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Katinaitė-Vaitkevičienė J, Patapas A. Assessment of the Quality of Obstetric Services From the Perspective of Maternity Patients and Service Providers in a Tertiary Care Obstetric Unit in Lithuania. Health Serv Insights 2023; 16:11786329231180790. [PMID: 37377885 PMCID: PMC10291411 DOI: 10.1177/11786329231180790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Although largely focused on the patient, the provision of healthcare services is a 2-way process and its success hinges on the interactions between patients and physicians. Given the growing role of subjective, patient-dependent assessment of the quality of care received, which is increasingly influenced by the individual aspects of the interaction between patients and care providers, in addition to the explicitly measurable, objective assessment of the quality of care received based on clinical indicators, quality assessment of services should especially consider and explore the attitudes, needs and dynamics of all the parties involved in the healthcare process. This study was designed to assess the attitudes of maternity patients and healthcare providers towards the quality of obstetric care. A quantitative questionnaire survey was conducted in a tertiary level healthcare facility providing obstetric services in Lithuania. Research findings suggested that maternity patients rate both the technical and functional quality of obstetric services higher than the staff providing it. Midwives and obstetricians-gynaecologists view quality assurance as a complex process, rather than focus solely on quantitative indicators. Since midwives were rated slightly higher than physicians in terms of services they provide, it may be appropriate to ensure and encourage a wider use of midwife-only deliveries in low-risk births. A comprehensive assessment of the quality assurance aspects as viewed by the patients and the staff should be included in the regular quality assessments of healthcare facilities as one of the most informative assessment tools on the service quality.
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Uscher-Pines L, Kapinos KA, Mehrotra A, Demirci J, Ray KN, Alvarado G, DeYoreo M. Use of and Attitudes About Telelactation Services among New Parents. Telemed J E Health 2023; 29:607-611. [PMID: 35930242 PMCID: PMC10079243 DOI: 10.1089/tmj.2022.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 01/04/2023] Open
Abstract
Background: We conducted a national, cross-sectional survey among new parents to explore use and acceptability of telelactation. Methods: Recruitment occurred between October 2021 and January 2022 on Ovia's parenting mobile phone application. Poststratification survey weights were used, and logistic and linear regression models estimated associations between demographics and telelactation use. Results: Among 1,617 respondents, 33.8% had at least one telelactation visit. Odds of any telelactation visit(s) were greater for parents who gave birth in 2021 versus 2019 (odds ratio [OR]: 1.69, 95% confidence interval [CI]: 1.26-2.25), insured by Medicaid (OR: 1.43, 95% CI: 1.02-2.02), and younger parents (OR: 2.07, 95% CI: 1.32-3.34). In total, 56.0% agreed that they would be comfortable breastfeeding over video to get help, and 27.6% agreed that lactation support over video is as good as in-person support. Conclusions: Telelactation is increasingly common and acceptable to many parents.
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Affiliation(s)
| | | | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Jill Demirci
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Kristin N. Ray
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Maria DeYoreo
- Health Care Division, RAND Corporation, Arlington, Virginia, USA
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DeYoreo M, Kapinos K, Lawrence R, Alvarado G, Waymouth M, Demirci JR, Uscher-Pines L. Changes in Breastfeeding and Lactation Support Experiences During COVID. J Womens Health (Larchmt) 2023; 32:150-160. [PMID: 36576992 PMCID: PMC9940799 DOI: 10.1089/jwh.2022.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: We surveyed parents who gave birth from 2019 to 2021 to examine changes in breastfeeding experiences and professional and lay breastfeeding support services due to the coronavirus disease 2019 (COVID-19) pandemic. We also examined racial and ethnic disparities in breastfeeding support. Materials and Methods: A cross-sectional opt-in survey of 1,617 parents was administered on Ovia's parenting app in January 2022. Respondents were 18-45 years of age and delivered in one of three birth cohorts: August-December 2019, March-May 2020, or June-August 2021. We fit linear and logistic regression models wherein the outcomes were six breastfeeding support and experience measures, adjusting for birth cohort and respondent demographics. Results: Parents who gave birth in the early pandemic versus those in the prepandemic had reduced odds of interacting with lactation consultants (odds ratio [OR]: 0.63; 95% confidence interval [CI]: 0.44-0.90), attending breastfeeding classes (OR: 0.71; 95% CI: 0.54-0.94), meeting breastfeeding goals (OR: 0.65; 95% CI: 0.46-0.92), and reporting it was easy to get breastfeeding help (estimate: -0.36; 95% CI: -0.55 to -0.17). Birth cohort was not associated with use of donor milk or receipt of in-hospital help. The later pandemic cohort differed from the prepandemic cohort for one outcome: they were less likely to meet their breastfeeding goals (OR: 0.67; 95% CI: 0.48-0.95). There were racial and ethnic disparities in the use of multiple types of breastfeeding support. Although one-third of respondents felt that the pandemic facilitated breastfeeding because of more time at home, 18% felt the pandemic posed additional challenges including disruptions to lactation support. Conclusions: Parents who gave birth in the later pandemic did not report significant disruptions to professional breastfeeding support, likely as a result of the growth of virtual services. However, disparities in receipt of support require policy attention and action.
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Affiliation(s)
| | - Kandice Kapinos
- RAND Corporation, Arlington, Virginia, USA.,Department of Population and Data Sciences, UTSW, Dallas, Texas, USA
| | | | | | | | | | - Lori Uscher-Pines
- RAND Corporation, Arlington, Virginia, USA.,Address correspondence to: Lori Uscher-Pines, PhD, RAND Corporation, 1200 S Hayes Street, Arlington, VA 22202, USA
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Shah NT, Plough A. Why health care needs designers. J Hosp Med 2022. [PMID: 36380635 DOI: 10.1002/jhm.12999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Neel T Shah
- Maven Clinic, New York, New York, USA
- Harvard Medical School, Boston, Massachussetts, USA
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Thenuwara KN, Dexter F, Ledolter J, Radke SM, Epstein RH. Patients in Iowa Counties Lacking Hospitals With Labor and Delivery Services Disproportionately Receive Care at Level III Maternal Care Hospitals When Undergoing Cesarean Delivery: A Retrospective Longitudinal Study. Cureus 2022; 14:e30683. [DOI: 10.7759/cureus.30683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2022] [Indexed: 11/07/2022] Open
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Mehrotra A, Wolfberg A, Shah NT, Plough A, Weiseth A, Blaine AI, Noddin K, Nakamoto CH, Richard JV, Bradley D. Impact of an educational program and decision tool on choice of maternity hospital: the delivery decisions randomized clinical trial. BMC Pregnancy Childbirth 2022; 22:759. [PMID: 36217115 PMCID: PMC9549827 DOI: 10.1186/s12884-022-05087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Reducing cesarean rates is a public health priority. To help pregnant people select hospitals with lower cesarean rates, numerous organizations publish publically hospital cesarean rate data. Few pregnant people use these data when deciding where to deliver. We sought to determine whether making cesarean rate data more accessible and understandable increases the likelihood of pregnant people selecting low-cesarean rate hospitals. Methods We conducted a 1:1 randomized controlled trial in 2019–2021 among users of a fertility and pregnancy mobile application. Eligible participants were trying to conceive for fewer than five months or were 28–104 days into their pregnancies. Of 189,456 participants approached and enrolled, 120,621 participants met entry criteria and were included in analyses. The intervention group was offered an educational program explaining the importance of hospital cesarean rates and an interactive tool presenting hospital cesarean rates as 1-to-5-star ratings. Control group users were offered an educational program about hospital choice and a hospital choice tool without cesarean rate data. The primary outcome was the star rating of the hospital selected by each patient during pregnancy. Secondary outcomes were the importance of cesarean rates in choosing a hospital and delivery method (post-hoc secondary outcome). Results Of 120,621 participants (mean [SD] age, 27.8 [7.9]), 12,284 (10.2%) reported their choice of hospital during pregnancy, with similar reporting rates in the intervention and control groups. Intervention group participants selected hospitals with higher star ratings (2.52 vs 2.16; difference, 0.37 [95% CI, 0.32 to 0.43] p < 0.001) and were more likely to believe that the hospitals they chose would impact their chances of having cesarean deliveries (38.5% vs 33.1%, p < 0.001) but did not assign higher priority to cesarean delivery rates when choosing their hospitals (76.2% vs 74.3%, p = 0.05). There was no difference in self-reported cesarean rates between the intervention and control groups (31.4% vs 31.4%, p = 0.98). Conclusion People offered an educational program and interactive tool to compare hospital cesarean rates were more likely to use cesarean data in selecting a hospital and selected hospitals with lower cesarean rates but were not less likely to have a cesarean. Clinical Trial Registration Registered December 9, 2016 at clinicaltrials.gov, First enrollment November 2019. ID NCT02987803, https://clinicaltrials.gov/ct2/show/NCT02987803 Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05087-y.
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Affiliation(s)
- Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA, 02115, 617-432-3905, US.
| | | | - Neel T Shah
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Boston, MA, US.,Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, US
| | - Avery Plough
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Boston, MA, US
| | - Amber Weiseth
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Boston, MA, US
| | | | | | - Carter H Nakamoto
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA, 02115, 617-432-3905, US
| | - Jessica V Richard
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA, 02115, 617-432-3905, US
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Gourevitch RA, Chien AT, Bambury EA, Shah NT, Riedl C, Rosenthal MB, Sinaiko AD. Patterns of Use of a Price Transparency Tool for Childbirth Among Pregnant Individuals With Commercial Insurance. JAMA Netw Open 2021; 4:e2121410. [PMID: 34406401 PMCID: PMC8374613 DOI: 10.1001/jamanetworkopen.2021.21410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE When introduced a decade ago, patient-facing price transparency tools had low use rates and were largely not associated with changes in spending. Little is known about how such tools are used by pregnant individuals in anticipation of childbirth, a shoppable service with increasing out-of-pocket spending. OBJECTIVE To measure changes over time in the patterns and characteristics of use of a price transparency tool by pregnant individuals, and to identify the association between price transparency tool use, coinsurance, and childbirth spending. DESIGN, SETTING, AND PARTICIPANTS This descriptive cross-sectional study of 2 cohorts used data from a US commercial health insurance company that launched a web-based price transparency tool in 2010. Data on all price transparency tool queries for 2 periods (January 1, 2011, to December 31, 2012, and January 1, 2015, to December 31, 2016) were obtained. The sample included enrollees aged 19 to 45 years who had a delivery episode during 2 periods (November 1, 2011, to December 31, 2012, or November 1, 2015, to December 31, 2016) and were continuously enrolled for the 10 months prior to delivery (N = 253 606). EXPOSURES Access to a web-based price transparency tool that provided individualized out-of-pocket price estimates for vaginal and cesarean deliveries. MAIN OUTCOMES AND MEASURES The primary outcomes were searches on the price transparency tool by delivery mode (vaginal or cesarean), timing (first, second, or third trimester), and individual characteristics (age at childbirth, rurality, pregnancy risk status, coinsurance exposure, area educational attainment, and area median household income). Another outcome was the association of out-of-pocket childbirth spending with price transparency tool use. RESULTS The sample included 253 606 pregnant individuals, of whom 131 224 (51.7%) were in the 2011 to 2012 cohort and 122 382 (48.3%) were in the 2015 to 2016 cohort. In the 2015 to 2016 cohort, the mean (SD) age was 31 years (5.2 years) and most individuals had coinsurance for delivery (94 251 [77.0%]). Price searching increased from 5.9% in the 2011 to 2012 cohort to 13.0% in the 2015 to 2016 cohort. In the 2015 to 2016 cohort, 43.9% of searchers' first price query was in their first trimester. The adjusted probability of searching was lower for individuals with a high-risk pregnancy due to a previous cesarean delivery (11.5%; 95% CI, 11.0%-12.1%) vs individuals with low-risk pregnancy (13.4%; 95% CI, 12.9%-14.0%). Use increased monotonically with coinsurance, from 9.2% (95% CI, 8.7%-9.8%) among individuals with no coinsurance to 15.0% (95% CI, 14.4%-15.5%) among individuals with 11% or higher coinsurance. After adjusting for covariates, searching was positively associated with out-of-pocket delivery episode spending. Among patients with 11% coinsurance or higher, early and late searchers spent more out of pocket ($59.57 [95% CI, $33.44-$85.96] and $73.33 [95% CI, $32.04-$115.29], respectively), compared with never searchers. CONCLUSIONS AND RELEVANCE The results of this cross-sectional study indicate that the proportion of pregnant individuals who sought price information before childbirth more than doubled within the first 6 years of availability of a price transparency tool. These findings suggest that price information may help individuals anticipate their out-of-pocket childbirth costs.
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Affiliation(s)
| | - Alyna T. Chien
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth A. Bambury
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Neel T. Shah
- Ariadne Labs, Boston, Massachusetts
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Meredith B. Rosenthal
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anna D. Sinaiko
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Hebert LE, Freedman L, Stulberg DB. Choosing a hospital for obstetric, gynecologic, or reproductive healthcare: what matters most to patients? Am J Obstet Gynecol MFM 2019; 2:100067. [PMID: 33345982 DOI: 10.1016/j.ajogmf.2019.100067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/06/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite millions of U.S. women receiving obstetric/gynecologic or reproductive care in a hospital each year, little is known about which factors matter most to women in choosing a hospital for this care. OBJECTIVE(S) To describe women's reasons for choosing their hospital for obstetric/gynecologic or reproductive care, and to examine characteristics associated with reporting specific factors as important in hospital choice. MATERIALS AND METHODS We conducted a nationally representative, cross-sectional survey of women aged 18-45 years. The 2016 survey recruited women from AmeriSpeak, a probability-based research panel. A total of 1430 women completed the survey. All data analysis used weighting and accounted for the complex survey design. We conducted bivariate and multinomial logistic regression modeling to assess associations. RESULTS Three-fourths of women cited a hospital's overall reputation/quality as a reason, and one-third named this as the most important reason for choosing a hospital. A total of 14% reported hospital religious affiliation as a reason. Compared to those with no prior deliveries, women who had delivered an infant were more likely to report that their top reason was specialty services/provider (relative risk ratio, 2.97; 95% confidence interval, 1.96-4.52) and were also more likely to report overall hospital quality/reputation as their top reason (relative risk ratio, 1.52; 95% confidence interval, 1.06-2.17), compared to logistical reasons. Metropolitan versus non-metropolitan residence was also a significant factor in hospital choice. CONCLUSION Women endorse many factors when choosing a hospital for reproductive care, but perceived quality and reputation outweigh logistical concerns such as location and insurance.
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Affiliation(s)
- Luciana E Hebert
- Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL.
| | - Lori Freedman
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, Oakland, CA
| | - Debra B Stulberg
- Department of Family Medicine, University of Chicago, Chicago, IL
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Siam ZA, McConnell M, Golub G, Nyakora G, Rothschild C, Cohen J. Accuracy of patient perceptions of maternity facility quality and the choice of providers in Nairobi, Kenya: a cohort study. BMJ Open 2019; 9:e029486. [PMID: 31366657 PMCID: PMC6677992 DOI: 10.1136/bmjopen-2019-029486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study aimed to assess the accuracy of pregnant women's perceptions of maternity facility quality and the association between perception accuracy and the quality of facility chosen for delivery. DESIGN A cohort study. SETTING Nairobi, Kenya. PARTICIPANTS 180 women, surveyed during pregnancy and 2 to 4 weeks after delivery. PRIMARY OUTCOME MEASURES Women were surveyed during pregnancy regarding their perceptions of the quality of all facilities they were considering during delivery and then, after delivery, about their ultimate facility choice. Perceptions of quality were based on perceived ability to handle emergencies and complications. Delivery facilities were assigned a quality index score based on a direct assessment of performance of emergency 'signal functions', skilled provider availability, medical equipment and drug stocks. 'Accurate perceptions' was a binary variable equal to one if a woman's ranking of facilities based on her quality perception equalled the index ranking. Ordinary least squares and logistic regressions were used to analyse associations between accurate perceptions and quality of the facility chosen for delivery. RESULTS Assessed technical quality was modest, with an average index score of 0.65. 44% of women had accurate perceptions of quality ranking. Accurate perceptions were associated with a 0.069 higher delivery facility quality score (p=0.039; 95% CI: 0.004 to 0.135) and with a 14.5% point higher probability of delivering in a facility in the top quartile of the quality index (p=0.015; 95% CI: 0.029 to 0.260). CONCLUSIONS Patient misperceptions of technical quality were associated with use of lower quality facilities. Larger studies could determine whether improving patient information about relative facility quality can encourage use of higher quality care.
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Affiliation(s)
- Zeina Ali Siam
- Graduate School of Arts and Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - Margaret McConnell
- Department of Global Health and Population, Harvard University, Boston, Massachusetts, USA
| | | | | | - Claire Rothschild
- Department Epidemiology, University of Washington, Seattle, Washington, USA
| | - Jessica Cohen
- Department of Global Health and Population, Harvard University, Boston, Massachusetts, USA
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Milla C, Guo M, Chang A, Chen N, Miyamura J, Sentell T. Patient Perspectives in Comparing Hospitals for Childbirth: Insights from Hawai'i. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2019; 78:89-97. [PMID: 30854254 PMCID: PMC6401201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Childbirth is a national priority area for healthcare quality improvement. Patient perspectives are increasingly valued in healthcare, yet Asian American and Pacific Islander (AAPI) perspectives of healthcare quality are often understudied, particularly from individuals with limited English proficiency (LEP). Our study goal was to understand factors that consumers in Hawai'i, including AAPI and those with LEP, use to compare patient care in hospitals, especially for childbirth. A total of 400 women ages 18 years and older with a recent childbirth completed an in-person interview in English (n=291), Tagalog (n=42), Chinese (n=36), or Marshallese (n=31) on O'ahu, Hawai'i. Participants described if (yes/no), and how (open-ended), they believed hospitals in the state varied in providing patient care. Open-ended responses were coded by two independent raters using the framework approach. Respondents were 53.3% Asian, 30.8% Pacific Islander, 13.5% White, and 2.5% other race/ethnicity; 17.8% reported limited English proficiency. Overall, 66.8% of respondents affirmed that local hospitals varied in patient care; Marshallese, other Pacific Islanders, and non-English speakers were significantly less likely to say that Hawai'i hospitals varied in patient care. Among those who endorsed hospital variation, commonly reported themes about this variation were: (1) patient experience, (2) patient overall impression, (3) childbirth options (eg, waterbirths), (4) staff, (5) facilities (eg, "emergency capabilities"), (6) high-tech levels of care, and (7) the hospital's area of focus (eg, "women and children"). We provide insights into factors that diverse patients use to compare patient care in hospitals in Hawai'i to add value, relevance, and engagement to healthcare quality research and dissemination efforts.
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Affiliation(s)
- Charmaine Milla
- Molecular Biosciences and Bioengineering, University of Hawai'i at Manoa, Honolulu, HI (CM)
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (MG, TS)
- Department of OB/GYN, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (AC)
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA (NC)
- Hawai'i Health Information Corporation, Honolulu, HI (JM)
| | - Mary Guo
- Molecular Biosciences and Bioengineering, University of Hawai'i at Manoa, Honolulu, HI (CM)
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (MG, TS)
- Department of OB/GYN, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (AC)
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA (NC)
- Hawai'i Health Information Corporation, Honolulu, HI (JM)
| | - Ann Chang
- Molecular Biosciences and Bioengineering, University of Hawai'i at Manoa, Honolulu, HI (CM)
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (MG, TS)
- Department of OB/GYN, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (AC)
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA (NC)
- Hawai'i Health Information Corporation, Honolulu, HI (JM)
| | - Nancy Chen
- Molecular Biosciences and Bioengineering, University of Hawai'i at Manoa, Honolulu, HI (CM)
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (MG, TS)
- Department of OB/GYN, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (AC)
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA (NC)
- Hawai'i Health Information Corporation, Honolulu, HI (JM)
| | - Jill Miyamura
- Molecular Biosciences and Bioengineering, University of Hawai'i at Manoa, Honolulu, HI (CM)
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (MG, TS)
- Department of OB/GYN, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (AC)
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA (NC)
- Hawai'i Health Information Corporation, Honolulu, HI (JM)
| | - Tetine Sentell
- Molecular Biosciences and Bioengineering, University of Hawai'i at Manoa, Honolulu, HI (CM)
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (MG, TS)
- Department of OB/GYN, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (AC)
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA (NC)
- Hawai'i Health Information Corporation, Honolulu, HI (JM)
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Gourevitch RA, Mehrotra A, Galvin G, Plough AC, Shah NT. Does comparing cesarean delivery rates influence women's choice of obstetric hospital? THE AMERICAN JOURNAL OF MANAGED CARE 2019; 25:e33-e38. [PMID: 30763041 PMCID: PMC6456810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Despite public reporting of wide variation in hospital cesarean delivery rates, few women access this information when deciding where to deliver. We hypothesized that making cesarean delivery rate data more easily accessible and understandable would increase the likelihood of women selecting a hospital with a low cesarean delivery rate. STUDY DESIGN We conducted a randomized controlled trial of 18,293 users of the Ovia Health mobile apps in 2016-2017. All enrollees were given an explanation of cesarean delivery rate data, and those randomized to the intervention group were also given an interactive tool that presented those data for the 10 closest hospitals with obstetric services. Our outcome measures were enrollees' self-reported delivery hospital and views on cesarean delivery rates. METHODS Intent-to-treat analysis using 2-sided Pearson's χ2 tests. RESULTS There was no significant difference across the experimental groups in the proportion of women who selected hospitals with low cesarean delivery rates (7.0% control vs 6.8% intervention; P = .54). Women in the intervention group were more likely to believe that hospitals in their community had differing cesarean delivery rates (66.9% vs 55.9%; P <.001) and to report that they looked at cesarean delivery rates when choosing their hospital (44.5% vs 33.9%; P <.001). CONCLUSIONS Providing women with an interactive tool to compare cesarean delivery rates across hospitals in their community improved women's familiarity with variation in cesarean delivery rates but did not increase their likelihood of selecting hospitals with lower rates.
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Affiliation(s)
- Rebecca A Gourevitch
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115.
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Jacquemyn Y. Accreditation and resulting clerical duties represent commercial excesses that are ethically and scientifically unacceptable. Facts Views Vis Obgyn 2018; 10:59-61. [PMID: 31110643 PMCID: PMC6516189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
It is scientifically and ethically unjustified to continue hospital accreditation organized by commercial organisations such as Joint Commission International (JCI) as these harm patients and health care workers, result in needless excess costs without improved outcome and endanger the future of healthcare. All energy should go to bottom up shared decision making.
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Years Versus Days Between Successive Surgeries, After an Initial Outpatient Procedure, for the Median Patient Versus the Median Surgeon in the State of Iowa. Anesth Analg 2018; 126:787-793. [DOI: 10.1213/ane.0000000000002774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gourevitch RA, Mehrotra A, Galvin G, Karp M, Plough A, Shah NT. How do pregnant women use quality measures when choosing their obstetric provider? Birth 2017; 44:120-127. [PMID: 28124390 PMCID: PMC5484308 DOI: 10.1111/birt.12273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Given increased public reporting of the wide variation in hospital obstetric quality, we sought to understand how women incorporate quality measures into their selection of an obstetric hospital. METHODS We surveyed 6141 women through Ovia Pregnancy, an application used by women to track their pregnancy. We used t tests and chi-square tests to compare response patterns by age, parity, and risk status. RESULTS Most respondents (73.2%) emphasized their choice of obstetrician/midwife over their choice of hospital. Over half of respondents (55.1%) did not believe that their choice of hospital would affect their likelihood of having a cesarean delivery. While most respondents (74.9%) understood that quality of care varied across hospitals, few prioritized reported hospital quality metrics. Younger women and nulliparous women were more likely to be unfamiliar with quality metrics. When offered a choice, only 43.6% of respondents reported that they would be willing to travel 20 additional miles farther from their home to deliver at a hospital with a 20 percentage point lower cesarean delivery rate. DISCUSSION Women's lack of interest in available quality metrics is driven by differences in how women and clinicians/researchers conceptualize obstetric quality. Quality metrics are reported at the hospital level, but women care more about their choice of obstetrician and the quality of their outpatient prenatal care. Additionally, many women do not believe that a hospital's quality score influences the care they will receive. Presentations of hospital quality data should more clearly convey how hospital-level characteristics can affect women's experiences, including the fact that their chosen obstetrician/midwife may not deliver their baby.
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Affiliation(s)
| | - Ateev Mehrotra
- Harvard Medical SchoolBostonMAUSA
- Division of General Internal Medicine and Primary CareBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Grace Galvin
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public HealthBostonMAUSA
| | - Melinda Karp
- Blue Cross Blue Shield of MassachusettsBostonMAUSA
| | - Avery Plough
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public HealthBostonMAUSA
| | - Neel T. Shah
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public HealthBostonMAUSA
- Department of Obstetrics and GynecologyBeth Israel Deaconess Medical CenterBostonMAUSA
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