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Wong MS, Wells M, Zamanzadeh D, Akre S, Pevnick JM, Bui AAT, Gregory KD. Applying Automated Machine Learning to Predict Mode of Delivery Using Ongoing Intrapartum Data in Laboring Patients. Am J Perinatol 2024; 41:e412-e419. [PMID: 35752169 DOI: 10.1055/a-1885-1697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study aimed to develop and validate a machine learning (ML) model to predict the probability of a vaginal delivery (Partometer) using data iteratively obtained during labor from the electronic health record. STUDY DESIGN A retrospective cohort study of deliveries at an academic, tertiary care hospital was conducted from 2013 to 2019 who had at least two cervical examinations. The population was divided into those delivered by physicians with nulliparous term singleton vertex (NTSV) cesarean delivery rates <23.9% (Partometer cohort) and the remainder (control cohort). The cesarean rate among this population of lower risk patients is a standard metric by which to compare provider rates; <23.9% was the Healthy People 2020 goal. A supervised automated ML approach was applied to generate a model for each population. The primary outcome was accuracy of the model developed on the Partometer cohort at 4 hours from admission to labor and delivery. Secondary outcomes included discrimination ability (receiver operating characteristics-area under the curve [ROC-AUC]), precision-recall AUC, and calibration of the Partometer. To assess generalizability, we compared the performance and clinical predictors identified by the Partometer to the control model. RESULTS There were 37,932 deliveries during the study period; after exclusions, 9,385 deliveries were included in the Partometer cohort and 19,683 in the control cohort. Accuracy of predicting vaginal delivery at 4 hours was 87.1% for the Partometer (ROC-AUC: 0.82). Clinical predictors of greatest importance in the stacked Intrapartum Partometer Model included the Admission Model prediction and ongoing measures of dilatation and station which mirrored those found in the control population. CONCLUSION Using automated ML and intrapartum factors improved the accuracy of prediction of probability of a vaginal delivery over both previously published models based on logistic regression. Harnessing real-time data and ML could represent the bridge to generating a truly prescriptive tool to augment clinical decision-making, predict labor outcomes, and reduce maternal and neonatal morbidity. KEY POINTS · Our ML-based model yielded accurate predictions of mode of delivery early in labor.. · Predictors for models created on populations with high and low cesarean rates were the same.. · A ML-based model may provide meaningful guidance to clinicians managing labor..
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Affiliation(s)
- Melissa S Wong
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Matthew Wells
- Enterprise Data Intelligence, Cedars-Sinai Medical Center, Los Angeles, California
| | - Davina Zamanzadeh
- Medical and Imaging Informatics (MII) Group, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California
| | - Samir Akre
- Medical and Imaging Informatics (MII) Group, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California
| | - Joshua M Pevnick
- Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alex A T Bui
- Medical and Imaging Informatics (MII) Group, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
- Department of Community Health Sciences, Los Angeles, California Fielding School of Public Health, Los Angeles, California
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Saeb S, Korst LM, Fridman M, McCulloch J, Greene N, Gregory KD. Capacity-Building for Collecting Patient-Reported Outcomes and Experiences (PRO) Data Across Hospitals. Matern Child Health J 2023:10.1007/s10995-023-03720-6. [PMID: 37347378 PMCID: PMC10359358 DOI: 10.1007/s10995-023-03720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Patient-reported outcomes and experiences (PRO) data are an integral component of health care quality measurement and PROs are now being collected by many healthcare systems. However, hospital organizational capacity-building for the collection and sharing of PROs is a complex process. We sought to identify the factors that facilitated capacity-building for PRO data collection in a nascent quality improvement learning collaborative of 16 hospitals that has the goal of improving the childbirth experience. DESCRIPTION We used standard qualitative case study methodologies based on a conceptual framework that hypothesizes that adequate organizational incentives and capacities allow successful achievement of project milestones in a collaborative setting. The 4 project milestones considered in this study were: (1) Agreements; (2) System Design; (3) System Development and Operations; and (4) Implementation. To evaluate the success of reaching each milestone, critical incidents were logged and tracked to determine the capacities and incentives needed to resolve them. ASSESSMENT The pace of the implementation of PRO data collection through the 4 milestones was uneven across hospitals and largely dependent on limited hospital capacities in the following 8 dimensions: (1) Incentives; (2) Leadership; (3) Policies; (4) Operating systems; (5) Information technology; (6) Legal aspects; (7) Cross-hospital collaboration; and (8) Patient engagement. From this case study, a trajectory for capacity-building in each dimension is discussed. CONCLUSION The implementation of PRO data collection in a quality improvement learning collaborative was dependent on multiple organizational capacities for the achievement of project milestones.
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Affiliation(s)
- Samia Saeb
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | | | - Naomi Greene
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Fridman M, Korst LM, Reynen DJ, Nicholas LA, Greene N, Saeb S, Troyan JL, Gregory KD. Using Potentially Preventable Severe Maternal Morbidity to Monitor Hospital Performance. Jt Comm J Qual Patient Saf 2023; 49:129-137. [PMID: 36646608 DOI: 10.1016/j.jcjq.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) measure of severe maternal morbidity (SMM) quantifies the burden of SMM but is not restricted to potentially preventable SMM. The authors adapted the CDC SMM measure for this purpose and evaluated it for use as a hospital performance measure. METHODS Guidelines for defining performance SMM (pSMM) were (1) exclusion of preexisting conditions from outcome; (2) exclusion of inconsistently documented outcomes; and (3) risk adjustment for conditions that preceded hospitalization. California maternal hospital discharge data from 2016 to 2017 were used for model development, and 2018 data were used for model testing and evaluation of hospital performance. Separate models were developed for hospital types (Community, Teaching, Integrated Delivery System [IDS], and IDS Teaching), generating model-based expected pSMM values. Observed-to-expected (O/E) ratios were calculated for hospitals and used to categorize them as overperforming, average performing, or underperforming using 95% confidence intervals. Performance categories were compared for pSMM vs. CDC SMM (excluding blood transfusion). RESULTS The overall 2016-2018 pSMM rate was 0.44%. All hospital types had over- and underperformers, and the proportions of Community, Teaching, IDS, and IDS Teaching hospitals whose performance differed from their performance on the CDC SMM measure were 12.1%, 25.0%, 38.9%, and 66.7%, respectively. CONCLUSION The rate of potentially preventable SMM as defined by pSMM (0.44%) was less than half the previously published rate of CDC SMM (1.03%). pSMM identified differences in performance across hospitals, and pSMM and CDC SMM classified hospitals' performances differently. pSMM may be suitable for hospital comparisons because it identifies potentially preventable, hospital-acquired SMM that should be responsive to quality improvement activities.
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Wong MS, samira torna, Wells M, Gregory KD. Automated clinical decision support eliminates racial disparities in aspirin recommendation. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Wong MS, samira torna, Wells M, Gregory KD. Beyond chart review: using NLP as a performance improvement tool to track aspirin utilization. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Wong MS, Gregory KD, Spiegel BMR, Khalil C. Patient perceptions of virtual reality for pain relief in labor: A qualitative study. Front Pain Res (Lausanne) 2022; 3:1063751. [PMID: 36582195 PMCID: PMC9792960 DOI: 10.3389/fpain.2022.1063751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
Introduction Labor represents the most common reason for hospitalization, and most patients will use some form of pain management during their labor. While some studies have suggested that virtual reality (VR) may be an effective option for managing pain, more study is necessary to understand the patient experience of VR. The aim of this study is to characterize the effect of VR on patient perceptions of coping in labor and their descriptions of the VR experience. Methodology A nested prospective, descriptive study within a randomized controlled trial of VR in laboring patients. We included nulliparous, term patients, having contractions at least every 5 min, a pain score on the Wong-Baker pain scale of 4-7, and who had been randomized to receive the 30 min virtual reality intervention in the trial. Subjects completed a childbirth self-efficacy inventory prior to the intervention. After the intervention, they completed a modified childbirth self-efficacy inventory related to VR and underwent a structured interview. Self-efficacy scores were compared using t-tests and qualitative, thematic analysis was performed using Dedoose. Results Twenty-one subjects received the VR intervention. Twenty subjects completed the post-intervention survey and structured interview; one declined due to discomfort. Subjects noted a significant increase in perceived degree to which VR could improve their self-efficacy in managing pain during labor. Thematic analysis revealed that subjects described the VR experience as allowing them to connect with their breathing, feeling more relaxed, and being distracted from pain. In total, 70% believed VR reduced their pain, 60% felt it reduced their anxiety, and 100% would recommend VR availability for laboring patients. Conclusion VR can improve patient self-efficacy for managing pain in labor. Future studies should focus on the content of the visualizations, optimized user experience and design, and effectiveness with ongoing exposure to VR content in labor.
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Affiliation(s)
- Melissa S. Wong
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Kimberly D. Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Brennan M. R. Spiegel
- Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, United States,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Carine Khalil
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, United States,Le Laboratoire Interdisciplinaire de Recherche Appliquée en Economie de la Santé (LIRAES) Lab, Paris Descartes University, Paris, France
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Hendrix CL, Werchan D, Lenniger C, Ablow JC, Amstadter AB, Austin A, Babineau V, Bogat GA, Cioffredi LA, Conradt E, Crowell SE, Dumitriu D, Elliott AJ, Fifer W, Firestein M, Gao W, Gotlib I, Graham A, Gregory KD, Gustafsson H, Havens KL, Hockett C, Howell BR, Humphreys KL, Jallo N, King LS, Kinser PA, Levendosky AA, Lonstein JS, Lucchini M, Marcus R, Monk C, Moyer S, Muzik M, Nuttall AK, Potter AS, Rogers C, Salisbury A, Shuffrey LC, Smith BA, Smyser CD, Smith L, Sullivan E, Zhou J, Brito NH, Thomason ME. Geotemporal analysis of perinatal care changes and maternal mental health: an example from the COVID-19 pandemic. Arch Womens Ment Health 2022; 25:943-956. [PMID: 35962855 PMCID: PMC9375091 DOI: 10.1007/s00737-022-01252-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/29/2022] [Indexed: 01/21/2023]
Abstract
Our primary objective was to document COVID-19 induced changes to perinatal care across the USA and examine the implication of these changes for maternal mental health. We performed an observational cross-sectional study with convenience sampling using direct patient reports from 1918 postpartum and 3868 pregnant individuals collected between April 2020 and December 2020 from 10 states across the USA. We leverage a subgroup of these participants who gave birth prior to March 2020 to estimate the pre-pandemic prevalence of specific birthing practices as a comparison. Our primary analyses describe the prevalence and timing of perinatal care changes, compare perinatal care changes depending on when and where individuals gave birth, and assess the linkage between perinatal care alterations and maternal anxiety and depressive symptoms. Seventy-eight percent of pregnant participants and 63% of postpartum participants reported at least one change to their perinatal care between March and August 2020. However, the prevalence and nature of specific perinatal care changes occurred unevenly over time and across geographic locations. The separation of infants and mothers immediately after birth and the cancelation of prenatal visits were associated with worsened depression and anxiety symptoms in mothers after controlling for sociodemographic factors, mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic. Our analyses reveal widespread changes to perinatal care across the US that fluctuated depending on where and when individuals gave birth. Disruptions to perinatal care may also exacerbate mental health concerns, so focused treatments that can mitigate the negative psychiatric sequelae of interrupted care are warranted.
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Affiliation(s)
- Cassandra L Hendrix
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, USA.
| | - Denise Werchan
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, USA
| | - Carly Lenniger
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, USA
| | | | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Autumn Austin
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, USA
| | - Vanessa Babineau
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - G Anne Bogat
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | | | - Elisabeth Conradt
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
- Department of Psychiatry, University of Utah Medical School, Salt Lake City, UT, USA
- Department of Obstetrics and Gynecology, University of Utah Medical School, Salt Lake City, UT, USA
| | - Dani Dumitriu
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Amy J Elliott
- Department of Pediatrics, University of South Dakota School of Medicine, Vermillion, SD, USA
- Avera Research Institute, Sioux Falls, SD, USA
| | - William Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Morgan Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Wei Gao
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Biomedical Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ian Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Alice Graham
- Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, USA
| | - Kimberly D Gregory
- Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hanna Gustafsson
- Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, USA
| | - Kathryn L Havens
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Christine Hockett
- Department of Pediatrics, University of South Dakota School of Medicine, Vermillion, SD, USA
- Avera Research Institute, Sioux Falls, SD, USA
| | - Brittany R Howell
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
- Department of Human Development and Family Science, Virginia Tech University, Blacksburg, VA, USA
| | - Kathryn L Humphreys
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Nancy Jallo
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Lucy S King
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Patricia A Kinser
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Joseph S Lonstein
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel Marcus
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Sara Moyer
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Maria Muzik
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, VA, USA
| | - Amy K Nuttall
- Human Development and Family Studies, Michigan State University, East Lansing, MI, USA
| | | | - Cynthia Rogers
- Department of Psychiatry, Washington University Medical School in Saint Louis, Saint Louis, MO, USA
| | - Amy Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Lauren C Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Beth A Smith
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
- Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Los Angeles, CA, USA
- Division of Research On Children, Youth, and Families, Childrens Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher D Smyser
- Departments of Neurology, Pediatrics, and Radiology, Washington University Medical School in Saint Louis, Saint Louis, MO, USA
| | - Lynne Smith
- The Lundquist Institute, Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Elinor Sullivan
- Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, USA
| | - Judy Zhou
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Natalie H Brito
- Department of Applied Psychology, New York University, New York, NY, USA
| | - Moriah E Thomason
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, USA
- Neuroscience Institute, New York University Medical Center, New York, NY, USA
- Department of Population Health, New York University Medical Center, New York, NY, USA
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Chelmow D, Gregory KD, Witkop C, Hoffstetter S, Humphrey L, Picardo C, Stevermer JJ, Cantor AG, Nelson HD, Son S, Conry JA, Garcia F, Kendig SM, O'Reilly N, Qaseem A, Ramos D, Salganicoff A, Wood JK, Zahn C. Preventing Obesity in Midlife Women: A Recommendation From the Women's Preventive Services Initiative. Ann Intern Med 2022; 175:1305-1309. [PMID: 35914264 DOI: 10.7326/m22-0252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient advocacy representatives, developed a recommendation for counseling midlife women aged 40 to 60 years with normal or overweight body mass index (BMI; 18.5 to 29.9 kg/m2) to maintain weight or limit weight gain to prevent obesity with the long-term goals of optimizing health, function, and well-being. This recommendation is intended to guide clinical practice and coverage of clinical preventive health services for the Health Resources and Services Administration and other stakeholders. Clinicians providing preventive health care to women in primary care settings are the target audience for this recommendation. METHODS The WPSI developed this recommendation after evaluating results of a systematic review of the effectiveness and harms of interventions to prevent weight gain and obesity in women aged 40 to 60 years without obesity. Seven randomized clinical trials including 51 638 participants and using various counseling and behavioral interventions were included. Trials indicated favorable weight changes with interventions that were statistically significantly different from control groups in 4 of 5 trials of counseling, but not in 2 trials of exercise. Few harms were reported. RECOMMENDATION The WPSI recommends counseling midlife women aged 40 to 60 years with normal or overweight BMI (18.5 to 29.9 kg/m2) to maintain weight or limit weight gain to prevent obesity. Counseling may include individualized discussion of healthy eating and physical activity.
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Affiliation(s)
- David Chelmow
- Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia (D.C.)
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California (K.D.G.)
| | - Catherine Witkop
- Departments of Preventive Medicine and Gynecologic Surgery & Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland (C.W.)
| | - Susan Hoffstetter
- Department of Obstetrics, Gynecology and Women's Health, Saint Louis University School of Medicine, St. Louis, Missouri (S.H.)
| | | | - Carla Picardo
- Women's Wellness & Gynecology, Erie, and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (C.P.)
| | - James J Stevermer
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, Missouri (J.J.S.)
| | - Amy G Cantor
- Departments of Medical Informatics and Clinical Epidemiology, Family Medicine, and Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (A.G.C.)
| | - Heidi D Nelson
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California (H.D.N.)
| | - Sarah Son
- American College of Obstetricians and Gynecologists, Washington, DC (S.S., N.O., C.Z.)
| | - Jeanne A Conry
- American College of Obstetricians and Gynecologists, Granite Bay, California (J.A.C.)
| | | | - Susan M Kendig
- Nurse Practitioners in Women's Health, Washington, DC (S.M.K.)
| | - Nancy O'Reilly
- American College of Obstetricians and Gynecologists, Washington, DC (S.S., N.O., C.Z.)
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
| | - Diana Ramos
- University of Southern California Keck School of Medicine, Los Angeles, California (D.R.)
| | | | - Julie K Wood
- American Academy of Family Physicians, Leawood, Kansas (J.K.W.)
| | - Christopher Zahn
- American College of Obstetricians and Gynecologists, Washington, DC (S.S., N.O., C.Z.)
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Monk C, Dimidjian S, Galinsky E, Gregory KD, Hoffman MC, Howell EA, Miller ES, Osborne C, Rogers CE, Saxbe DE, D'Alton ME. The Transition to Parenthood in Obstetrics: Enhancing Prenatal Care for Two Generation Impact. Am J Obstet Gynecol MFM 2022; 4:100678. [PMID: 35728782 DOI: 10.1016/j.ajogmf.2022.100678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
Abstract
Obstetrics, the specialty overseeing infant and parent health before birth, could be expanded to address the inter-related areas of parents' prenatal impact on children's brain development and their own psychosocial needs during a time of immense change and neuroplasticity. Obstetrics is primed for the shift that is happening in pediatrics, which is moving from its traditional focus on physical health to a coordinated, whole child, two or multi-generation approach. Pediatric care now includes developmental screening, parenting education, parent coaching, access to developmental specialists, brain-building caregiving skills, linkages to community resources, and tiered interventions with psychologists. Drawing on decades of Developmental Origins of Health and Disease research highlighting the prenatal beginnings of future health and new studies on the transition to parenthood describing adult development from pregnancy to early postpartum, we propose that, similar to pediatrics, the integration of education and intervention strategies into the prenatal care ecosystem should be tested for its potential to improve child cognitive and social-emotional development and parental mental health. Pediatric care programs can serve as models of change for the systematic development, testing and, incorporation of new content into prenatal care as universal, first-tier treatment as well as evidenced-based, triaged interventions according to level of need. To promote optimal beginnings for the whole family, we propose an augmented prenatal care ecosystem that aligns with, and could build on, current major efforts to enhance perinatal care individualization through consideration of medical, social, and structural determinants of health.
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Affiliation(s)
- Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY.
| | - Sona Dimidjian
- Department of Psychology and Neuroscience, University Colorado, Boulder
| | | | | | - M Camille Hoffman
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora; Department of Psychiatry, University of Colorado School of Medicine, Aurora
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL; Department of Psychiatry and Behavioral Health Sciences, Northwestern University, Chicago, IL
| | - Cynthia Osborne
- Department of Leadership, Policy, and Organizations, Peabody College, Vanderbilt University, Nashville, TN
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Darby E Saxbe
- Department of Psychology, University of Southern California, Los Angeles
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
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Jackson FM, Bryant A, Gregory KD, Hardeman R, Howell EA. Introduction: The Quest for Birth Equity and Justice-Now is the Time. Matern Child Health J 2022; 26:659-660. [PMID: 35378666 PMCID: PMC8979722 DOI: 10.1007/s10995-022-03436-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
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Edmonds JK, Woodbury SR, Lipsitz SR, Weiseth A, Farrell ME, Shah NT, Greene N, Gregory KD. Comparing Methods of Identifying Outlying Nurses in Audits of Low-Risk Cesarean Delivery Rates. J Nurs Care Qual 2022; 37:149-154. [PMID: 34446663 DOI: 10.1097/ncq.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The low-risk cesarean delivery (CD) rate is an established performance indicator for providers in maternity care for quality improvement purposes. PURPOSE Our objectives were to assess nurse performance using adjusted nurse-level CD rates and to compare methods of identifying nurse outliers. METHODS We conducted a retrospective, cohort study of 6970 births attended by 181 registered nurses in one hospital's maternity unit. Adjusted and unadjusted nurse-level CD rates were compared and agreement between 3 definitions (statistical, top decile, over a benchmark) of outliers calculated. RESULTS Adjusted nurse-level CD rates varied from 5.5% to 53.2%, and the unadjusted rates varied from 5% to 50%. Risk adjustment had little impact on the ranking of nurses, and outliers were consistently identified by 3 definitions. CONCLUSIONS Trade-offs between statistical certainty and feasibility need to be considered when classifying nurse outliers. Findings can help target interventions to improve nurse performance.
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Affiliation(s)
- Joyce K Edmonds
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts (Dr Edmonds); Science and Technology, Ariadne Labs, Boston, Massachusetts (Mr Woodbury and Drs Lipsitz, Weiseth, and Shah); Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, and the Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts (Dr Farrell); Division of Maternal Fetal Medicine (Dr Gregory), Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California (Dr Greene)
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12
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Dellapiana G, Gupta M, Burwick RM, Greene N, Gregory KD. Elevated blood pressures during epidural placement are associated with increased risk of hypertensive disorders of pregnancy. J Matern Fetal Neonatal Med 2022; 35:9282-9287. [PMID: 35078390 DOI: 10.1080/14767058.2022.2026918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Many providers ignore hypertensive blood pressures (BPs) during epidural placement, attributing them to patient pain or malposition. We aimed to determine if an elevated BP during epidural placement was associated with increased risk for developing a hypertensive disorder of pregnancy (HDP). METHODS Cohort study of previously normotensive nulliparous, singleton, term patients who received neuraxial analgesia and delivered at our institution in 2016. Primary exposure was BP during epidural window (one hour before and after epidural procedure start time). Primary outcome was HDP (gestational hypertension, preeclampsia, eclampsia, or HELLP syndrome) prior to discharge. Statistics included χ2, t-test, and multivariable logistic regression; α = 0.05. RESULTS One thousand and eight hundred patients met study criteria. Patients with elevated BP during epidural window (n = 566, 31.4%) were more likely to develop HDP than patients who remained normotensive during epidural window (20.1% vs. 6.4%, adjusted OR 3.57 [95% CI 2.61-4.89]). The incidence of HDP increased in association with BP severity during epidural window: 7.3% for maximum systolic blood pressure (SBP) <140 mmHg; 18.4% for maximum SBP 140-159 mmHg (OR 2.9, 95% CI 2.0-4.0); and 29.9% for maximum SBP ≥160 mmHg (OR 5.4, 95% CI 2.9-9.8). The trend was similar for maximum diastolic BP. The magnitude of increased odds for HDP was highest for Black patients with elevated BP during epidural window (40.9% vs. 10.1%, OR 6.1, 95% CI 2.4-16). CONCLUSIONS Previously normotensive patients with an elevated BP during labor epidural placement are significantly more likely to develop HDP than patients who remain normotensive. Elevated BP during epidural placement should not be disregarded to ensure timely diagnosis and treatment.
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Affiliation(s)
- Gabriela Dellapiana
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center & Burnes Allen Research Institute, Los Angeles, CA, USA
| | - Megha Gupta
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal Fetal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Richard M Burwick
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center & Burnes Allen Research Institute, Los Angeles, CA, USA
| | - Naomi Greene
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center & Burnes Allen Research Institute, Los Angeles, CA, USA
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center & Burnes Allen Research Institute, Los Angeles, CA, USA.,The Helping Hands of Los Angeles Miriam Jacobs Chair in Maternal Fetal Medicine, Los Angeles, CA, USA
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13
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Werchan DM, Hendrix CL, Ablow JC, Amstadter AB, Austin AC, Babineau V, Anne Bogat G, Cioffredi LA, Conradt E, Crowell SE, Dumitriu D, Fifer W, Firestein MR, Gao W, Gotlib IH, Graham AM, Gregory KD, Gustafsson HC, Havens KL, Howell BR, Humphreys KL, King LS, Kinser PA, Krans EE, Lenniger C, Levendosky AA, Lonstein JS, Marcus R, Monk C, Moyer S, Muzik M, Nuttall AK, Potter AS, Salisbury A, Shuffrey LC, Smith BA, Smith L, Sullivan EL, Zhou J, Thomason ME, Brito NH. Behavioral coping phenotypes and associated psychosocial outcomes of pregnant and postpartum women during the COVID-19 pandemic. Sci Rep 2022; 12:1209. [PMID: 35075202 PMCID: PMC8786860 DOI: 10.1038/s41598-022-05299-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 12/16/2021] [Indexed: 11/09/2022] Open
Abstract
The impact of COVID-19-related stress on perinatal women is of heightened public health concern given the established intergenerational impact of maternal stress-exposure on infants and fetuses. There is urgent need to characterize the coping styles associated with adverse psychosocial outcomes in perinatal women during the COVID-19 pandemic to help mitigate the potential for lasting sequelae on both mothers and infants. This study uses a data-driven approach to identify the patterns of behavioral coping strategies that associate with maternal psychosocial distress during the COVID-19 pandemic in a large multicenter sample of pregnant women (N = 2876) and postpartum women (N = 1536). Data was collected from 9 states across the United States from March to October 2020. Women reported behaviors they were engaging in to manage pandemic-related stress, symptoms of depression, anxiety and global psychological distress, as well as changes in energy levels, sleep quality and stress levels. Using latent profile analysis, we identified four behavioral phenotypes of coping strategies. Critically, phenotypes with high levels of passive coping strategies (increased screen time, social media, and intake of comfort foods) were associated with elevated symptoms of depression, anxiety, and global psychological distress, as well as worsening stress and energy levels, relative to other coping phenotypes. In contrast, phenotypes with high levels of active coping strategies (social support, and self-care) were associated with greater resiliency relative to other phenotypes. The identification of these widespread coping phenotypes reveals novel behavioral patterns associated with risk and resiliency to pandemic-related stress in perinatal women. These findings may contribute to early identification of women at risk for poor long-term outcomes and indicate malleable targets for interventions aimed at mitigating lasting sequelae on women and children during the COVID-19 pandemic.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Dani Dumitriu
- Columbia University Irving Medical Center, New York, USA
| | - William Fifer
- Columbia University Irving Medical Center, New York, USA
| | | | - Wei Gao
- Cedars-Sinai Medical Center, Los Angeles, USA
| | | | | | | | | | | | - Brittany R Howell
- Department of Human Development and Family Science, Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Blacksburg, USA
| | | | | | | | | | | | | | | | | | - Catherine Monk
- Columbia University Irving Medical Center, New York, USA
| | - Sara Moyer
- Virginia Commonwealth University, Richmond, USA
| | | | | | | | | | | | - Beth A Smith
- University of Southern California, Los Angeles, USA
| | - Lynne Smith
- The Lundquist Institute at Harbor-UCLA, West Carson, USA
| | | | - Judy Zhou
- University of Southern California, Los Angeles, USA
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14
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Wong MS, Wells M, Parrinella K, Gregory KD. EHR phenotyping by Natural Language Processing improves detection of patients at risk for preeclampsia. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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15
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Wong MS, Parrinella K, Wells M, Gregory KD. Black pregnant people are less likely to be recommended aspirin prophylaxis for preeclampsia. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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16
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Dellapiana G, Gregory KD. Postpartum Hemorrhage Carts: Saving Time Can Save Lives. Jt Comm J Qual Patient Saf 2021; 48:67-68. [PMID: 34887199 DOI: 10.1016/j.jcjq.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Fridman M, Korst LM, Reynen DJ, Nicholas LA, Greene N, Saeb S, Troyan JL, Gregory KD. Severe Maternal Morbidity in California Hospitals: Performance Based on a Validated Multivariable Prediction Model. Jt Comm J Qual Patient Saf 2021; 47:686-695. [PMID: 34548236 DOI: 10.1016/j.jcjq.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Severe maternal morbidity (SMM) is under development as a quality indicator for maternal health care. The aim of this study is to evaluate California hospital performance based on a standardized SMM measure. METHODS California maternal hospital delivery discharge data from 2016 to 2017 were used to develop logistic regression models for SMM, adjusted for clinical risk factors at admission. Data from 2018 were used to test the models and evaluate hospital performance. SMM was defined per the Centers for Disease Control and Prevention, including (excluding) blood transfusion. Independent models were developed for each hospital type: community, teaching, integrated delivery system (IDS), and IDS teaching. Within each type, model-based expected SMM values and observed-to-expected (O/E) ratios were calculated for each hospital. For each hospital type, hospitals were ranked by O/E ratio, and over- and underperforming hospitals were identified using 95% confidence intervals. RESULTS Rates of SMM including (excluding) transfusion by hospital type were 1.7% (0.9%) for community, 2.7% (1.5%) for teaching, 2.3% (1.2%) for IDS, and 3.0% (1.6%) for IDS teaching hospitals. In higher-volume community hospitals (≥ 500 births/year), the proportion of underperformers including (excluding) transfusion was 20.7% (11.0%). Summing over all hospital types, 25.3% (14.9%) of hospitals were identified as underperformers in that they experienced significantly more SMM events than expected including (excluding) transfusion. CONCLUSION California hospital discharge data demonstrated significant hospital variation in standardized childbirth SMM. These data suggest that a standardized SMM measure may help guide and monitor statewide quality improvement efforts.
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Abstract
OBJECTIVE Virtual reality (VR) represents a potential method for easing labor pain and in nonpregnant patients has been shown to achieve similar or greater analgesia than hydromorphone. Few studies of VR have been performed in pregnant women. The aim of this randomized controlled trial (RCT) is to evaluate whether VR is effective in reducing pain in laboring women. STUDY DESIGN An open-label, RCT of nulliparous, term women in labor in a tertiary care hospital. We included women with a pain score level of 4 to 7 having regular contractions at least every 5 minutes. We excluded women who had received any pharmacologic pain relief including neuraxial analgesia and those with contraindications to VR. Participants were randomized to up to 30 minutes of either VR or the control arm (no additional intervention). Our primary outcome was the difference in differences from pre- to postintervention pain score. Prespecified secondary outcomes included postintervention pain scores, duration of intervention use, pharmacologic analgesia use, maternal vitals, and obstetric outcomes. RESULTS From March 2018 to February 2019, 40 subjects were enrolled, randomized, and completed the study; 19 were randomized to control and 21 to the VR arm. Most baseline characteristics were similar between groups. For the primary outcome, those assigned to the control arm had a statistically significant increase in pain of +0.58, while the VR arm had a significant reduction in pain of -0.52 (p = 0.03). There was also a difference in the proportion who had a minimum clinically important difference in pain (0% control and 23.8% VR; p = 0.049). Postintervention maternal heart rate was higher in the control arm (86.8 vs. 76.3, p = 0.01). Most other secondary outcomes did not differ. CONCLUSION In our study, we found that VR was effective for reducing pain in women in labor as compared with those receiving no intervention. KEY POINTS · Virtual reality (VR) represents a nonpharmacologic option for pain relief.. · VR has been little studied in pregnant or laboring women.. · VR was associated with a reduction in pain in nulliparous women in labor..
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Affiliation(s)
- Melissa S Wong
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California.,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brennan M R Spiegel
- Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California.,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California
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19
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Greene N, Kilcoyne J, Grey A, Gregory KD. Method to Calculate Nurse-Specific Cesarean Rates for the First and Second Stages of Labor. J Obstet Gynecol Neonatal Nurs 2021; 50:632-641. [PMID: 34310902 DOI: 10.1016/j.jogn.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/28/2022] Open
Abstract
To date, efforts to safely lower the cesarean birth rate for women with low-risk pregnancies have largely ignored the influence of labor and delivery nurses on mode of birth. This is mainly because of the complexity involved in attributing outcomes to specific nurses whose care had the greatest effect on mode of birth. An additional level of complexity arises from the type of care given to the woman during different stages of labor. In this article, we describe a strategy to designate nurses to births using an electronic medical record flowsheet, and we describe a method to calculate nurse-specific cesarean birth rates for the first and second stages of labor. Similar to physician-specific rates, we found wide variation in nurse-specific cesarean birth rates in both stages of labor, which suggests an opportunity to learn from best practices.
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20
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Chen KL, Brozen M, Rollman JE, Ward T, Norris KC, Gregory KD, Zimmerman FJ. How is the COVID-19 pandemic shaping transportation access to health care? Transp Res Interdiscip Perspect 2021; 10:100338. [PMID: 34514368 PMCID: PMC8422279 DOI: 10.1016/j.trip.2021.100338] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 05/22/2023]
Abstract
The Coronavirus disease 19 (COVID-19) pandemic has disrupted both transportation and health systems. While about 40% of Americans have delayed seeking medical care during the pandemic, it remains unclear to what extent transportation is contributing to missed care. To understand the relationship between transportation and unmet health care needs during the pandemic, this paper synthesizes existing knowledge on transportation patterns and barriers across five types of health care needs. While the literature is limited by the absence of detailed data for trips to health care, key themes emerged across populations and settings. We find that some patients, many of whom already experience transportation disadvantage, likely need extra support during the pandemic to overcome new travel barriers related to changes in public transit or the inability to rely on others for rides. Telemedicine is working as a partial substitute for some visits but cannot fulfill all health care needs, especially for vulnerable groups. Structural inequality during the pandemic has likely compounded health care access barriers for low-income individuals and people of color, who face not only disproportionate health risks, but also greater difficulty in transportation access and heightened economic hardship due to COVID-19. Partnerships between health and transportation systems hold promise for jointly addressing disparities in health- and transportation-related challenges but are largely limited to Medicaid-enrolled patients. Our findings suggest that transportation and health care providers should look for additional strategies to ensure that transportation access is not a reason for delayed medical care during and after the COVID-19 pandemic.
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Affiliation(s)
- Katherine L Chen
- National Clinician Scholars Program, University of California (UCLA), Los Angeles, CA, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Division of General Internal Medicine & Health Services Research, UCLA, Los Angeles, CA, USA
| | - Madeline Brozen
- Lewis Center for Regional Policy Studies at the UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Jeffrey E Rollman
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Tayler Ward
- Lewis Center for Regional Policy Studies at the UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Keith C Norris
- Division of General Internal Medicine & Health Services Research, UCLA, Los Angeles, CA, USA
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars Sinai Medical Center & Burnes and Allen Research Institute, Los Angeles, CA, USA
| | - Frederick J Zimmerman
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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21
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Saeb S, Korst LM, Fridman M, Gregory KD, McCulloch J, Greene N. 675 The childbirth experience survey (CBEX): an analysis of qualitative survey data. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Wong MS, Gregory KD, Wells M. 1148 Racial disparities in cesarean delivery rates: can a machine learning model reduce these biases? Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.1172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Korst LM, Gregory KD, Nicholas LA, Saeb S, Reynen DJ, Troyan JL, Greene N, Fridman M. A scoping review of severe maternal morbidity: describing risk factors and methodological approaches to inform population-based surveillance. Matern Health Neonatol Perinatol 2021; 7:3. [PMID: 33407937 PMCID: PMC7789633 DOI: 10.1186/s40748-020-00123-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Current interest in using severe maternal morbidity (SMM) as a quality indicator for maternal healthcare will require the development of a standardized method for estimating hospital or regional SMM rates that includes adjustment and/or stratification for risk factors. Objective To perform a scoping review to identify methodological considerations and potential covariates for risk adjustment for delivery-associated SMM. Search methods Following the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews, systematic searches were conducted with the entire PubMed and EMBASE electronic databases to identify publications using the key term “severe maternal morbidity.” Selection criteria Included studies required population-based cohort data and testing or adjustment of risk factors for SMM occurring during the delivery admission. Descriptive studies and those using surveillance-based data collection methods were excluded. Data collection and analysis Information was extracted into a pre-defined database. Study design and eligibility, overall quality and results, SMM definitions, and patient-, hospital-, and community-level risk factors and their definitions were assessed. Main results Eligibility criteria were met by 81 studies. Methodological approaches were heterogeneous and study results could not be combined quantitatively because of wide variability in data sources, study designs, eligibility criteria, definitions of SMM, and risk-factor selection and definitions. Of the 180 potential risk factors identified, 41 were categorized as pre-existing conditions (e.g., chronic hypertension), 22 as obstetrical conditions (e.g., multiple gestation), 22 as intrapartum conditions (e.g., delivery route), 15 as non-clinical variables (e.g., insurance type), 58 as hospital-level variables (e.g., delivery volume), and 22 as community-level variables (e.g., neighborhood poverty). Conclusions The development of a risk adjustment strategy that will allow for SMM comparisons across hospitals or regions will require harmonization regarding: a) the standardization of the SMM definition; b) the data sources and population used; and c) the selection and definition of risk factors of interest. Supplementary Information The online version contains supplementary material available at 10.1186/s40748-020-00123-1.
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Affiliation(s)
- Lisa M Korst
- Childbirth Research Associates, LLC, North Hollywood, CA, USA.
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, CA, USA.,Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Community Health Sciences, Fielding School of Public Health at UCLA, Los Angeles, CA, USA
| | - Lisa A Nicholas
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Samia Saeb
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, CA, USA
| | - David J Reynen
- Maternal, Child and Adolescent Health Division, California Department of Public Health, Sacramento, CA, USA
| | - Jennifer L Troyan
- Maternal, Child and Adolescent Health Division, California Department of Public Health, Sacramento, CA, USA
| | - Naomi Greene
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, CA, USA
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Abstract
PURPOSE We report a case of a pregnant female presenting with pituitary apoplexy and simultaneous SARS-CoV-2 infection with a focus on management decisions. CLINICAL HISTORY A 28-year-old G5P1 38w1d female presented with 4 days of blurry vision, left dilated pupil, and headache. She tested positive for SARS-CoV-2 on routine nasal swab testing but denied cough or fever. Endocrine testing demonstrated an elevated serum prolactin level, and central hypothyroidism. MRI showed a cystic-solid lesion with a fluid level in the pituitary fossa and expansion of the sella consistent with pituitary apoplexy. Her visual symptoms improved with corticosteroid administration and surgery was delayed to two weeks after her initial COVID-19 infection and to allow for safe delivery of the child. A vaginal delivery under epidural anesthetic occurred at 39 weeks. Two days later, transsphenoidal resection of the mass was performed under strict COVID-19 precautions including use of Powered Air Purifying Respirators (PAPRs) and limited OR personnel given high risk of infection during endonasal procedures. Pathology demonstrated a liquefied hemorrhagic mass suggestive of pituitary apoplexy. She made a full recovery and was discharged home two days after surgery. CONCLUSION Here we demonstrate the first known case of successful elective induction of vaginal delivery and transsphenoidal intervention in a near full term gravid patient presenting with pituitary apoplexy and acute SARS-CoV-2 infection. Further reports may help determine if there is a causal relationship or if these events are unrelated. Close adherence to guidelines for caregivers can greatly reduce risk of infection.
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Affiliation(s)
- Julie L Chan
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kimberly D Gregory
- Cedars-Sinai Medical Center, Maternal Fetal Medicine, Los Angeles, CA, USA
| | - Sarah S Smithson
- Cedars-Sinai Medical Center, Maternal Fetal Medicine, Los Angeles, CA, USA
| | - Mariam Naqvi
- Cedars-Sinai Medical Center, Maternal Fetal Medicine, Los Angeles, CA, USA
| | - Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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25
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Gregory KD, Chelmow D, Nelson HD, Van Niel MS, Conry JA, Garcia F, Kendig SM, O'Reilly N, Qaseem A, Ramos D, Salganicoff A, Son S, Wood JK, Zahn C. Screening for Anxiety in Adolescent and Adult Women: A Recommendation From the Women's Preventive Services Initiative. Ann Intern Med 2020; 173:48-56. [PMID: 32510990 DOI: 10.7326/m20-0580] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
DESCRIPTION The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient representatives, developed a recommendation on screening for anxiety in adolescent and adult women to improve detection; achieve earlier diagnosis and treatment; and improve health, function, and well-being. The WPSI's recommendations are intended to guide clinical practice and coverage of services for the Health Resources and Services Administration and other stakeholders. The target audience for this recommendation includes all clinicians providing preventive health care to women, particularly in primary care settings. This recommendation applies to women and adolescent girls aged 13 years or older who are not currently diagnosed with anxiety disorders, including pregnant and postpartum women. METHODS The WPSI developed this recommendation after evaluating results of a systematic review of the effectiveness of screening, accuracy of screening instruments, and benefits and harms of treatments in adolescent girls and adult women. No studies directly evaluated the overall effectiveness or harms of screening for anxiety. Twenty-seven screening instruments and their variations were moderately to highly accurate in identifying anxiety (33 individual studies and 2 systematic reviews; 171 studies total). Symptoms improved and relapse rates decreased with psychological therapies (246 randomized controlled trials [RCTs] in 5 systematic reviews) and with selective serotonin reuptake inhibitors or selective serotonin and norepinephrine reuptake inhibitors (126 RCTs in 3 systematic reviews). The WPSI also considered the effect of screening on symptom progression and identification of associated and underlying conditions, as well as implementation factors. RECOMMENDATION The WPSI recommends screening for anxiety in women and adolescent girls aged 13 years or older who are not currently diagnosed with anxiety disorders, including pregnant and postpartum women. Optimal screening intervals are unknown, and clinical judgment should be used to determine frequency. When screening suggests the presence of anxiety, further evaluation is necessary to establish the diagnosis and determine appropriate treatment and follow-up.
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Affiliation(s)
| | - David Chelmow
- Virginia Commonwealth University School of Medicine, Richmond, Virginia (D.C.)
| | - Heidi D Nelson
- Oregon Health & Science University, Portland, Oregon (H.D.N.)
| | | | - Jeanne A Conry
- American College of Obstetricians and Gynecologists, Washington, DC (J.A.C., N.O., S.S., C.Z.)
| | | | - Susan M Kendig
- National Association of Nurse Practitioners in Women's Health, Washington, DC (S.M.K.)
| | - Nancy O'Reilly
- American College of Obstetricians and Gynecologists, Washington, DC (J.A.C., N.O., S.S., C.Z.)
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
| | - Diana Ramos
- California Department of Public Health, Sacramento, California (D.R.)
| | | | - Sarah Son
- American College of Obstetricians and Gynecologists, Washington, DC (J.A.C., N.O., S.S., C.Z.)
| | - Julie K Wood
- American Academy of Family Physicians, Leawood, Kansas (J.K.W.)
| | - Christopher Zahn
- American College of Obstetricians and Gynecologists, Washington, DC (J.A.C., N.O., S.S., C.Z.)
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Rice LW, Espey E, Fenner DE, Gregory KD, Askins J, Lockwood CJ. Universal access to contraception: women, families, and communities benefit. Am J Obstet Gynecol 2020; 222:150.e1-150.e5. [PMID: 31542250 DOI: 10.1016/j.ajog.2019.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/27/2019] [Accepted: 09/12/2019] [Indexed: 11/28/2022]
Abstract
Universal access to contraception benefits society: unintended pregnancies, maternal mortality, preterm birth, abortions, and obesity would be reduced by increasing access to affordable contraception. Women should be able to choose when and whether to use contraception, choose which method to use, and have ready access to their chosen method. State and national government should support unrestricted access to all contraceptives. As obstetrician-gynecologists, we have a critical mandate, based on principle and mission, to step up with leadership on this vital medical and public health issue, to improve the lives of women, their families, and society. The field of Obstetrics and Gynecology must provide the leadership for moving forward. The American Gynecological and Obstetrical Society (AGOS), representing academic and public policy leaders from across all disciplines of Obstetrics and Gynecology, is well positioned to serve as a unifying organization, focused on developing a strong unified advocacy voice to fight for accessible contraception for all in the United States.
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Affiliation(s)
- Laurel W Rice
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI.
| | - Eve Espey
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM
| | - Dee E Fenner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jacquelyn Askins
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI
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Wong MS, Wells M, Gregory KD. 567: Building a better Bishop: using machine learning to develop real-time cesarean delivery predictions. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wong MS, Spiegel BM, Gregory KD. 39: Virtual Reality reduces pain in laboring women: a randomized controlled trial. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
OBJECTIVE To evaluate whether prophylactic antibiotics at the time of placement of an intrauterine balloon tamponade (IBT) is associated with a reduction in postpartum endometritis. STUDY DESIGN Retrospective cohort study of patients who received an IBT from January 1, 2012, to December 12, 2016. Patients were included if the IBT remained in place at least 2 hours and excluded if chorioamnionitis was present. Patients who received prophylactic antibiotics at the time of IBT placement were compared with those who did not. RESULTS A total of 149 subjects received an IBT; 36 were excluded due to early removal or chorioamnionitis. Of the remaining, 59 received prophylactic antibiotics and 54 did not. Baseline characteristics were similar between the groups except mode of delivery. The majority (65%) of those who did not receive prophylactic antibiotics had a cesarean delivery (p = 0.03). The overall incidence of endometritis was 15%. The incidence of endometritis was greater among those patients who did not receive prophylactic antibiotics compared with those who did (5 vs. 26%; p < 0.002; odds ratio [OR]: 6.53; 95% confidence interval [CI]: 1.76-24.25). This association remained after adjustment for mode of delivery and receiving group B Streptococcus antibiotics prior to delivery (adjusted OR: 5.9; 95% CI: 1.58-22.35). CONCLUSION Prophylactic antibiotics were associated with a reduction in postpartum endometritis among patients receiving an IBT.
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Affiliation(s)
- Melissa S Wong
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gabriela Dellapiana
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Naomi Greene
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
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Wong MS, Gregory KD, Almario CV. 755: Economic analysis of Tranexamic Acid: applying the WOMAN trial data to a contemporary US population. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Korst LM, Fridman M, Saeb S, Greene N, Fink A, Gregory KD. The Development of a Conceptual Framework and Preliminary Item Bank for Childbirth-Specific Patient-Reported Outcome Measures. Health Serv Res 2018; 53:3373-3399. [PMID: 29797513 PMCID: PMC6153166 DOI: 10.1111/1475-6773.12856] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To develop a conceptual framework and preliminary item bank for childbirth-specific patient-reported outcome (PRO) domains. DATA SOURCES Women, who were U.S. residents, ≥18 years old, and ≥20 weeks pregnant, were surveyed regarding their childbirth values and preferences (V&P) using online panels. STUDY DESIGN Using community-based research techniques and Patient-Reported Outcomes Management Information System (PROMIS® ) methodology, we conducted a comprehensive literature review to identify self-reported survey items regarding patient-reported V&P and childbirth experiences and outcomes (PROs). The V&P/PRO domains were validated by focus groups. We conducted a cross-sectional observational study and fitted a multivariable logistic regression model to each V&P item to describe "who" wanted each item. PRINCIPAL FINDINGS We identified 5,880 V&P/PRO items that mapped to 19 domains and 58 subdomains. We present results for the 2,250 survey respondents who anticipated a vaginal delivery in a hospital. Wide variation existed regarding each V&P item, and personal characteristics, such as maternal confidence and ability to cope well with pain, were frequent predictors in the models. The resulting preliminary item bank consisted of 60 key personal characteristics and 63 V&P/PROs. CONCLUSIONS The conceptual framework and preliminary (PROMIS® ) item bank presented here provide a foundation for the development of childbirth-specific V&P/PROs.
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Affiliation(s)
| | | | - Samia Saeb
- Department of Obstetrics and GynecologyCedars‐Sinai Medical CenterBurns Allen Research InstituteLos AngelesCA
| | - Naomi Greene
- Department of Obstetrics and GynecologyCedars‐Sinai Medical CenterBurns Allen Research InstituteLos AngelesCA
| | - Arlene Fink
- Division of General Internal Medicine and Department of Health Policy ManagementUniversity of California Los AngelesLos AngelesCA
| | - Kimberly D. Gregory
- Department of Obstetrics and GynecologyCedars‐Sinai Medical CenterBurns Allen Research InstituteLos AngelesCA
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O'Reilly N, Nelson HD, Conry JM, Frost J, Gregory KD, Kendig SM, Phipps M, Salganicoff A, Ramos D, Zahn C, Qaseem A. Screening for Urinary Incontinence in Women: A Recommendation From the Women's Preventive Services Initiative. Ann Intern Med 2018; 169:320-328. [PMID: 30105360 DOI: 10.7326/m18-0595] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION Recommendation on screening for urinary incontinence in women by the Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient representatives. The WPSI's recommendations are intended to guide clinical practice and coverage of services for the Health Resources and Services Administration and other stakeholders. The target audience for this recommendation includes all clinicians providing preventive health care for women, particularly in primary care settings. This recommendation applies to women of all ages, as well as adolescents. METHODS The WPSI developed this recommendation after evaluating evidence regarding the benefits and harms of screening for urinary incontinence in women. The evaluation included a systematic review of the accuracy of screening instruments and the benefits and harms of treatments. Indirect evidence was used to link screening and health outcomes in the chain of evidence that might support screening in the absence of direct evidence. The WPSI also considered the effect of screening on symptom progression and avoidance of costly and complex treatments, as well as implementation factors. RECOMMENDATION The WPSI recommends screening women for urinary incontinence annually. Screening ideally should assess whether women experience urinary incontinence and whether it affects their activities and quality of life. The WPSI recommends referring women for further evaluation and treatment if indicated.
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Affiliation(s)
- Nancy O'Reilly
- American College of Obstetricians and Gynecologists, Washington, DC (N.O., J.M.C., C.Z.)
| | - Heidi D Nelson
- Oregon Health & Science University, Portland, Oregon (H.D.N.)
| | - Jeanne M Conry
- American College of Obstetricians and Gynecologists, Washington, DC (N.O., J.M.C., C.Z.)
| | - Jennifer Frost
- American Academy of Family Physicians, Leawood, Kansas (J.F.)
| | | | - Susan M Kendig
- National Association of Nurse Practitioners in Women's Health, Washington, DC (S.M.K.)
| | - Maureen Phipps
- Women and Infants Hospital of Rhode Island, Providence, Rhode Island (M.P.)
| | | | - Diana Ramos
- California Department of Public Health, Sacramento, California (D.R.)
| | - Christopher Zahn
- American College of Obstetricians and Gynecologists, Washington, DC (N.O., J.M.C., C.Z.)
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
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Howell EA, Brown H, Brumley J, Bryant AS, Caughey AB, Cornell AM, Grant JH, Gregory KD, Gullo SM, Kozhimannil KB, Mhyre JM, Toledo P, D’Oria R, Ngoh M, Grobman WA. Reduction of Peripartum Racial and Ethnic Disparities: A Conceptual Framework and Maternal Safety Consensus Bundle. J Obstet Gynecol Neonatal Nurs 2018; 47:275-289. [DOI: 10.1016/j.jogn.2018.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Howell EA, Brown H, Brumley J, Bryant AS, Caughey AB, Cornell AM, Grant JH, Gregory KD, Gullo SM, Kozhimannil KB, Mhyre JM, Toledo P, D'Oria R, Ngoh M, Grobman WA. Reduction of Peripartum Racial and Ethnic Disparities: A Conceptual Framework and Maternal Safety Consensus Bundle. J Midwifery Womens Health 2018; 63:366-376. [DOI: 10.1111/jmwh.12756] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 11/29/2022]
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Afshar Y, Mei JY, Gregory KD, Kilpatrick SJ, Esakoff TF. Birth plans-Impact on mode of delivery, obstetrical interventions, and birth experience satisfaction: A prospective cohort study. Birth 2018; 45:43-49. [PMID: 29094374 DOI: 10.1111/birt.12320] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine whether the presence of a birth plan was associated with mode of delivery, obstetrical interventions, and patient satisfaction. METHODS This was a prospective cohort study of singleton pregnancies greater than 34 weeks' gestation powered to evaluate a difference in mode of delivery. Maternal characteristics, antenatal factors, neonatal characteristics, and patient satisfaction measures were compared between groups. Differences between groups were analyzed using chi-squared for categorical variables, Fisher exact test for dichotomous variables, and Wilcoxon rank sum test for continuous or ordinal variables. RESULTS Three hundred women were recruited: 143 (48%) had a birth plan. There was no significant difference in the risk of cesarean delivery for women with a birth plan compared with those without a birth plan (21% vs 16%, adjusted odds ratio [adjOR] 1.11 [95% confidence interval (CI) 0.61-2.04]). Women with a birth plan were 28% less likely to receive oxytocin (P < .01), 29% less likely to undergo artificial rupture of membranes (P < .01), and 31% less likely to have an epidural (P < .01). There was no difference in the length of labor (P = .12). Women with a birth plan were less satisfied (P < .01) and felt less in control (P < .01) of their birth experience than those without a birth plan. CONCLUSION Women with and without a birth plan had similar odds of cesarean delivery. Though they had fewer obstetrical interventions, they were less satisfied with their birth experience, compared with women without birth plans. Further research is needed to understand how to improve childbirth-related patient satisfaction.
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Affiliation(s)
- Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
| | - Jenny Y Mei
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
| | - Kimberly D Gregory
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sarah J Kilpatrick
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tania F Esakoff
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Lundsberg LS, Lee HC, Dueñas GV, Gregory KD, Grossetta Nardini HK, Pettker CM, Illuzzi JL, Xu X. Quality Assurance Practices in Obstetric Care: A Survey of Hospitals in California. Obstet Gynecol 2018; 131:214-223. [PMID: 29324608 PMCID: PMC7020098 DOI: 10.1097/aog.0000000000002437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess hospital practices in obstetric quality management activities and identify institutional characteristics associated with utilization of evidence-supported practices. METHODS Data for this study came from a statewide survey of obstetric hospitals in California regarding their organization and delivery of perinatal care. We analyzed responses from 185 hospitals that completed quality assurance sections of the survey to assess their practices in a broad spectrum of quality enhancement activities. The association between institutional characteristics and adoption of evidence-supported practices (ie, those supported by prior literature or recommended by professional organizations as beneficial for improving birth outcome or patient safety) was examined using bivariate analysis and appropriate statistical tests. RESULTS Most hospitals regularly audited adherence to written protocols regarding critical areas of care; however, 77.7% and 16.8% reported not having written guidelines on diagnosis of labor arrest and management of abnormal fetal heart rate, respectively. Private nonprofit hospitals were more likely to have a written protocol for management of abnormal fetal heart rate (P=.002). One in 10 hospitals (9.7%) did not regularly review cases with significant morbidity or mortality, and only 69.0% regularly tracked indications for cesarean delivery. Moreover, 26.3%, 14.3%, and 8.7% of the hospitals reported never performing interprofessional simulations for eclampsia, shoulder dystocia, or postpartum hemorrhage, respectively. Teaching status was associated with more frequent simulations in these three areas (P≤.04 for all), while larger volume was associated with more frequent simulations for eclampsia (P=.04). CONCLUSION Hospitals in California engage in a wide range of practices to assure or improve quality of obstetric care, but substantial variation in practice exists among hospitals. There is opportunity for improvement in adoption of evidence-supported practices.
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Affiliation(s)
- Lisbet S Lundsberg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut; the Department of Pediatrics, Division of Neonatal & Developmental Medicine, Stanford University School of Medicine, Stanford, California; the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California; and Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
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Batra P, Mangione CM, Cheng E, Steers WN, Nguyen TA, Bell D, Kuo AA, Gregory KD. A Cluster Randomized Controlled Trial of the MyFamilyPlan Online Preconception Health Education Tool. Am J Health Promot 2017; 32:897-905. [DOI: 10.1177/0890117117700585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To evaluate whether exposure to MyFamilyPlan—a web-based preconception health education module—changes the proportion of women discussing reproductive health with providers at well-woman visits. Design: Cluster randomized controlled trial. One hundred thirty participants per arm distributed among 34 clusters (physicians) required to detect a 20% change in the primary outcome. Setting: Urban academic medical center (California). Participants: Eligible women were 18 to 45 years old, were English speaking, were nonpregnant, were able to access the Internet, and had an upcoming well-woman visit. E-mail and phone recruitment between September 2015 and May 2016; 292 enrollees randomized. Intervention: Intervention participants completed the MyFamilyPlan module online 7 to 10 days before a scheduled well-woman visit; control participants reviewed standard online preconception health education materials. Measures: The primary outcome was self-reported discussion of reproductive health with the physician at the well-woman visit. Self-reported secondary outcomes were folic acid use, contraceptive method initiation/change, and self-efficacy score. Analysis: Multilevel multivariate logistic regression. Results: After adjusting for covariates and cluster, exposure to MyFamilyPlan was the only variable significantly associated with an increase in the proportion of women discussing reproductive health with providers (odds ratio: 1.97, 95% confidence interval: 1.22-3.19). Prespecified secondary outcomes were unaffected. Conclusion: MyFamilyPlan exposure was associated with a significant increase in the proportion of women who reported discussing reproductive health with providers and may promote preconception health awareness; more work is needed to affect associated behaviors.
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Affiliation(s)
- Priya Batra
- Center for Healthy Communities, School of Medicine, University of California, Riverside, CA, USA
| | - Carol M. Mangione
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Eric Cheng
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - W. Neil Steers
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Tina A. Nguyen
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
| | - Douglas Bell
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Alice A. Kuo
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Internal Medicine, University of California, Los Angeles, CA, USA
- Department of Pediatrics, University of California, Los Angeles, CA, USA
| | - Kimberly D. Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Afshar Y, Wang ET, Mei J, Esakoff TF, Pisarska MD, Gregory KD. Childbirth Education Class and Birth Plans Are Associated with a Vaginal Delivery. Birth 2017; 44:29-34. [PMID: 27859592 DOI: 10.1111/birt.12263] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND To determine whether the mode of delivery was different between women who attended childbirth education (CBE) class, had a birth plan, or both compared with those who did not attend CBE class or have a birth plan. METHODS This is a retrospective cross-sectional study of women who delivered singleton gestations > 24 weeks at our institution between August 2011 and June 2014. Based on a self-report at the time of admission for labor, women were stratified into four categories: those who attended a CBE class, those with a birth plan, both, and those with neither CBE or birth plan. The primary outcome was the mode of delivery. Multivariate logistic regression analyses adjusting for clinical covariates were performed. RESULTS In this study, 14,630 deliveries met the inclusion criteria: 31.9 percent of the women attended CBE class, 12.0 percent had a birth plan, and 8.8 percent had both. Women who attended CBE or had a birth plan were older (p < 0.001), more likely to be nulliparous (p < 0.001), had a lower body mass index (p < 0.001), and were less likely to be African-American (p < 0.001). After adjusting for significant covariates, women who participated in either option or both had higher odds of a vaginal delivery (CBE: OR 1.26 [95% CI 1.15-1.39]; birth plan: OR 1.98 [95% CI 1.56-2.51]; and both: OR 1.69 [95% CI 1.46-1.95]) compared with controls. CONCLUSION Attending CBE class and/or having a birth plan were associated with a vaginal delivery. These findings suggest that patient education and birth preparation may influence the mode of delivery. CBE and birth plans could be used as quality improvement tools to potentially decrease cesarean rates.
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Affiliation(s)
- Yalda Afshar
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Erica T Wang
- Division of Reproductive Endocrinology and Infertility in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jenny Mei
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Tania F Esakoff
- Division of Maternal Fetal Medicine in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Margareta D Pisarska
- Division of Reproductive Endocrinology and Infertility in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kimberly D Gregory
- Division of Maternal Fetal Medicine in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Batra P, Fridman M, Leng M, Gregory KD. 719: California births, 2009-2011: describing high utilizers of postpartum emergency department care. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gregory KD, Greene N, Fridman M, Saeb S, Fink A, Korst L. 168: The black box of hospital culture: what are the hospital characteristics associated with vaginal delivery. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Objective To evaluate whether a subcategory system for category II tracings can improve team communication and perinatal outcomes. Study Design We collected data prospectively for 15 months, first using the NICHD system, followed by the ABC system, which divides category II tracings into subcategories A, B, and C, each representing increased risk for metabolic acidemia. We surveyed providers about communication effectiveness and agreement on tracing interpretation for each system. In cases where the communication system was used to alert an off-site physician about a category II tracing, we compared arrival to L&D and NICU admissions. Results The ABC system was preferred (69%, n = 152) and considered a more effective tool for communicating concerning fetal status (80% vs. 43%, p < 0.01). Participants also reported greater agreement on tracing interpretation (79% for ABC vs. 64% for NICHD, p = 0.046). When an off-site physician was contacted about a category II tracing (n = 95), they were more likely to arrive to L&D (44% vs. 20%, p < 0.01) and have fewer NICU admissions (0% vs. 6%, p < 0.01) with the ABC system. Conclusion The ABC system resulted in improved team communication, increased physician response, and decreased NICU admissions. Using standardized communication may offer a useful strategy for identifying and expediting care.
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Affiliation(s)
- Christina A Penfield
- Department of Obstetrics and Gynecology, University of California Irvine, Orange, California
| | - Connie Hong
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Samia El Haj Ibrahim
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sarah J Kilpatrick
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
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Abstract
BACKGROUND To categorize individual birth plan requests and determine if number of requests and request fulfillment is associated with birth experience satisfaction. METHODS This is a sub-analysis of a prospective cohort study of 302 women with singleton pregnancies with and without birth plans. Women with a hard copy of their birth plans who completed a postdelivery satisfaction survey were included in this study. We described the number and type of birth plan requests and associated the number of requests and request fulfillment with overall satisfaction, expectations met, and sense of control. Differences between groups were analyzed using chi-square, Spearman rank correlation, and logistic regression. RESULTS One hundred and nine women presented to Labor and Delivery with a hard copy of their prewritten birth plan. We identified 23 unique requests. The most common requests were no intravenous analgesia (82%) and exclusive breastfeeding (74%). The requests most fulfilled were avoidance of episiotomy (100%) and no operative vaginal delivery (89%). Having a higher number of requests fulfilled correlated with greater overall satisfaction (p = 0.03), higher chance of expectations being met (p < 0.01), and feeling more in control (p < 0.01). Having a high number of requests was associated with an 80 percent reduction in overall satisfaction with the birth experience (p < 0.01). CONCLUSIONS Having a higher number of requests fulfilled was positively associated with birth experience satisfaction, while having a high number of requests was inversely associated with birth experience satisfaction. Further research is needed to understand how to improve birth plan-related birth experience satisfaction.
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Affiliation(s)
- Jenny Y Mei
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Yalda Afshar
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Korst LM, Fridman M, Estarziau M, Gregory KD, Mitchell C. The Feasibility of Tracking Elective Deliveries Prior to 39 Gestational Weeks: Lessons From Three California Projects. Matern Child Health J 2016; 19:2128-37. [PMID: 25656731 DOI: 10.1007/s10995-015-1725-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The tracking of elective deliveries (ED) prior to 39 gestational weeks has become a mandatory requirement for all hospitals with ≥1,100 deliveries for accreditation by The Joint Commission (TJC); however, the feasibility and accuracy of monitoring efforts remain problematic for many hospitals. Here, we evaluated the feasibility of three operational approaches to tracking ED. We used mixed methods to evaluate the feasibility of 3 different approaches to tracking ED: (1) using administrative data, (2) using electronic medical record (EMR) data, and (3) using targeted data collection in a county-wide quality improvement (QI) effort. For (1), we analyzed data from the California 2009 linked birth cohort dataset, and calculated hospital rates of ED using TJC technical specifications. For (2), we performed a case study of a project that recruited hospitals to provide EMR data for the TJC measure calculation. For (3), we performed a case study of a project that recruited hospitals to prospectively track elective inductions of labor. For (1), hospital discharge data were insufficient without supplementation from the EMR or birth certificate. For (2), legal and operational issues surrounding data sharing, and non-standardized data elements prohibited hospital participation. For (3), the QI approach successfully established policies and data collection systems yet lacked infrastructure to assure sustainability at a hospital or regional level. In summary, ED tracking required the coordination and support of multiple resources to enable hospitals to satisfactorily report on this measure.
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Affiliation(s)
- Lisa M Korst
- Childbirth Research Associates, North Hollywood, CA, USA
| | | | - Melanie Estarziau
- Maternal, Child and Adolescent Health Division, California Department of Public Health, Sacramento, CA, USA
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, David Geffen School of Medicine and Department of Community Health Sciences, School of Public Health, UCLA, Los Angeles, CA, USA.
- Department of Obstetrics and Gynecology, Burns Allen Research Institute, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 160 West Tower, Los Angeles, CA, 90048, USA.
| | - Connie Mitchell
- Office of Health Equity, California Department of Public Health, Sacramento, CA, USA
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Fridman M, Greene NH, Korst LM, Lawton E, Ibrahim SEH, Griffin F, Nicholas L, Gregory KD. Evaluating the effect of maternal health conditions on severe maternal morbidity adjusting for emergent cesarean delivery: A mediation analysis approach. ACTA ACUST UNITED AC 2016. [DOI: 10.5430/jer.v2n2p36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Feldman DS, Bollman DL, Fridman M, Korst LM, El Haj Ibrahim S, Fink A, Gregory KD. Do laborists improve delivery outcomes for laboring women in California community hospitals? Am J Obstet Gynecol 2015; 213:587.e1-587.e13. [PMID: 26026921 DOI: 10.1016/j.ajog.2015.05.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We sought to determine the impact of the laborist staffing model on cesarean rates and maternal morbidity in California community hospitals. STUDY DESIGN This is a cross-sectional study comparing cesarean rates, vaginal birth after cesarean rates, composite maternal morbidity, and severe maternal morbidity for laboring women in California community hospitals with and without laborists. We conducted interviews with nurse managers to obtain data regarding hospital policies, practices, and the presence of laborists, and linked this information with patient-level hospital discharge data for all deliveries in 2012. RESULTS Of 248 childbirth hospitals, 239 (96.4%) participated; 182 community hospitals were studied, and these hospitals provided 221,247 deliveries for analysis. Hospitals with laborists (n = 43, 23.6%) were busier, had more clinical resources, and cared for higher-risk patients. There was no difference in the unadjusted primary cesarean rate for laborist vs nonlaborist hospitals (11.3% vs 11.7%; P = .382) but there was a higher maternal composite morbidity rate (14.4% vs 12.0%; P = .0006). After adjusting for patient and hospital characteristics, there were no differences in laborist vs nonlaborist hospitals for any of the specified outcomes. Hospitals with laborists had higher attempted trial of labor after cesarean rates, and lower repeat cesarean rates (90.9% vs 95.9%; P < .0001). However, among women attempting trial of labor after cesarean, there was no difference in the vaginal birth after cesarean success rate. CONCLUSION We were unable to demonstrate differences in cesarean and maternal childbirth complication rates in community hospitals with and without laborists. Further efforts are needed to understand how the laborist staffing model contributes to neonatal outcomes, cost and efficiency of care, and patient and physician satisfaction.
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Korst LM, Feldman DS, Bollman DL, Fridman M, El Haj Ibrahim S, Fink A, Gregory KD. Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate care. Am J Obstet Gynecol 2015. [PMID: 26196455 DOI: 10.1016/j.ajog.2015.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Measures of maternal mortality and severe maternal morbidity have risen in the United States, sparking national interest regarding hospitals' ability to provide maternal risk-appropriate care. We examined the extent to which hospitals could be classified by increasingly sophisticated maternal levels of care. STUDY DESIGN We performed a cross-sectional survey to identify hospital-specific resources and classify hospitals by criteria for basic, intermediate, and regional maternal levels of care in all nonmilitary childbirth hospitals in California. We measured hospital compliance with maternal level of care criteria that were produced via consensus based on professional standards at 2 regional summits funded by the March of Dimes through a cooperative agreement with the Community Perinatal Network in 2007 (California Perinatal Summit on Risk-Appropriate Care). RESULTS The response rate was 96% (239 of 248 hospitals). Only 82 hospitals (34%) were classifiable under these criteria (35 basic, 42 intermediate, and 5 regional) because most (157 [66%]) did not meet the required set of basic criteria. The unmet criteria preventing assignment into the basic category included the ability to perform a cesarean delivery within 30 minutes 100% of the time (only 64% met), pediatrician availability day and night (only 56% met), and radiology department ultrasound capability within 12 hours (only 83% met). Only 29 of classified hospitals (35%) had a nursery or neonatal intensive care unit level that matched the maternal level of care, and for most remaining hospitals (52 of 53), the neonatal intensive care unit level was higher than the maternal care level. CONCLUSION Childbirth services varied widely across California hospitals, and most hospitals did not fit easily into proposed levels. Cognizance of this existing variation is critical to determining the optimal configuration of services for basic, intermediate, and regional maternal levels of care.
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Affiliation(s)
- Lisa M Korst
- Childbirth Research Associates, North Hollywood, CA
| | - Daniele S Feldman
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, CA
| | | | | | - Samia El Haj Ibrahim
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, CA
| | - Arlene Fink
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Health Policy and Management, Fielding School of Public Health at UCLA, Los Angeles, CA; Langley Research Institute, Pacific Palisades, CA
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, CA; Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Community Health Sciences, Fielding School of Public Health at UCLA, Los Angeles, CA.
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Korst LM, Feldman DS, Bollman DL, Fridman M, El Haj Ibrahim S, Fink A, Wyatt L, Gregory KD. Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals. Am J Obstet Gynecol 2015; 213:523.e1-8. [PMID: 26275353 DOI: 10.1016/j.ajog.2015.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/15/2015] [Accepted: 08/05/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the study was to describe the resources and activities associated with childbirth services. STUDY DESIGN We adapted models for assessing the quality of healthcare to generate a conceptual framework hypothesizing that childbirth hospital resources and activities contributed to maternal and neonatal outcomes. We used this framework to guide development of a survey, which we administered by telephone to hospital labor and delivery nurse managers in California. We describe the findings by hospital type (ie, integrated delivery system [IDS], teaching, and other [community] hospitals). RESULTS Of 248 nonmilitary childbirth hospitals in California, 239 (96%)responded; 187 community, 27 teaching, and 25 IDS hospitals reported. The context of services varied across hospital types, with community hospitals more likely to have for-profit ownership, be in a rural or isolated location, and have fewer annual deliveries per hospital. Results included the findings of the following: (1) 24 hour anesthesia availability in 50% of community vs 100% of IDS and teaching hospitals (P < .001); (2) 24 hour in-house labor and delivery physician coverage in 5% of community vs 100% of IDS and 48% of teaching hospitals (P < .001); (3) 24 hour blood bank availability in 88% of community vs 96% of IDS and 100% of teaching hospitals (P = .092); (4) adult subspecialty intensive care unit availability in 33% of community vs 36% of IDS and 82% of teaching hospitals (P < .001); (5) ability to perform emergency cesarean delivery in 30 minutes 100% of the time in 56% of community vs 100% of IDS and 85% of teaching hospitals (P < .001); (6) pediatric care available both day and night in 54% of community vs 63% of IDS vs 76% of teaching hospitals (P = .087); and (7) no neonatal intensive care unit in 44% of community vs 12% of IDS and 4% of teaching hospitals (P < .001). CONCLUSION Childbirth services varied widely across California hospitals. Cognizance of this variation and linkage of these data to childbirth outcomes should assist in the identification of key resources and activities that optimize the hospital environment for pregnant women and set the groundwork for identifying criteria for the provision of maternal risk-appropriate care.
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Affiliation(s)
- Lisa M Korst
- Childbirth Research Associates, North Hollywood, CA
| | - Daniele S Feldman
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns and Allen Research Institute, Los Angeles, CA
| | | | | | - Samia El Haj Ibrahim
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns and Allen Research Institute, Los Angeles, CA
| | - Arlene Fink
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA; Langley Research Institute, Pacific Palisades, CA
| | - Lacey Wyatt
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns and Allen Research Institute, Los Angeles, CA; Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA; Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA.
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Curtin SC, Gregory KD, Korst LM, Uddin SF. Maternal Morbidity for Vaginal and Cesarean Deliveries, According to Previous Cesarean History: New Data From the Birth Certificate, 2013. Natl Vital Stat Rep 2015; 64:1-13, back cover. [PMID: 26046963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This report presents recent findings for 2013 on four maternal morbidities associated with labor and delivery-maternal transfusion, ruptured uterus, unplanned hysterectomy, and intensive care unit (ICU) admission-that are collected on birth certificates for a 41-state and District of Columbia reporting area, which represents 90% of all births in the United States.
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Feldman DS, Fridman M, Bollman L, Korst L, Ibrahim SEH, Fink A, Gregory KD. Severe Obesity on Labor and Delivery: Variation in Hospital Resources Among California Hospitals. J Patient Cent Res Rev 2015. [DOI: 10.17294/2330-0698.1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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