Toward More Optimal Birth Outcomes
Women want to have a good birth, in which both they and the baby are healthy and happy at the end. For most women, the optimal birth outcome is a spontaneous vaginal birth (SVB), one without forceps or a vacuum. Some women may be surprised to learn that the hospital where they give birth has a significant effect on the kind of birth they will have.
Spontaneous Vaginal Birth Varies Significantly Across U.S. Hospitals
Rebecca R. S. Clark and Eileen Lake
Abstract [from journal]
Background: Birth is the most common reason for hospitalization in the United States. Hospital variation in maternal outcomes is an important indicator of health care quality. Spontaneous vaginal birth (SVB) is the most optimal birth outcome for the majority of mothers and newborns. The purpose of this study was to examine hospital‐level variation in SVB overall and among low‐risk women in a four‐state sample representing 25% of births in the United States in 2016.
Hospital Safety-Net Status and Performance on Publicly Reported Episode Spending Measures
Amol S. Navathe, Lingmei Zhou, Joshua M. Liao
Abstract [from journal]
Objectives: As part of its strategy to improve health care value and contain hospital costs, Medicare trialed public reporting for episode-based spending via 6 novel Clinical Episode-Based Payment (CEBP) measures for cellulitis, kidney/urinary tract infection, gastrointestinal hemorrhage, spinal fusion, cholecystectomy, and aortic aneurysm. Because safety-net hospitals may fare more poorly than other hospitals under value-based reforms, we evaluated the relationship between safety-net status and
Inside the Pandemic's Health Provider Financial Crisis
The Gears Of Knowledge Translation: Process Evaluation Of The Dissemination And Implementation Of A Patient Engagement Toolkit
Shimrit Keddem, Aneeza Z. Agha, Judith A. Long, Becky Shasha, Leslie R. M. Hausmann, Judy A. Shea
Abstract [from journal]
Background: Patient engagement is a key tenet of patient-centered care and is associated with many positive health outcomes. To improve resources for patient engagement, we created a web-based, interactive patient engagement toolkit to improve patient engagement in primary care across the Veterans Health Administration (VHA).
Objective: To use the knowledge translation (KT) framework to evaluate the dissemination and implementation of a patient engagement toolkit at facilities across one
...Improving The Resident Educational Experience In A Level IV Neonatal/Infant Intensive Care Unit
Sara C. Handley, Nicole Pouppirt, Eric Zucker, Katherine A. Coughlin, Anne Ades
Abstract [from journal]
The neonatal/infant intensive care unit (N/IICU) at the Children's Hospital of Philadelphia is a 98-bed, level IV unit through which second-year pediatric residents rotate monthly. We developed a quality improvement project to improve the resident educational experience using goal setting. Primary objectives were to increase resident educational goal identification to 65% and goal achievement to 85% by June 2017. Secondary objectives were to (1) increase in-person feedback from fellows and/or attendings to 90% by June 2017 and (2)
...Decreases in Acute Care Surgery in Response to COVID-19
When the pandemic hit the United States, surgical centers across the country reduced the number of elective and nonemergent procedures they performed.
An Asthma Population Health Improvement Initiative For Children With Frequent Hospitalizations
Chén C. Kenyon, Douglas Strane, G. Chandler Floyd, Ethan G. Jacobi, Tina J. Penrose, Jeffrey M. Ewig, Sigrid Payne DaVeiga, Joseph J. Zorc, David M. Rubin, Tyra C. Bryant-Stephens
Abstract [from journal]
Objectives: A relatively small proportion of children with asthma account for an outsized proportion of health care use. Our goal was to use quality improvement methodology to reduce repeat emergency department (ED) and inpatient care for patients with frequent asthma-related hospitalization.
Methods: Children ages 2 to 17 with ≥3 asthma-related hospitalizations in the previous year who received primary care at 3 in-network clinics were eligible to receive a bundle of 4 services including (1)
...Adolescents, Psychiatric Hospitalization, and COVID-19
As we approach the sixth month of widespread community transmission of COVID-19 in the United States, our focus must shift beyond acute management of disease to the broader effects of this pandemic on health and wellbeing. In particular, it is important that we understand the consequences of the COVID-19 pandemic on the mental health of children and adolescents.
Improving Emergency Care For Children With Medical Complexity: Parent & Physicians' Perspectives
Christian D. Pulcini, Zoe Belardo, Tara Ketterer, Joseph J. Zorc, Cynthia Mollen
Abstract [from journal]
Objectives: Children with medical complexity (CMC) have high rates of emergency department (ED) utilization, but little evidence exists on the perceptions of parents and pediatric emergency medicine (PEM) physicians about emergency care. We sought to explore parent and PEM physicians' perspectives about 1) ED care for CMC, and 2) how emergency care can be improved.
Methods: We performed semi-structured interviews with parents and PEM physicians at a single academic, children's hospital.
...Hospital Readmission and Post-Acute Care Use After Intensive Care Unit Admissions: New ICU Quality Metrics?
Christopher F. Chesley, Michael O. Harhay, Dylan S. Small, Asaf Hanish, Hallie C. Prescott, Mark E. Mikkelsen
Abstract [from journal]
Objective: Care coordination is a national priority. Post-acute care use and hospital readmission appear to be common after critical illness. It is unknown whether specialty critical care units have different readmission rates and what these trends have been over time.
Methods: In this retrospective cohort study, a cohort of 53,539 medical/surgical patients who were treated in a critical care unit during their index admission were compared with 209,686 patients who were not treated in a
...Does Hospitalization For Thromboembolism Improve Oral Anticoagulant Adherence In Patients With Atrial Fibrillation?
Thanh Phuong Pham Nguyen, Yong Chen, Dylan Thibault, Charles E. Leonard, Sean Hennessy, Allison Willis
Abstract [from journal]
Background: It is not known how medication adherence changes after hospitalization for a sentinel thromboembolic event.
Objective: The purpose of this study was to examine the impact of hospitalization for ischemic stroke or thromboembolism on postdischarge adherence to oral anticoagulants in patients with atrial fibrillation.
Methods: We conducted a quasi-experimental pre-post observational study using a large U.S. commercial insurance health care claims database.
...Chronic Hospital Nurse Understaffing Meets COVID-19
A study of hospitals in New York and Illinois at the start of the COVID-19 pandemic found that most did not meet benchmark patient-to-nurse staffing ratios for medical-surgical or intensive care units. New York City hospitals had especially low staffing ratios. Understaffed hospitals were associated with less job satisfaction among nurses, unfavorable grades for patient safety and quality of care, and hesitance by nurses and patients to recommend their hospitals.
COVID-19 Outbreak Among Adolescents At An Inpatient Behavioral Health Hospital
Polina Krass, Charles Zimbrick-Rogers, Chioma Iheagwara, Carol A. Ford, Michele Calderoni
Abstract [from journal]
Purpose: We report on a coronavirus disease 2019 (COVID-19) outbreak among adolescents at an inpatient behavioral health facility that was identified within 5 weeks of known viral transmission in the surrounding community.
Methods: Clinical records were reviewed for all inpatients aged <18 years with laboratory-confirmed COVID-19 between March 23 and April 21, 2020.
Results: A total of 19 COVID-19-positive patients aged 11-17 years were identified. Patients most
...Pediatric ED Utilization During COVID-19
