant patients of racial/ethnic minorities have higher preeclampsia rates. Home blood pressure monitoring (HBPM) has been investigated for disparity reduction. Smaller studies showed patients find HBPM to be a helpful intervention postpartum. Further investigation is needed to define the role of HPBM in an at-risk and diverse population antepartum. OBJECTIVE To assess patient perception of HBPM among diverse patients at high risk of disease development. STUDY DESIGN Prospective study conducted from April 2020-September 2021. HBPM kits were advertised and interested parties across the United States responded. Cuff Kits were then distributed to participating providers. Providers distributed the kits to patients meeting high-risk criteria for disease development, prioritizing those of racial/ethnic minorities. Surveys were distributed quarterly to providers and patients to assess HBPM perception. RESULTS 2910 Cuff Kits were distributed to patients at 179 sites in 14 states. Of those, 1160 were distributed to Black patients, 1045 to White patients, and 500 to Hispanic patients. 117 patients completed surveys, with most patients finding Cuff Kits "very valuable" or "valuable" (68.4% and 19.7%, respectively). Most providers (73.4%) felt the Cuff Kits influenced patient care. CONCLUSIONS Most patients receiving Cuff Kits reported a beneficial impact on disease understanding and most belonged to racial/ethnic groups at higher risk of adverse outcomes. Providers found HBPM had a beneficial impact on care. Though more research is needed to illustrate the impact of HBPM on outcomes, this study suggests that among racial/ethnic minorities and those at the high risk, HBPM is a well-received intervention.
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Affiliation(s)
- Courtney Bisson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago Medicine, Chicago, IL, United States
| | - Sydney Dautel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago Medicine, Chicago, IL, United States
| | - Ariel Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Rebecca Britt
- Preeclampsia Foundation, Melbourne, FL, United States
| | - Easha Patel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago Medicine, Chicago, IL, United States
| | - Sunitha Suresh
- Department of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, NorthShore University Health System, Evanston, IL, United States
| | - Eleni Tsigas
- Preeclampsia Foundation, Melbourne, FL, United States
| | - Sarosh Rana
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago Medicine, Chicago, IL, United States.
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Benhamou D, Mercier FJ, Van de Velde M, Lucas N, Sng BL, Gaiser R. Education in obstetric anesthesiology: an international approach. Int J Obstet Anesth 2023; 55:103896. [PMID: 37270857 DOI: 10.1016/j.ijoa.2023.103896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/26/2023] [Accepted: 04/24/2023] [Indexed: 06/06/2023]
Abstract
Competency-based training and active teaching methods are increasingly becoming accepted and utilized in medical schools and hospitals, and obstetric anesthesiology training is expected to follow this process. This article summarizes current modalities of obstetric anesthesiology training in five countries from various parts of the world. Analysis of these curricula shows that implementation of new educational methods is variable, incomplete, and lacking in data related to patient outcomes. Research in assessments and practical applications are required to avoid wide ranges of educational strategies.
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Affiliation(s)
- D Benhamou
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP.Université Paris Saclay, Hôpital Bicêtre, Le Kremlin Bicêtre Cedex, France.
| | - F J Mercier
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP.Université Paris Saclay, Hôpital Antoine Béclère, Clamart Cedex, France
| | - M Van de Velde
- Department of Cardiovascular Sciences, KU Leuven, and Department of Anaesthesiology, UZ Leuven, Leuven, Belgium
| | - N Lucas
- London North West Healthcare NHS Trust, United Kingdom
| | - B L Sng
- Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore and Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - R Gaiser
- Yale School of Medicine, New Haven, CT, USA
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Dormire SL, Gary JC, Norman JM, Harvey IS. Insights into fear: A phenomenological study of Black mothers. J Adv Nurs 2021; 77:4490-4499. [PMID: 34245167 DOI: 10.1111/jan.14963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/29/2021] [Accepted: 06/10/2021] [Indexed: 12/01/2022]
Abstract
AIM The aim of the study was to explore the lived experience of stress as described by Black childbearing women. DESIGN A phenomenological approach was used. METHODS Seven mothers who met inclusion criteria participated in both individual and group interviews between August 2018 and August 2019. Each session was audio recorded and professionally transcribed. Consistent with van Manen's phenomenological approach, three rounds of reflective transcript analysis were conducted over several months. RESULTS Several stress themes were identified from the data. However, the most pervasive theme was the fear of having a son and keeping him safe. In this paper, the themes of Living in Fear and Living with Fear are detailed. CONCLUSION Previous research has found that Black populations in America fear for their safety. This study identified a pervasive and profound fear for their children, specifically sons who are at a higher risk of being killed in normal daily activities. Mothers also expressed fears about their responsibility to keep them safe by providing the right tools. IMPACT Although scientists have long studied poor pregnancy outcomes for Black American women, the disparity persists. This study sought to identify stressors acknowledged by Black mothers themselves. For the first time, Black mothers stated that their primary stress is fear for their children's lives. The role this fear has in adverse pregnancy outcomes, if any, is yet to be determined.
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Affiliation(s)
| | - Jodie C Gary
- College of Nursing, Texas A&M University, Bryan, TX, USA
| | - Jamil M Norman
- College of Nursing, Walden University, Minneapolis, MN, USA
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Uduwana SR, Nemerofsky SL. A Questionnaire Assessing Utilization of Delayed Cord Clamping. Am J Perinatol 2021; 40:773-779. [PMID: 34144627 DOI: 10.1055/s-0041-1731047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The study aimed to assess the practice of delayed cord clamping (DCC) and the awareness of its benefits for newborns between Obstetric (OB) and neonatal physicians. We examined if provider characteristics including years of experience, level of training, familiarity of the American College of Obstetricians and Gynecologists (ACOG)/American Academy of Pediatrics (AAP) recommendations, institutional policy, and the racial and ethnic background of patient population were associated with implementation of DCC. STUDY DESIGN This research is a cross-sectional online questionnaire study. RESULTS 975 questionnaires were returned. Overall, the awareness of ACOG versus AAP recommendations was 94 versus 86% (p < 0.01). 86 versus 78% of OB and neonatal physicians practiced or witnessed DCC >50% of the time, respectively (p < 0.01). An equal number of OB and neonatal physicians believed in the benefits to newborns of DCC. Physicians with >10 years of practice were less likely to acknowledge DCC benefits. Physicians with a majority of non-White patients were less likely to practice/witness DCC (p < 0.05). CONCLUSION There continues to be room for improvement in the practice of DCC. Institutional policies and awareness of ACOG/AAP recommendations impact the understanding of the benefits of DCC and the likelihood of the practice. There is a significant difference in the practice of DCC among patients with different racial backgrounds. Hospital leadership may consider investing in the education and implementation of updated guidelines to ensure DCC is routinely practiced. KEY POINTS · Knowledge of AAP/ACOG and institutional policies improved the practice of DCC.. · There is racial disparity in the practice of DCC.. · Physicians in practice for >10 years were less likely to know the benefits of DCC to full-term neonates..
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Affiliation(s)
- Shanika R Uduwana
- Division of Neonatology, Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, Children's Hospital at Montefiore, Bronx, New York.,Department of Pediatrics, Long Island Jewish Medical Center, Northwell Health, Queens, New York
| | - Sheri L Nemerofsky
- Division of Neonatology, Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, Children's Hospital at Montefiore, Bronx, New York
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9
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Racism and urogynecology: what is the connection? Int Urogynecol J 2020; 31:2455-2456. [PMID: 32897462 PMCID: PMC7477731 DOI: 10.1007/s00192-020-04507-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 11/18/2022]
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10
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Abman SH. "Holistic Promotion of Scholarship and Advancement" APS racism series: at the intersection of equity, science, and social justice. Pediatr Res 2020; 88:694-695. [PMID: 32916687 DOI: 10.1038/s41390-020-01131-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Steven H Abman
- Pediatric Heart Lung Center, University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, Aurora, CO, 80045, USA.
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Racism and social injustice as determinants of child health: the American Pediatric Society Issue of the Year. Pediatr Res 2020; 88:691-693. [PMID: 32987397 PMCID: PMC7537573 DOI: 10.1038/s41390-020-01126-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 11/25/2022]
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