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Montoya-Williams D, Barreto A, Laguna-Torres A, Worsley D, Wallis K, Peña MM, Palladino L, Salva N, Levine L, Rivera A, Hernandez R, Fuentes-Afflick E, Yun K, Lorch S, Virudachalam S. Philadelphia Latine Immigrant Birthing People's Perspectives on Mitigating the Chilling Effect on Prenatal Care Utilization. Med Care 2024; 62:404-415. [PMID: 38728679 PMCID: PMC11090453 DOI: 10.1097/mlr.0000000000002002] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
RESEARCH DESIGN Community-engaged qualitative study using inductive thematic analysis of semistructured interviews. OBJECTIVE To understand Latine immigrants' recent prenatal care experiences and develop community-informed strategies to mitigate policy-related chilling effects on prenatal care utilization. BACKGROUND Decreased health care utilization among immigrants due to punitive immigration policies (ie, the "chilling effect") has been well-documented among Latine birthing people both pre and postnatally. PATIENTS AND METHODS Currently or recently pregnant immigrant Latine people in greater Philadelphia were recruited from an obstetric clinic, 2 pediatric primary care clinics, and 2 community-based organization client pools. Thematic saturation was achieved with 24 people. Participants' pregnancy narratives and their perspectives on how health care providers and systems could make prenatal care feel safer and more comfortable for immigrants. RESULTS Participants' recommendations for mitigating the chilling effect during the prenatal period included training prenatal health care providers to sensitively initiate discussions about immigrants' rights and reaffirm confidentiality around immigration status. Participants suggested that health care systems should expand sources of information for pregnant immigrants, either by partnering with community organizations to disseminate information or by increasing access to trusted individuals knowledgeable about immigrants' rights to health care. Participants also suggested training non-medical office staff in the use of interpreters. CONCLUSION Immigrant Latine pregnant and birthing people in greater Philadelphia described ongoing fear and confusion regarding the utilization of prenatal care, as well as experiences of discrimination. Participants' suggestions for mitigating immigration-related chilling effects can be translated into potential policy and programmatic interventions which could be implemented locally and evaluated for broader applicability.
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Affiliation(s)
- Diana Montoya-Williams
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- CHOP PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alejandra Barreto
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alicia Laguna-Torres
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diana Worsley
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- CHOP PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kate Wallis
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Developmental-Behavioral Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michelle-Marie Peña
- Department of Pediatrics, Division of Neonatology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Lauren Palladino
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicole Salva
- Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, PA, USA
| | - Lisa Levine
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, PA, USA
| | | | | | - Elena Fuentes-Afflick
- Division of General Pediatrics University of California, San Francisco, San Francisco, CA
| | - Katherine Yun
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott Lorch
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- CHOP PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Senbagam Virudachalam
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Bann CM, Okoniewski KC, Clarke L, Wilson-Costello D, Merhar S, DeMauro S, Lorch S, Ambalavanan N, Peralta-Carcelen M, Limperopoulos C, Poindexter B, Davis JM, Walsh M, Newman J. Psychological distress among postpartum women who took opioids during pregnancy: the role of perceived stigma in healthcare settings. Arch Womens Ment Health 2024; 27:275-283. [PMID: 37955711 PMCID: PMC10933137 DOI: 10.1007/s00737-023-01390-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/24/2023] [Indexed: 11/14/2023]
Abstract
This study examined the relationship between perceived stigma in healthcare settings during pregnancy and psychological distress and well-being in the postpartum period among individuals who took opioids while pregnant. Analyses included 134 birth mothers of opioid-exposed infants. At 0-1 months postpartum, perceived stigma and psychological distress were measured using the Prenatal Opioid use Perceived Stigma scale and measures from the Patient-Reported Outcome Measurement Information System (PROMIS). Food insecurity, housing instability, and Adverse Childhood Experiences (ACEs) were also assessed. Linear and generalized linear mixed-effect models were conducted to compare PROMIS scale scores and unmet needs by stigma, adjusting for site/location, age, race/ethnicity, marital status, education, public insurance, and parity. More than half of participants (54%) perceived stigma in healthcare settings. Individuals reporting stigma had higher depression, anxiety, and anger scores (p < 0.001) indicating greater psychological distress in the postpartum period compared to those reporting no stigma, after controlling for demographic characteristics. In addition, they scored significantly lower on the PROMIS meaning and purpose scale, an indicator of well-being (p = 0.002). Those reporting stigma were more likely to have food insecurity (p = 0.003), three or more ACEs (p = 0.040), verbal or physical abuse during pregnancy (p < 0.001), and less emotional support (p = 0.006) than those who did not. An association was observed between perceived stigma in the prenatal period and psychological distress in the postpartum period, providing support for stigma reduction interventions and education for healthcare providers on trauma-informed care.
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Affiliation(s)
- Carla M Bann
- Analytics Division, RTI International, Research Triangle Park, NC, USA.
| | - Katherine C Okoniewski
- Genomics, Ethics, and Translational Research Center, RTI International, Research Triangle Park, NC, USA
| | - Leslie Clarke
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | | | - Stephanie Merhar
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sara DeMauro
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott Lorch
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - Brenda Poindexter
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Michele Walsh
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Jamie Newman
- Analytics Division, RTI International, Research Triangle Park, NC, USA
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3
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Parlberg LM, Newman JE, Merhar S, Poindexter B, DeMauro S, Lorch S, Peralta-Carcelen M, Wilson-Costello D, Ambalavanan N, Limperopoulos C, Mack N, Davis JM, Walsh M, Bann CM. Risk factors for food insecurity and association with prenatal care utilization among women who took opioids during pregnancy. Res Sq 2024:rs.3.rs-3921909. [PMID: 38585728 PMCID: PMC10996811 DOI: 10.21203/rs.3.rs-3921909/v1] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Background Food insecurity during pregnancy is associated with poorer outcomes for both mothers and their newborns. Given the ongoing opioid crisis in the United States, mothers who take opioids during pregnancy may be at particular risk of experiencing food insecurity. Methods This research utilized data from 254 biological mothers of infants in the Advancing Clinical Trials in Neonatal Opioid Withdrawal Syndrome (ACT NOW) Outcomes of Babies with Opioid Exposure (OBOE) Study. We examined factors associated with food insecurity among mothers of infants with antenatal opioid exposure and their unexposed (control) counterparts. Chi-square tests and logistic regression were used to compare food insecurity by sociodemographic characteristics, opioid use, prior traumatic experiences, and housing instability. Similar analyses were conducted to examine the relationship between food insecurity during pregnancy and receipt of adequate prenatal care. Results Overall, 58 (23%) of the mothers screened positive for food insecurity. Food insecurity was more common among mothers who took opioids during pregnancy (28% vs. 14%; p =0.007), had public insurance (25% vs. 8%; p = 0.027), had housing instability (28% vs. 11%, p = 0.002), experienced three or more adverse experiences in their childhood (37% vs. 17%; p < 0.001), and reported physical or emotional abuse during their pregnancy (44% vs. 17%; p < 0.001). Mothers with food insecurity during pregnancy were less likely to have received adequate prenatal care (78% vs. 90%; p = 0.020). This difference remained after controlling for demographic characteristics (AOR (95% CI) = 0.39 (0.16, 1.00), p = 0.049). Conclusions This study adds to the body of evidence supporting the need for screening and development of interventions to address food insecurity during pregnancy, particularly among mothers of infants with antenatal opioid exposure, for which limited data are available. The findings revealed that food insecurity frequently co-occurs with housing instability and prior trauma, indicating that a multifaceted intervention incorporating principles of trauma-informed health care is needed. Although those with food insecurity are at increased risk for poor pregnancy outcomes, they were less likely to have received adequate prenatal care despite high levels of public insurance coverage among study participants, suggesting additional strategies are needed to address barriers to health care among this population. Trial registration The Outcomes of Babies with Opioid Exposure (OBOE) Study is registered at Clinical Trials.gov (NCT04149509) (04/11/2019).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Michele Walsh
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
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Cusack SV, Gavazzi F, Peixoto de Barcelos I, Modesti NB, Woidill S, Formanowski B, DeMauro SB, Lorch S, Vincent A, Jawad AF, Estilow T, Glanzman AM, Vanderver A, Adang LA. Characterization of Fine Motor and Visual Motor Skills in Aicardi-Goutières Syndrome. J Child Neurol 2024; 39:147-154. [PMID: 38532733 PMCID: PMC11098691 DOI: 10.1177/08830738241241786] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Aicardi-Goutières syndrome is a genetic inflammatory disorder resulting in dispersed neurologic dysfunction. Despite a recognition of overall motor impairment, fine and visual motor skills are undercharacterized. We hypothesize that there is a spectrum of fine and visual motor skills in the Aicardi-Goutières syndrome population as captured by a standard outcome measure, the Peabody Developmental Motor Scales (PDMS-2), which will be proportional to overall disease severity.In a cohort of 74 subjects, the Peabody Developmental Motor Scales-2 grasping and visual-motor integration subtests were administered concurrently with the Aicardi-Goutières syndrome Severity Scale (severe [range 0-3], moderate [range 4-8], and attenuated [range 9-11]). The cohort was also compared by genotype and performance as defined by raw scores. The distribution of Peabody Developmental Motor Scales-2 scores within a genotype was assessed by interquartile ranges (IQRs).Peabody Developmental Motor Scales-2 grasping and visual-motor integration performance was the least variable in the TREX1-cohort (IQR: 10.00-12.00) versus the SAMHD1 and IFIH1 cohorts (IQR: 51.00-132.00 and 48.50-134.00, respectively). Neurologic severity highly correlated with both fine and visual motor skills (Spearman correlation: r = 0.87, 0.91, respectively). A floor effect (lowest 10% of possible scores) was observed within the severe cohort (n = 32/35), whereas a ceiling effect (top 10%) was observed in the attenuated cohort (n = 13/17).This study characterized the spectrum of fine and visual motor function in the Aicardi-Goutières syndrome population, which correlated with overall neurologic dysfunction. The Peabody Developmental Motor Scales-2 grasping and visual-motor integration showed promise as potential assessment tools in moderate and attenuated Aicardi-Goutières syndrome cohorts. A better understanding of fine and visual motor function in this population will benefit clinical care and clinical trial design.
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Affiliation(s)
- Stacy V. Cusack
- Department of Occupational Therapy, Children’s Hospital of Philadelphia
| | - Francesco Gavazzi
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Nicholson B. Modesti
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sarah Woidill
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brielle Formanowski
- Department of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sara B. DeMauro
- Department of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott Lorch
- Department of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ariel Vincent
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abbas F. Jawad
- Division of General Peds, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Timothy Estilow
- Department of Occupational Therapy, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Allan M. Glanzman
- Department of Physical Therapy, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adeline Vanderver
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics , Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Laura A. Adang
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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5
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Leonard SA, Formanowski BL, Phibbs CS, Lorch S, Main EK, Kozhimannil KB, Passarella M, Bateman BT. Chronic Hypertension in Pregnancy and Racial-Ethnic Disparities in Complications. Obstet Gynecol 2023; 142:862-871. [PMID: 37678888 PMCID: PMC10510794 DOI: 10.1097/aog.0000000000005342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 04/14/2023] [Revised: 06/09/2023] [Accepted: 06/15/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To evaluate whether there are individual- and population-level associations between chronic hypertension and pregnancy complications, and to assess differences across seven racial-ethnic groups. METHODS This population-based study used linked vital statistics and hospitalization discharge data from all live and stillbirths in California (2008-2018), Michigan (2008-2020), Oregon (2008-2020), Pennsylvania (2008-2014), and South Carolina (2008-2020). We used multivariable log-binomial regression models to estimate risk ratios (RRs) and population attributable risk (PAR) percentages with 95% CIs for associations between chronic hypertension and several obstetric and neonatal outcomes, selected based on prior evidence and pathologic pathways. We adjusted models for demographic factors (race and ethnicity, payment method, educational attainment), age, body mass index, obstetric history, delivery year, and state, and conducted analyses stratified across seven racial-ethnic groups. RESULTS The study included 7,955,713 pregnancies, of which 168,972 (2.1%) were complicated by chronic hypertension. Chronic hypertension was associated with several adverse obstetric and neonatal outcomes, with the largest adjusted PAR percentages observed for preeclampsia with severe features or eclampsia (22.4; 95% CI 22.2-22.6), acute renal failure (13.6; 95% CI 12.6-14.6), and pulmonary edema (10.7; 95% CI 8.9-12.6). Estimated RRs overall were similar across racial-ethnic groups, but PAR percentages varied. The adjusted PAR percentages (95% CI) for severe maternal morbidity-a widely used composite of acute severe events-for people who were American Indian or Alaska Native, Asian, Black, Latino, Native Hawaiian or Other Pacific Islander, White, and Multiracial or Other were 5.0 (1.1-8.8), 3.7 (3.0-4.3), 9.0 (8.2-9.8), 3.9 (3.6-4.3), 11.6 (6.4-16.5), 3.2 (2.9-3.5), and 5.5 (4.2-6.9), respectively. CONCLUSION Chronic hypertension accounts for a substantial fraction of obstetric and neonatal morbidity and contributes to higher complication rates, particularly for people who are Black or Native Hawaiian or Other Pacific Islander.
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Affiliation(s)
- Stephanie A Leonard
- Department of Obstetrics and Gynecology, the Department of Pediatrics, and the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, and the Health Economics Resource Center, Veterans Affairs Palo Alto Healthcare System, Menlo Park, California; the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and the Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota
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6
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Bann CM, Newman JE, Okoniewski KC, Clarke L, Wilson-Costello D, Merhar S, Mack N, DeMauro S, Lorch S, Ambalavanan N, Limperopoulos C, Poindexter B, Walsh M, Davis JM. Psychometric Properties of the Prenatal Opioid Use Perceived Stigma Scale and Its Use in Prenatal Care. J Obstet Gynecol Neonatal Nurs 2023; 52:150-158. [PMID: 36696952 PMCID: PMC9992302 DOI: 10.1016/j.jogn.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To examine the psychometric properties of the Prenatal Opioid Use Perceived Stigma (POPS) scale and to assess the relationship of POPS scores to adequate prenatal care. DESIGN Prospective cohort study. SETTING Medical centers in Alabama, Ohio, and Pennsylvania (N = 4). PARTICIPANTS Women (N = 127) who took opioids during pregnancy and whose infants participated in the Outcomes of Babies With Opioid Exposure Study. METHODS Participants reported their perceptions of stigma during pregnancy by responding to the eight items on the POPS scale. We evaluated the instrument's internal consistency reliability (Cronbach's alpha), structural validity (factor analysis), and convergent validity (relationship with measures of similar constructs). In addition, to assess construct validity, we used logistic regression to examine the relationship of POPS scores to the receipt of adequate prenatal care. RESULTS The internal consistency of the POPS scale was high (Cronbach's α = .88), and all item-total correlations were greater than 0.50. The factor analysis confirmed that the items cluster into one factor. Participants who reported greater perceived stigma toward substance users and everyday discrimination in medical settings had higher POPS scores, which supported the convergent validity of the scale. POPS scores were significantly associated with not receiving adequate prenatal care, adjusted OR = 1.47, 95% confidence interval [1.19, 1.83], p < .001. CONCLUSION The psychometric testing of the POPS scale provided initial support for the reliability and validity of the instrument. It may be a useful tool with which to assess perceived stigma among women who take opioids, a potential barrier to seeking health care during pregnancy.
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Clark RRS, French R, Lorch S, O'Rourke K, Rosenbaum KEF, Lake ET. Within-Hospital Concordance of Opioid Exposure Diagnosis Coding in Mothers and Newborns. Hosp Pediatr 2021; 11:825-833. [PMID: 34230061 DOI: 10.1542/hpeds.2020-003863] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES We measured within-hospital concordance of mothers with opioid use disorder (OUD) and newborns with neonatal abstinence syndrome (NAS) or opioid exposure (OE). Secondarily, we described the demographics of mothers and newborns with and without opioid-related diagnoses. METHODS We used hospital discharge abstracts from California, Florida, New Jersey, and Pennsylvania in 2016. Descriptive statistics were used to compare newborns and mothers with and without opioid-related diagnoses. Within-hospital frequencies of mothers with OUD and newborns with NAS and OE were compared. Pearson's correlation coefficients were calculated. RESULTS In 474 hospitals, we found 896 702 mothers (0.6% with OUD) and 910 867 newborns (0.47% with NAS, 0.85% with OE, and 0.07% with both). Although the frequency of mothers and newborns with opioid-related diagnoses in a hospital was strongly correlated (r = 0.81), more infants were identified than mothers in most hospitals (68.3%). Mothers with OUD were more likely to be white (79% vs 40.9%), on Medicaid (75.4% vs 44.0%), and receive care in rural hospitals (20.6% vs 17.6%), compared with mothers without OUD. Newborns with NAS had demographics similar to women with OUD. Newborns with OE were disproportionately Black (22% vs 7%) or Hispanic (22% vs 9%). CONCLUSIONS More newborns are diagnosed with opioid-related disorders than mothers are. Although infants diagnosed with NAS had demographics similar to mothers with OUD, infants with OE were more likely to be Black or Hispanic. The lack of diagnostic coding of maternal OUD and the racial differences in diagnoses warrant attention.
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Affiliation(s)
- Rebecca R S Clark
- Center for Health Outcomes and Policy Research, School of Nursing .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel French
- Center for Health Outcomes and Policy Research, School of Nursing.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott Lorch
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kathleen O'Rourke
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathleen E Fitzpatrick Rosenbaum
- Center for Health Outcomes and Policy Research, School of Nursing.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eileen T Lake
- Center for Health Outcomes and Policy Research, School of Nursing.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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8
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Nelin TD, Lorch S, Jensen EA, Alexiou S, Gibbs K, Napolitano N, Monk HM, Furth S, Shults J, Bamat NA. The association between diuretic class exposures and enteral electrolyte use in infants developing grade 2 or 3 bronchopulmonary dysplasia in United States children's hospitals. J Perinatol 2021; 41:779-785. [PMID: 33510422 DOI: 10.1038/s41372-021-00924-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 05/29/2020] [Revised: 11/04/2020] [Accepted: 01/14/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the association between chronic diuretic exposures and enteral electrolyte use in infants developing severe bronchopulmonary dysplasia (sBPD). STUDY DESIGN Retrospective longitudinal cohort study in infants admitted to United States children's hospitals. We identified diuretic exposures and measured enteral NaCl and KCl use during pre-defined exposure risk-interval days. We used mixed-effects logistic regression to model the association between diuretic exposures and electrolyte use. RESULTS We identified 442,341 subject-days in 3252 infants. All common diuretic classes and class combinations were associated with increased NaCl and KCl use. Thiazide monotherapy was associated with greater electrolyte use than loop monotherapy. The addition of potassium-sparing diuretics was associated with a limited reduction in KCl use compared to thiazide monotherapy. CONCLUSIONS Chronic diuretic exposures are associated with increased NaCl and KCl use. Presumptions about the relative impact of different diuretic classes on electrolyte derangements may be inaccurate and require further study.
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Affiliation(s)
- Timothy D Nelin
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Scott Lorch
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erik A Jensen
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Chronic Lung Disease Program, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stamatia Alexiou
- Chronic Lung Disease Program, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kathleen Gibbs
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Chronic Lung Disease Program, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Natalie Napolitano
- Chronic Lung Disease Program, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Respiratory Therapy Department, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Heather M Monk
- Pharmacy Services, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan Furth
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Justine Shults
- Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nicolas A Bamat
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Chronic Lung Disease Program, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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9
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Lake ET, French R, Clark RRS, O'Rourke K, Lorch S. Newborns With Neonatal Abstinence Syndrome Are Concentrated in Poorer-Quality Hospitals. Hosp Pediatr 2021; 11:342-349. [PMID: 33737332 DOI: 10.1542/hpeds.2020-003145] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine the extent to which newborns with neonatal abstinence syndrome (NAS) are concentrated in some hospitals as compared with newborns without NAS and whether care quality and safety differed among these hospitals. We hypothesized that newborns with NAS would be cared for in poorer-quality hospitals. METHODS Secondary analysis of 3 2016 data sets: (1) the panel study of effects of changes in nursing on patient outcomes-US survey of hospital registered nurses regarding work conditions and safety, (2) inpatient discharge abstracts, and (3) the American Hospital Association annual survey. Newborns in 266 hospitals from the 4 states where the panel study of effects of changes in nursing on patient outcomes was conducted were included. We used Lorenz curves to determine if newborns with NAS were concentrated in different hospitals than newborns without NAS and whether care quality and safety differed among those hospitals. Quality and safety were assessed by staff nurses by using standard survey questions. RESULTS Of the 659 403 newborns in this study, 3130 were diagnosed with noniatrogenic NAS. We found that newborns with NAS were cared for in different hospitals compared with newborns without NAS (Gini coefficient 0.62, 95% confidence interval, 0.56-0.68) and that the hospitals in which they received care were rated as having poorer quality and safety (Gini coefficient 0.12, 95% confidence interval, 0.01-0.23). CONCLUSIONS Newborns with NAS are cared for in poorer-quality hospitals than other newborns. Our findings are of concern because poorer-quality care is linked to patient outcomes. As stakeholders seek to address the opioid epidemic and improve outcomes of newborns with NAS, our findings suggest the importance of examining hospital factors.
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Affiliation(s)
- Eileen T Lake
- Center for Health Outcomes and Policy Research, School of Nursing and .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel French
- Center for Health Outcomes and Policy Research, School of Nursing and.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca R S Clark
- Center for Health Outcomes and Policy Research, School of Nursing and.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathleen O'Rourke
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Scott Lorch
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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10
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Fierro J, Piccione J, Lorch S. Clinical Factors Influencing Time to Decannulation in Children with Tracheostomy and Ventilator Dependence Secondary to Bronchopulmonary Dysplasia. J Pediatr 2021; 228:31-35. [PMID: 32861694 DOI: 10.1016/j.jpeds.2020.08.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/02/2020] [Revised: 07/17/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether demographic or clinical factors affected the time to tracheostomy decannulation for patients with severe bronchopulmonary dysplasia (BPD). STUDY DESIGN We retrospectively abstracted information from the electronic medical record for 93 patients with BPD or chronic lung disease of prematurity with tracheostomy and ventilator dependence cared for in our Pulmonary Clinic between January 1, 2006, and December 31, 2015. Univariable and multivariable models controlling for sex, race, ethnicity, and gestational age assessed the impact of cohort demographics, comorbid medical conditions, and physician factors on time to decannulation. RESULTS The mean age of the 66 patients who were decannulated was 3.3 ± 1.12 years. Having a chronic neurologic condition was associated with a prolonged time to tracheostomy decannulation (hazard ratio, 0.3; 95% CI, 0.1-0.9), particularly if the patient was not decannulated by 3 years of age. Individuals who had only pulmonary hypertension, required airway reconstruction, or had none of the identified risk factors had similar rates of tracheostomy decannulation. Race, ethnicity, and provider clinical volume were not significantly associated with time to decannulation. CONCLUSIONS A chronic neurologic condition was the sole factor significantly associated with time to tracheostomy decannulation in our patients with severe BPD. Further work to understand the driving factors for this association will allow clinicians to provide families with more informed guidance as they navigate the complex process of long-term mechanical ventilation.
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Affiliation(s)
- Julie Fierro
- Division of Pulmonology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Joseph Piccione
- Division of Pulmonology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Scott Lorch
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Perinatal and Pediatric Health Disparities Research, The Children's Hospital of Philadelphia, Philadelphia, PA; Leonard Davis Institute of Health Economics, The Wharton School, The University of Pennsylvania, Philadelphia, PA
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11
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Campbell MJ, Lorch S, Rychik J, Quartermain MD, Passarella M, Groeneveld PW. Socioeconomic barriers to prenatal diagnosis of critical congenital heart disease. Prenat Diagn 2020; 41:341-346. [PMID: 33169368 DOI: 10.1002/pd.5864] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The study was designed to assess the impact of socioeconomic barriers on the rate of prenatal diagnosis of critical congenital heart disease (CCHD). METHODS This was a retrospective review of the Medicaid analytic extract (MAX) dataset, a national Medicaid administrative claims database with linked maternal-infant claims, from 2007 to 2012. Infants with CCHD were identified by searching for International Classification of Diseases (ICD) 9 codes and Procedural Coding System (PCS) codes for CCHD within the first 6 months after the delivery date. Multivariate logistic regression was used to evaluate the effect of maternal and socioeconomic factors on the prenatal diagnosis rate. RESULTS There were 4702 mother-infant dyads included in the analysis. The prenatal diagnosis rate of CCHD was 27.9%. Factors independently associated with odds of prenatal diagnosis of CCHD were presence of maternal diabetes (OR, 2.055; P < .001), ZIP code level median household income (OR, 1.005; P = .015), sonographer labor quotient (OR, 1.804; P = .047), the year of the delivery (OR, 1.155; P < .001), and needing a view other than a 4 chamber or outflow tract view to obtain the diagnosis (OR, 0.383; P < .001). CONCLUSION Maternal health, diabetes, socioeconomic factors, and access to sonographers impacts prenatal diagnosis of CCHD.
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Affiliation(s)
- Matthew J Campbell
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Scott Lorch
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jack Rychik
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael D Quartermain
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Molly Passarella
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter W Groeneveld
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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12
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Guttmann K, Patterson C, Haines T, Hoffman C, Masten M, Lorch S, Chuo J. Parent Stress in Relation to Use of Bedside Telehealth, an Initiative to Improve Family-Centeredness of Care in the Neonatal Intensive Care Unit. J Patient Exp 2020; 7:1378-1383. [PMID: 33457590 PMCID: PMC7786780 DOI: 10.1177/2374373520950927] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Since the onset of the COVID-19 pandemic, telehealth technologies have become critical to providing family and patient-centered care. Little is known about the impact of these technologies on parent stress levels in the Neonatal Intensive Care Unit (NICU). We sought to determine the impact of bedside web cameras on stress levels of parents in the NICU in order to work toward interventions that might improve family-centered care. A validated survey, the Parental Stress Scale NICU, was administered to parents of babies admitted to the Children’s Hospital of Philadelphia Neonatal/Infant Intensive Care Unit on days 7 to 10 of hospitalization. Parents were also asked if they used the available AngelEye Camera while their baby was hospitalized. Stress levels were analyzed for associations with the use of the bedside cameras. Parents who reported using the bedside camera also reported lower levels of stress relating to being separated from their babies. Bedside web camera interventions may hold potential for reducing parent stress related to separation from their babies, especially in the setting of a global pandemic.
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Affiliation(s)
- Katherine Guttmann
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chavis Patterson
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Tracey Haines
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Casey Hoffman
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Marjorie Masten
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Scott Lorch
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John Chuo
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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13
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Phibbs C, Lorch S, Schmitt S, Main E, Kozhimannil K, Leonard S, Phibbs C. Racial/Ethnic Disparities in Costs, Length of Stay, and Severity of Severe Maternal Morbidity. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13537] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- C. Phibbs
- Loyola Marymount University Los Angeles CA United States
| | - S. Lorch
- Leonard Davis Institute of Health Economics Philadelphia PA United States
| | - S. Schmitt
- Stanford University Palo Alto CA United States
| | - E. Main
- California Maternal Quality Care Collaborative Stanford University School of Medicine Stanford CA United States
| | - K. Kozhimannil
- Department of Health Policy & Management School of Public Health University of Minnesota Minneapolis MN United States
| | - S. Leonard
- Stanford University School of Medicine Stanford CA United States
| | - C. Phibbs
- Stanford University & Palo Alto VA Menlo Park CA United States
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14
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Phibbs C, Leonard S, Kozhimannil K, Main E, Phibbs C, Schmitt S, Lorch S. Expanding the Estimate of the Costs of Severe Maternal Morbidity to Include Readmissions, Physician Fees, and Infant Costs. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13536] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- C. Phibbs
- Stanford University & Palo Alto VA Menlo Park CA United States
| | - S. Leonard
- Stanford University School of Medicine Stanford CA United States
| | - K. Kozhimannil
- Department of Health Policy & Management School of Public Health University of Minnesota Minneapolis MN United States
| | - E. Main
- California Maternal Quality Care Collaborative Stanford University School of Medicine Stanford CA United States
| | - C. Phibbs
- Loyola Marymount University Los Angeles CA United States
| | - S. Schmitt
- Stanford University Palo Alto CA United States
| | - S. Lorch
- Leonard Davis Institute of Health Economics Philadelphia PA United States
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15
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Abstract
BACKGROUND Intraventricular hemorrhage (IVH) disproportionately affects black neonates. Other conditions that are more common in black neonates, including low birth weight and preterm delivery, have been linked with residential racial segregation (RRS). In this study, we investigated the association between RRS and IVH. METHODS A retrospective cohort of neonates born between 24 and 32 weeks' gestation was constructed by using birth certificates linked to medical records from California, Missouri, and Pennsylvania between 1995 and 2009. Dissimilarity, a measure of RRS indicating the proportion of minorities in the census tract of the mother in comparison to the larger metropolitan area, was linked to patient data, yielding a cohort of 70 775 infants. Propensity score analysis matched infants born to mothers living in high segregation to those living in less segregated areas on the basis of race, sociodemographic factors, and medical comorbidities to compare the risk of developing IVH. RESULTS Infants born to mothers in the most segregated quartile had a greater risk of developing IVH compared with those in the lowest quartile (12.9% vs 10.4%; P < .001). In 17 918 pairs matched on propensity scores, the risk of developing IVH was greater in the group exposed to a segregated environment (risk ratio = 1.08, 95% confidence interval: 1.01-1.15). This effect was stronger for black infants alone (risk ratio = 1.16; 95% confidence interval: 1.03-1.30). CONCLUSIONS RRS is associated with an increased risk of IVH in preterm neonates, but the effect size varies by race. This association persists after balancing for community factors and birth weight, representing a novel risk factor for IVH.
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Affiliation(s)
- Daria Murosko
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; and
| | - Molly Passerella
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott Lorch
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania
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16
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Herrick HM, Lorch S, Hsu JY, Catchpole K, Foglia EE. Impact of flow disruptions in the delivery room. Resuscitation 2020; 150:29-35. [PMID: 32194162 PMCID: PMC7205586 DOI: 10.1016/j.resuscitation.2020.02.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/04/2019] [Revised: 02/20/2020] [Accepted: 02/26/2020] [Indexed: 11/21/2022]
Abstract
AIM Flow disruptions (FDs) are deviations from the progression of care that compromise safety and efficiency of a specific process. The study aim was to identify the impact of FDs during neonatal resuscitation and determine their association with key process and outcome measures. METHODS Prospective observational study of video recorded delivery room resuscitations of neonates <32 weeks gestational age. FDs were classified using an adaptation of Wiegmann's FD tool. The primary outcome was target oxygenation saturation achievement at 5 min. Secondary outcomes included achieving target saturation at 10 min, time to positive pressure ventilation for initially apnoeic/bradycardic neonates, time to electrocardiogram signal, time to pulse oximetry signal, and time to stable airway. Multivariable logistic regression assessed association between FDs and achieving target saturations adjusting for gestational age and leader. Associations between FDs and time to event outcomes were assessed using Cox proportional hazards models. RESULTS Between 10/2017-7/2018, 32 videos were included. A mean of 52.6 FDs (standard deviation 17.9) occurred per resuscitation. Extraneous FDs were the most common FDs. FDs were associated with an adjusted odds ratio of 0.92 (95% confidence interval [CI] 0.80-1.05) of achieving target saturation at 5 min and 0.94 (95% CI 0.84-1.05) at 10 min. There was no significant evidence to show FDs were associated with time to event outcomes. CONCLUSIONS FDs occurred frequently during neonatal resuscitation. Measuring FDs is a feasible method to assess the impact of human factors in the delivery room and identify modifiable factors and practices to improve patient care.
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Affiliation(s)
- Heidi M Herrick
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Division of Neonatology, 2(nd) Floor, Main Building, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Scott Lorch
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Division of Neonatology, 2(nd) Floor, Main Building, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Jesse Y Hsu
- Department of Biostatistics, Epidemiology, and Informatics at The University of Pennsylvania Perelman School of Medicine, 629 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA.
| | - Kenneth Catchpole
- Department of Anesthesia and Perioperative Medicine & College of Nursing at The Medical University of South Carolina, Storm Eye Building, 167 Ashley Avenue, Suite 301, MSC 912, Charleston, SC 29425-9120, USA.
| | - Elizabeth E Foglia
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Division of Neonatology, 2(nd) Floor, Main Building, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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17
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Goyal MK, Johnson TJ, Chamberlain JM, Cook L, Webb M, Drendel AL, Alessandrini E, Bajaj L, Lorch S, Grundmeier RW, Alpern ER. Racial and Ethnic Differences in Emergency Department Pain Management of Children With Fractures. Pediatrics 2020; 145:peds.2019-3370. [PMID: 32312910 PMCID: PMC7193974 DOI: 10.1542/peds.2019-3370] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [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] [Accepted: 12/26/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To test the hypotheses that minority children with long-bone fractures are less likely to (1) receive analgesics, (2) receive opioid analgesics, and (3) achieve pain reduction. METHODS We performed a 3-year retrospective cross-sectional study of children <18 years old with long-bone fractures using the Pediatric Emergency Care Applied Research Network Registry (7 emergency departments). We performed bivariable and multivariable logistic regression to measure the association between patient race and ethnicity and (1) any analgesic, (2) opioid analgesic, (3) ≥2-point pain score reduction, and (4) optimal pain reduction (ie, to mild or no pain). RESULTS In 21 069 visits with moderate-to-severe pain, 86.1% received an analgesic and 45.4% received opioids. Of 8533 patients with reassessment of pain, 89.2% experienced ≥2-point reduction in pain score and 62.2% experienced optimal pain reduction. In multivariable analyses, minority children, compared with non-Hispanic (NH) white children, were more likely to receive any analgesics (NH African American: adjusted odds ratio [aOR] 1.72 [95% confidence interval 1.51-1.95]; Hispanic: 1.32 [1.16-1.51]) and achieve ≥2-point reduction in pain (NH African American: 1.42 [1.14-1.76]; Hispanic: 1.38 [1.04-1.83]) but were less likely to receive opioids (NH African American: aOR 0.86 [0.77-0.95]; Hispanic: aOR 0.86 [0.76-0.96]) or achieve optimal pain reduction (NH African American: aOR 0.78 [0.67-0.90]; Hispanic: aOR 0.80 [0.67-0.95]). CONCLUSIONS There are differences in process and outcome measures by race and ethnicity in the emergency department management of pain among children with long-bone fractures. Although minority children are more likely to receive analgesics and achieve ≥2-point reduction in pain, they are less likely to receive opioids and achieve optimal pain reduction.
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Affiliation(s)
- Monika K. Goyal
- Division of Emergency Medicine and Trauma Services, Department of Pediatrics, Children’s National Health System and The George Washington University, Washington, District of Columbia
| | - Tiffani J. Johnson
- Department of Pediatrics, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - James M. Chamberlain
- Division of Emergency Medicine and Trauma Services, Department of Pediatrics, Children’s National Health System and The George Washington University, Washington, District of Columbia
| | - Lawrence Cook
- Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, Utah
| | - Michael Webb
- Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, Utah
| | - Amy L. Drendel
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Evaline Alessandrini
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Lalit Bajaj
- Department of Pediatrics, School of Medicine, University of Colorado and Children’s Hospital Colorado, Aurora, Colorado; and
| | - Scott Lorch
- Department of Pediatrics, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert W. Grundmeier
- Department of Pediatrics, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth R. Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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18
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Campbell M, Lorch S, Rychik J, Quartermain MD, Groeneveld P. SOCIOECONOMIC BARRIERS TO PRENATAL DIAGNOSIS OF CRITICAL CONGENITAL HEART DISEASE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31186-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Mukhopadhyay S, Dhudasia M, Quarshie W, Bryan M, Grundmeier R, Jeffery G, Lorch S, Theoklis Z, Spergel J, Puopolo K. Maternal Intrapartum Group B Streptococcal Prophylaxis and Childhood Atopic Disorders. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.823] [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: 10/24/2022]
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20
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Montoya-Williams D, Bright M, Martinez S, Echavarria M, Mercado R, Lorch S, Thompson L. Associations Between a Healthy Start Program Prenatal Risk Screening Tool and Adverse Birth Outcomes: A Study Using the Mother/Infant Dyad Screening Cohort. J Womens Health (Larchmt) 2020; 29:647-655. [PMID: 31895651 DOI: 10.1089/jwh.2019.7712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/12/2022] Open
Abstract
Background: Florida's Healthy Start Program is a statewide prenatal screening program that aims to identify pregnant women at risk of adverse birth outcomes. However, the effectiveness of this legislatively mandated prenatal risk screening tool in predicting poor birth outcomes is unknown. This study aimed to evaluate associations between risk factors self-reported on this screening tool and adverse birth outcomes. Materials and Methods: A 1-year retrospective birth cohort at a large academic referral center was created. Risk factors reported on the tool by mothers who had a preterm or low-birthweight (LBW) infant were compared with those reported by mothers who delivered full-term non-LBW infants in bivariate and multivariate analyses. All data were extracted from maternal or infant electronic health records. Results: The Mother/Infant Dyad Screening cohort consisted of 528 dyads. We identified two items on the screening tool that significantly associated with adverse birth outcomes, but which do not currently contribute to the total risk score used to identify women for referral to preventive social services. These items were feeling alone and thinking it was not a good time to be pregnant. Conclusions: Comprehensive prenatal risk screening is an underutilized strategy in medicine. Florida's mandatory self-reported, prenatal survey can identify women at risk for poor neonatal outcomes. A more nuanced understanding how women are interpreting survey items and a re-evaluation of scoring practices may allow the tool to better serve as a model for other programs seeking to identify pregnant women at risk of poor birth outcomes.
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Affiliation(s)
- Diana Montoya-Williams
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melissa Bright
- Anita Zucker Center for Excellence in Early Childhood Studies, Gainesville, Florida
| | - Silvio Martinez
- College of Medicine, University of Florida, Gainesville, Florida
| | - Maria Echavarria
- Department of Pediatrics and University of Florida, Gainesville, Florida
| | - Rebeccah Mercado
- Department of Pediatrics and University of Florida, Gainesville, Florida
| | - Scott Lorch
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lindsay Thompson
- Department of Pediatrics and University of Florida, Gainesville, Florida.,Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
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21
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Boland MR, Kashyap A, Xiong J, Holmes J, Lorch S. Development and validation of the PEPPER framework (Prenatal Exposure PubMed ParsER) with applications to food additives. J Am Med Inform Assoc 2019; 25:1432-1443. [PMID: 30371821 PMCID: PMC6213088 DOI: 10.1093/jamia/ocy119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/13/2018] [Indexed: 11/14/2022] Open
Abstract
Background Globally, 36% of deaths among children can be attributed to environmental factors. However, no comprehensive list of environmental exposures exists. We seek to address this gap by developing a literature-mining algorithm to catalog prenatal environmental exposures. Methods We designed a framework called. PEPPER Prenatal Exposure PubMed ParsER to a) catalog prenatal exposures studied in the literature and b) identify study type. Using PubMed Central, PEPPER classifies article type (methodology, systematic review) and catalogs prenatal exposures. We coupled PEPPER with the FDA's food additive database to form a master set of exposures. Results We found that of 31 764 prenatal exposure studies only 53.0% were methodology studies. PEPPER consists of 219 prenatal exposures, including a common set of 43 exposures. PEPPER captured prenatal exposures from 56.4% of methodology studies (9492/16 832 studies). Two raters independently reviewed 50 randomly selected articles and annotated presence of exposures and study methodology type. Error rates for PEPPER's exposure assignment ranged from 0.56% to 1.30% depending on the rater. Evaluation of the study type assignment showed agreement ranging from 96% to 100% (kappa = 0.909, p < .001). Using a gold-standard set of relevant prenatal exposure studies, PEPPER achieved a recall of 94.4%. Conclusions Using curated exposures and food additives; PEPPER provides the first comprehensive list of 219 prenatal exposures studied in methodology papers. On average, 1.45 exposures were investigated per study. PEPPER successfully distinguished article type for all prenatal studies allowing literature gaps to be easily identified.
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Affiliation(s)
- Mary Regina Boland
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, USA.,Center for Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aditya Kashyap
- Data Science Masters Program, University of Pennsylvania, Philadelphia, PA, USA
| | - Jiadi Xiong
- Data Science Masters Program, University of Pennsylvania, Philadelphia, PA, USA
| | - John Holmes
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Scott Lorch
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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22
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Myers S, Lorch S, Passarella M, Carr B. 186 Pediatric Readiness of Hospitals Initially Caring for Severely Ill or Injured Children. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.192] [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: 11/25/2022]
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23
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Burris H, Lorch S, Kirpalani H, Pursley DM, Elovitz MA, Clougherty JE. Racial disparities in preterm birth in USA: a biosensor of physical and social environmental exposures. Arch Dis Child 2019; 104:931-935. [PMID: 30850379 PMCID: PMC6732250 DOI: 10.1136/archdischild-2018-316486] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [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: 01/10/2019] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 01/16/2023]
Abstract
Race is a social construct that involves a person’s self-assigned, and externally-perceived, group membership. Group membership can determine much about Americans’ lives and health. Complex health disorders such as cardiovascular disease, asthma, and obesity disproportionately affect Non-Hispanic black Americans. An individual’s risk of any of these disorders encompasses both genetic predisposition and environmental stimuli. We propose that environmental stressors may be large contributors to differences in preterm birth rates in the United States between racial groups. Environmental exposures differ by race due to ongoing residential, educational and economic racial segregation as well as discrimination. Characterizing and mitigating environmental factors that contribute to differential preterm risk could identify women at risk, prevent some preterm births, and reduce perinatal health disparities.
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Affiliation(s)
- Heather Burris
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania;,Corresponding Author: Heather H. Burris, Center for Research on Reproduction and Women’s Health, Biomedical Research Building II/III, Room 1352, 421 Curie Blvd., Philadelphia, PA, 19104-6160, (215) 573-4916 (phone), (215) 573-5408 (fax),
| | - Scott Lorch
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Haresh Kirpalani
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - DeWayne M. Pursley
- Department of Neonatology, Beth Israel Deaconess Medical Center, Department of Pediatrics at Harvard Medical School
| | - Michal A. Elovitz
- Department of Obstetrics and Gynecology, Maternal Child Health Research Center, Perelman School of Medicine, University of Pennsylvania
| | - Jane E. Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University
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Kennedy EH, Lorch S, Small DS. Robust causal inference with continuous instruments using the local instrumental variable curve. J R Stat Soc Series B Stat Methodol 2018. [DOI: 10.1111/rssb.12300] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Scott Lorch
- University of Pennsylvania; Philadelphia USA
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Heer K, Behringer D, Piermattei A, Bässler C, Brandl R, Fady B, Jehl H, Liepelt S, Lorch S, Piotti A, Vendramin G, Weller M, Ziegenhagen B, Büntgen U, Opgenoorth L. Linking dendroecology and association genetics in natural populations: Stress responses archived in tree rings associate with SNP genotypes in silver fir (Abies albaMill.). Mol Ecol 2018; 27:1428-1438. [DOI: 10.1111/mec.14538] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/08/2018] [Indexed: 01/07/2023]
Affiliation(s)
- K. Heer
- Faculty of Biology, Conservation Biology; Philipps-University Marburg; Marburg Germany
- Department of Ecology; Faculty of Biology; Philipps-University Marburg; Marburg Germany
| | - D. Behringer
- Faculty of Biology, Conservation Biology; Philipps-University Marburg; Marburg Germany
| | - A. Piermattei
- Department of Geography; University of Cambridge; Cambridge UK
- Department of Agricultural, Food and Environmental Sciences; Marche Polytechnic University; Ancona Italy
- Dendro Science; Swiss Federal Research Institute WSL; Birmensdorf Switzerland
| | - C. Bässler
- Bavarian Forest National Park; Grafenau Germany
| | - R. Brandl
- Department of Ecology; Faculty of Biology; Philipps-University Marburg; Marburg Germany
| | - B. Fady
- INRA; UR Ecologie des Forêts Méditerranéennes; Avignon France
| | - H. Jehl
- Bavarian Forest National Park; Grafenau Germany
| | - S. Liepelt
- Faculty of Biology, Conservation Biology; Philipps-University Marburg; Marburg Germany
| | - S. Lorch
- Department of Ecology; Faculty of Biology; Philipps-University Marburg; Marburg Germany
| | - A. Piotti
- National Research Council; Institute of Biosciences and Bioresources; Firenze Italy
| | - G.G. Vendramin
- National Research Council; Institute of Biosciences and Bioresources; Firenze Italy
| | - M. Weller
- Department of Ecology; Faculty of Biology; Philipps-University Marburg; Marburg Germany
| | - B. Ziegenhagen
- Faculty of Biology, Conservation Biology; Philipps-University Marburg; Marburg Germany
| | - U. Büntgen
- Department of Geography; University of Cambridge; Cambridge UK
- Dendro Science; Swiss Federal Research Institute WSL; Birmensdorf Switzerland
- CzechGlobe, Global Change Research Institute CAS and Masaryk University; Brno Czech Republic
| | - L. Opgenoorth
- Department of Ecology; Faculty of Biology; Philipps-University Marburg; Marburg Germany
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Srinivas SK, Small DS, Macheras M, Hsu JY, Caldwell D, Lorch S. Evaluating the impact of the laborist model of obstetric care on maternal and neonatal outcomes. Am J Obstet Gynecol 2016; 215:770.e1-770.e9. [PMID: 27530491 DOI: 10.1016/j.ajog.2016.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/28/2016] [Accepted: 08/08/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The laborist model of obstetric care represents a change in care delivery with the potential of improving maternal and neonatal outcomes. OBJECTIVE We evaluated the effectiveness of the laborist model of care compared to the traditional model of obstetric care using specific maternal and neonatal outcome measures. STUDY DESIGN This is a population cohort study with laborist and nonlaborist hospitals matched 1:2 on delivery volume, geography, teaching status, and neonatal intensive care unit level using data from the National Perinatal Information Center/Quality Analytic Services database. A before-and-after study design with an untreated comparison group analyzed with the method of difference-in-differences was used to examine the impact of laborists on maternal and neonatal outcome measures within the 3 years after implementing the laborist system, after adjusting for secular trends, sociodemographic factors, and maternal medical conditions. The final outcome measures evaluated included cesarean delivery, chorioamnionitis, induction of labor, preterm birth, prolonged length of stay, Apgar at 5 minutes of <7, birth asphyxia, birth injury, birth trauma, and neonatal death. RESULTS We studied nearly 550,000 women from 24 hospitals (8 laborist and 16 nonlaborist hospitals) from 1998 through 2011. Implementation of laborists was associated with fewer labor inductions (adjusted odds ratio, 0.85; 95% confidence interval, 0.71-0.99) and decreased rate of preterm birth (adjusted odds ratio, 0.83; 95% confidence interval, 0.72-0.96) after controlling for confounders. Laborists did not impact the cesarean delivery rate, chorioamnionitis, or prolonged length of stay. CONCLUSION Implementation of the laborist model was associated with a significant reduction in labor induction rate and preterm birth without adversely affecting other outcomes.
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Utidjian L, Hogan A, Michel J, Localio A, Karavite D, Song L, Ramos M, Fiks A, Lorch S, Grundmeier R. Clinical Decision Support and Palivizumab: A Means to Protect from Respiratory Syncytial Virus. Appl Clin Inform 2015; 6:769-84. [PMID: 26767069 PMCID: PMC4704044 DOI: 10.4338/aci-2015-08-ra-0096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 08/07/2015] [Accepted: 11/08/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Palivizumab can reduce hospitalizations due to respiratory syncytial virus (RSV), but many eligible infants fail to receive the full 5-dose series. The efficacy of clinical decision support (CDS) in fostering palivizumab receipt has not been studied. We sought a comprehensive solution for identifying eligible patients and addressing barriers to palivizumab administration. METHODS We developed workflow and CDS tools targeting patient identification and palivizumab administration. We randomized 10 practices to receive palivizumab-focused CDS and 10 to receive comprehensive CDS for premature infants in a 3-year longitudinal cluster-randomized trial with 2 baseline and 1 intervention RSV seasons. RESULTS There were 356 children eligible to receive palivizumab, with 194 in the palivizumab-focused group and 162 in the comprehensive CDS group. The proportion of doses administered to children in the palivizumab-focused intervention group increased from 68.4% and 65.5% in the two baseline seasons to 84.7% in the intervention season. In the comprehensive intervention group, proportions of doses administered declined during the baseline seasons (from 71.9% to 62.4%) with partial recovery to 67.9% during the intervention season. The palivizumab-focused group improved by 19.2 percentage points in the intervention season compared to the prior baseline season (p < 0.001), while the comprehensive intervention group only improved 5.5 percentage points (p = 0.288). The difference in change between study groups was significant (p = 0.05). CONCLUSIONS Workflow and CDS tools integrated in an EHR may increase the administration of palivizumab. The support focused on palivizumab, rather than comprehensive intervention, was more effective at improving palivizumab administration.
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Affiliation(s)
- L.H. Utidjian
- Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biomedical and Health, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - A. Hogan
- Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - J. Michel
- Department of Biomedical and Health, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - A.R. Localio
- Departments of Biostatics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - D. Karavite
- Department of Biomedical and Health, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - L. Song
- Healthcare Analytics Unit, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - M.J. Ramos
- Department of Biomedical and Health, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - A.G. Fiks
- Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biomedical and Health, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - S. Lorch
- Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - R.W. Grundmeier
- Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biomedical and Health, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Ruhstaller K, Srinivas S, Greene M, Lorch S, Bastek J. 825: Does external environment impact the rate of hypertensive disorders of pregnancy and gestational diabetes? Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.1031] [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: 10/24/2022]
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Srinivas S, Macheras M, Lorch S. 415: Should we regionalize care of women with medical comorbidities? Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.448] [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: 11/15/2022]
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Srinivas S, Macheras M, Lorch S. 416: Labor and delivery care models are associated with term birth outcomes. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.449] [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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Tucker Edmonds B, McKenzie F, Macheras M, Srinivas S, Lorch S. 618: Morbidity and mortality associated with mode of delivery for breech periviable neonates. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.651] [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: 11/28/2022]
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Zubizarreta JR, Small DS, Goyal NK, Lorch S, Rosenbaum PR. Stronger instruments via integer programming in an observational study of late preterm birth outcomes. Ann Appl Stat 2013. [DOI: 10.1214/12-aoas582] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Baiocchi M, Small DS, Lorch S, Rosenbaum PR. Building a Stronger Instrument in an Observational Study of Perinatal Care for Premature Infants. J Am Stat Assoc 2012. [DOI: 10.1198/jasa.2010.ap09490] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Mike Baiocchi
- Mike Baiocchi is Doctoral Student, Dylan S. Small is Associate Professor, and Paul R. Rosenbaum is Professor , Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia, PA 19104-6340. Scott Lorch is Assistant Professor of Pediatrics at the University of Pennsylvania School of Medicine and an Attending Physician in the Division of Neonatology at The Children’s Hospital of Philadelphia. This work was supported by grant SES-0849370 from the Measurement, Methodology and Statistics
| | - Dylan S. Small
- Mike Baiocchi is Doctoral Student, Dylan S. Small is Associate Professor, and Paul R. Rosenbaum is Professor , Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia, PA 19104-6340. Scott Lorch is Assistant Professor of Pediatrics at the University of Pennsylvania School of Medicine and an Attending Physician in the Division of Neonatology at The Children’s Hospital of Philadelphia. This work was supported by grant SES-0849370 from the Measurement, Methodology and Statistics
| | - Scott Lorch
- Mike Baiocchi is Doctoral Student, Dylan S. Small is Associate Professor, and Paul R. Rosenbaum is Professor , Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia, PA 19104-6340. Scott Lorch is Assistant Professor of Pediatrics at the University of Pennsylvania School of Medicine and an Attending Physician in the Division of Neonatology at The Children’s Hospital of Philadelphia. This work was supported by grant SES-0849370 from the Measurement, Methodology and Statistics
| | - Paul R. Rosenbaum
- Mike Baiocchi is Doctoral Student, Dylan S. Small is Associate Professor, and Paul R. Rosenbaum is Professor , Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia, PA 19104-6340. Scott Lorch is Assistant Professor of Pediatrics at the University of Pennsylvania School of Medicine and an Attending Physician in the Division of Neonatology at The Children’s Hospital of Philadelphia. This work was supported by grant SES-0849370 from the Measurement, Methodology and Statistics
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Rausch M, Lorch S, Chung K, Frederick M, Zhang J, Barnhart K. A cost-effectiveness analysis of surgical versus medical management of early pregnancy loss. Fertil Steril 2011; 97:355-60. [PMID: 22192348 DOI: 10.1016/j.fertnstert.2011.11.044] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 11/28/2011] [Accepted: 11/29/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the cost-effectiveness of medical and surgical management of early pregnancy loss. DESIGN Analyses of cost, effectiveness, and incremental cost-effectiveness ratios and utilities of a multicenter trial with 652 women with first-trimester pregnancy failure randomized to medical or surgical management. SETTING Analysis of data from a multicenter trial. PATIENT(S) Secondary analysis of a multicenter trial. INTERVENTION(S) Cost-effectiveness analysis. MAIN OUTCOME MEASURE(S) Cost and effectiveness of competing treatment strategies. RESULT(S) Cost analysis of treatment demonstrates an increased cost of US$336 for 13% increased efficacy of surgical management. This analysis was sensitive to the probability of an extra office visit, the cost of the visit, and the probability of success. When the surgical arm is divided into outpatient manual vacuum aspiration (MVA) versus inpatient electric vacuum aspiration (EVA), there is an increased cost of $745 for EVA but a decreased cost of $202 for MVA compared with medical management. In general, MVA was found to be more cost-effective than medical management. For treatment of incomplete or inevitable abortion, medical management was found to be less costly and more efficacious. Utilities studies demonstrated that a patient would need to prefer surgery 14% less than medication for its treatment efficacy to be outweighed by the desire to avoid surgery. CONCLUSION(S) Surgical or medical management of early pregnancy failure can be cost effective, depending on the circumstances. Surgery is cost effective and more efficacious when performed in an outpatient setting. For incomplete or inevitable abortion, medical management is cost effective and more efficacious.
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Affiliation(s)
- Mary Rausch
- North Shore University Hospital, Manhasset, New York, USA
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Zhang K, Small DS, Lorch S, Srinivas S, Rosenbaum PR. Using Split Samples and Evidence Factors in an Observational Study of Neonatal Outcomes. J Am Stat Assoc 2011. [DOI: 10.1198/jasa.2011.ap10604] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
OBJECTIVE Racial/ethnic minorities report preferences for resuscitative care at the end of life. The main objective of this study was to determine if there are racial/ethnic differences in use of intubation for periviable neonates. We hypothesized that infants born to black and Hispanic women are more likely to be resuscitated compared with infants born to white women. METHODS We conducted a retrospective cohort study of state-level maternal and infant hospital discharge data of women who delivered between 23.0 and 24.6 weeks' gestation linked to birth and death certificate data for California, Missouri, and Pennsylvania from 1995 to 2005 (N = 9632). RESULTS Overall, 78.9% of the population was aged 18 to 35 years, and almost half were nulliparous; 19.4% of the women were black, 36.6% were Hispanic, and 33.4% were white. Approximately 30% had less than a high school education, and 49.2% were federally insured. Overall, 44.7% of periviable neonates were intubated. In multivariable analyses adjusting for sociodemographic characteristics, black and Hispanic race/ethnicity was significantly associated with neonatal intubation (odds ratios [ORs]: 1.14 [95% confidence interval (CI): 1.01-1.29] and 1.22 [95% CI: 1.10-1.36], respectively). In models controlling for clustering at the level of the delivery hospital, black race remained a predictor of neonatal intubation (OR: 1.25 [95% CI: 1.07-1.46]), but differences among Hispanics dissipated (OR: 1.12 [95% CI: 0.98-1.27]). CONCLUSIONS Racial/ethnic differences exist in patterns of periviable resuscitation, which may reflect underlying differences in patient preference. Alternatively, institutional practices or resources may account for these differences. These findings have important implications for patient care and institutional practice. Our results lay the foundation for additional work to investigate how social, cultural, and institutional factors influence patient-provider decision-making regarding periviable care.
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Srinivas S, Fager C, Rlovitz M, Lorch S. 140: Is risk adjusted cesarean delivery rate in primparous women a good measure of quality? Am J Obstet Gynecol 2008. [DOI: 10.1016/j.ajog.2008.09.167] [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: 11/24/2022]
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Molinaro T, Haynes K, Lorch S, Barnhart K. A large general practice database can be used to estimate the incidence of behavioral disorders in children conceived after assisted reproduction, and the results are reassuring. Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.07.813] [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: 10/21/2022]
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Barnhart K, Lorch S, Ailawadi M. Reply of the Authors. Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.04.011] [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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Lorch S, Lightfoot R, Ohshima H, Virág L, Chen Q, Hertkorn C, Weiss M, Souza J, Ischiropoulos H, Yermilov V, Pignatelli B, Masuda M, Szabó C. Detection of peroxynitrite-induced protein and DNA modifications. Methods Mol Biol 2003; 196:247-75. [PMID: 12152205 DOI: 10.1385/1-59259-274-0:247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Scott Lorch
- Stokes Research Institute, Children's Hospital of Philadelphia, Department of Biochemistry and Biophysics, University of Pennsylvania Medical Center, Philadelphia, PA, USA
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Abstract
Two functions of home care, assistance to improve disabled and aged patients' mobility and function, and self-care that includes treatment, screening-monitoring, exercise assistance, and information exchange, are described, as are the technologies used for these functions. Social and economic pressures as well as professional rationales that expand the use of technologies at home are noted, as is their impact on the site of care and on the patient-doctor relationship.
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Lorch S. Technology and the work of the doctor outside the hospital. Int J Technol Assess Health Care 1988; 5:43-52. [PMID: 10292541 DOI: 10.1017/s0266462300005936] [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] [Indexed: 11/06/2022]
Abstract
This article examines the ends to which technology are employed in the office practice of medicine. It argues that the types of decisions technology supports are of greater impact on how medicine is practiced over the long view than the actual technologies themselves. The more relevant the technologies are to the effectiveness of diagnosis and treatment, the more they drive the practice of medicine toward a standard endeavor. Similarly, technologies that make existing tests and procedures more efficient often reduce the skill level that is needed to provide care. The results of these forces coupled with the increasing administrative, economic, and regulating pressures lead to a diminished role for physicians unless a conscious effort is made to introduce technologies that enhance their unique and discretionary work with patients.
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Quarton GC, McGuire MT, Lorch S. Man-machine natural language exchanges based on selected features of unrestricted input. I. The development of the time-shared computer as a research tool in studying dyadic communication. J Psychiatr Res 1967; 5:165-77. [PMID: 6056818 DOI: 10.1016/0022-3956(67)90029-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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McGuire MT, Lorch S, Quarton GC. Man-machine natural language exchanges based on selected features of unrestricted input. II. The use of the time-shared computer as a research tool in studying dyadic communication. J Psychiatr Res 1967; 5:177-91. [PMID: 6056819 DOI: 10.1016/0022-3956(67)90030-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Hardy HL, Rabe EW, Lorch S. United States, Beryllium Case Registry (1952-1966). Review of its methods and utility. J Occup Med 1967; 9:271-6. [PMID: 6026373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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