The intersection of maternity care, data transparency, health care costs and patient safety in a weekly curated list of articles of interest.
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This week’s collection of articles is brought to you by BabyLove. Are you in Minnesota near the Mall of America? Veronica Jacobsen and the whole team at BabyLove, an independent childbirth education center, have a lot to offer! Check out the class schedule and pass on the good word about BabyLove to pregnant friends in or around Eagan, MN.
CMQCC’s OB Hemorrhage Toolkit 2.0 is available for download. The Toolkit includes care guidelines (in checklist, flowchart or table chart formats) and a slide set for professional education in PDF format.
More than 2000 have been downloaded worldwide since March 24. Have you downloaded the toolkit for your hospital?
April was Cesarean Awareness Month and someone at Society for Maternal Fetal Medicine put a lot of time into creating a month-long social media campaign that ended up being a fantastic cheat sheet of recommendations for preventing a primary cesarean. See all of their tweets at the end of this article.
UCHealth aims to lower C-section rates
Women with epilepsy face tough choices over their medication
Review on how treatments for epilepsy in pregnancy may affect the unborn child, and the dilemma facing young women making decisions about their treatment. (Cochrane)
The battle for better maternity care shows the limits of the Amazon warehouse approach to medicine
“The issues around maternity care are a microcosm of the bigger battles in the NHS – centralisation, protocols and “efficiency savings” v making a space for common sense, professional judgement and personal relationships.”
Hospitals work to fast-track C-section’s
“Hospitals rework C-section policies to promote quicker bonding between mothers, babies”
Aid for consumers; Data helps health-care decisions
(Subscriber access only but I wrote it so I’m including it here anyway. PDF here.)
A Cluster-Randomized Trial to Reduce Cesarean Delivery Rates in Quebec
Audits of indications for cesarean delivery, feedback for health professionals, and implementation of best practices, as compared with usual care, resulted in a significant but small reduction in the rate of cesarean delivery, without adverse effects on maternal or neonatal outcomes. The benefit was driven by the effect of the intervention in low-risk pregnancies.
Pediatricians Issue New Guidelines for Hospital Release of Newborns
The decision to allow a healthy newborn to go home is made after careful review by health providers, but there can be wide variation in the degree of an infant’s readiness to leave the hospital, and a number of factors need to be considered, according to the AAP.
Continuing to Help Low-Income Women Access Primary Care
“…ACOG has launched the nationwide advocacy initiative, All-in for Women’s Primary Care. Regardless of whether your state has expanded its Medicaid program under the Affordable Care Act, your state can raise Medicaid primary care rates to Medicare levels for ob-gyns.”
A very cool interactive infographic from IOM that accompanies the report titled “Vital Signs: Core Metrics for Health and Health Care Progress”
A Big Step Forward for Health Care Transparency in New Mexico
One major reform to come out of the 2015 legislative session was a law that will dramatically increase the transparency of hospital prices and quality data.
The new statute, which passed both the Senate and House unanimously and was signed by the Governor, updates the existing Health Information System Act to allow the Department of Health to release hospital-specific quality and cost information. Much of this data has been collected from hospitals for the last two decades, but the old law prohibited the Department of Health from releasing it in a way that identifies specific hospitals.
The oddball start-up that shows how ObamaCare has made a friendlier insurance market
“It’s got a user-friendly website that offers providers after you type in your symptoms, along with free 24/7 internet consultations with doctors. It lets you compare prices from different providers and refill prescriptions with one click. It’s even partnering with CVS to build care locations throughout the state, and it’s hiring nurses to offer in-home follow-up services, especially for new moms.”
“Before the health reform law, all the incentives encouraged insurers to exploit consumers rather than help them. Most people who weren’t on government-provided insurance got their private coverage through their employer. (And still do.) In that case, insurers have an incentive to make employers happy, but little reason to offer customers transparency or quality service.”
Future of health care: innovation and personalized medicine
A very perky article on the impact of the fee-for-value approach
Commonwealth Fund’s Health Policy quiz
I failed this. Really badly.
Canadians unaware about the full cost of health care
Can Transparency Tools Further the ACA’s Goals of Reducing Costs?
What Hospital Websites of the Future Will Look Like
Leapfrog’s Leah Binder thinks that “[t]he hospital (and its website) of the 21st century will look very little like the ones we encounter today. And that will be a good thing for its customers—the patients.”
Hospitals Provide a Pulse in Struggling Rural Towns
Rural hospitals face huge challenges; nearly 50 of them have closed in the last four years, according to the North Carolina Rural Health Research Program. But the many successful hospitals, beyond providing an array of jobs from the bottom to the top of the economic ladder, also stimulate local spending and help attract new businesses that offer a stable of insured patients.
A Month of Cesarean Awareness Month Tweets from the Society for Maternal Fetal Medicine, 2015:
Results for #prevent1stcs
Thanks for all you do to keep #mothers and #babies safe! #Prevent1stCS #CAM2015 is part of this! http://ow.ly/KUj64
Advise on short/long-term risks of the surgery for both woman and baby- in present and future #Prevent1stCS #CAM2015 http://ow.ly/KUj63
Intermittent auscultation acceptable in low-risk patients without #FHR abnormalities #Prevent1stCS #CAM2015 http://ow.ly/KUj61
Repeated #cesarean increases risk of #accreta- a major safety concern for mom and baby #Prevent1stCS http://ow.ly/KUj5z
Category II tracings don’t mean CS - they mean evaluation and continued surveillance are needed #Prevent1stCS #CAM2015
Unless indicated, avoid elective induction with bishops score <8. Ripen if you must induce #Prevent1stCS #CAM2015 http://ow.ly/KUj5B
1st cs may slightly decrease neonatal risk, difference through lifespan increasingly smaller #Prevent1stCS #CAM2015 http://ow.ly/KUj5Z
#cesarean does have a place in modern practice and can be lifesaving for some moms and babies #Prevent1stCS #CAM2015 http://ow.ly/KUj5A
1st cs only small risk maternal morbidity, difference increases throughout reproductive life #Prevent1stCS #CAM2015 http://ow.ly/KUj5Y
Repeated #cesarean increases risk of #accreta- a major safety concern for mom and baby #Prevent1stCS #CAM2015 http://ow.ly/KUj5z
Counsel appropriately that elective cs 1st increased risk major maternal morbidity 10% by 4th #Prevent1stCS #CAM2015 http://ow.ly/KUj5y
Encourage policy changes at your hospital within NICHD and SMFM guidelines to help #Prevent1stCS #CAM2015 http://ow.ly/KUj5X
Excessive weight gain increases cs! Help women keep weight gain in IOM recommendations to #Prevent1stCS #CAM2015 http://ow.ly/KUj5V
EFW late gestation imprecise, counsel, reserve cs >4500 grms diabetics >5000 grms non-diabetics #Prevent1stCS #CAM2015
Document fetal presentation at 36 weeks to allow discussion and attempt of external version #Prevent1stCS #CAM2015 http://ow.ly/KUj5U
When inducing, don’t call failure til latent phase >24 hrs and >12-18 hrs of oxytocin after AROM #Prevent1stCS #CAM2015
Don’t forget cervical riping! Riping reduces risk of #cesarean when inducing unfavorable cervix #Prevent1stCS #CAM2015
If there are no maternal/fetal indications- hold off on induction of labor until 41 weeks #Prevent1stCS #CAM2015 http://ow.ly/KUj5T
@WHO proposes Robson system for comparing #caesarean rates between facilities/countries/regions.http://ow.ly/LCyqg @Lancet #Prevent1stCS
#Caesarean sections should only be performed when medically necessary says @WHO http://ow.ly/LCjFo #Prevent1stCS
Category 2 tracing? Consider scalp stim to assess fetal acid-base status as a safe alternative to #Prevent1stCS #CAM2015
#amnioinfusion for repetative variables may help #Prevent1stCS #CAM2015 http://ow.ly/KUj5S
Consider manual rotation for fetal malpresentation in #secondstage before #operativedelivery #Prevent1stCS #CAM2015 http://ow.ly/KUj5P
#Operative delivery by experienced and well-trained physicians is safe alternative to #Prevent1stCS #CAM2015 http://ow.ly/KUj5O
Diagnosis of arrest 2nd stage is >2 hour muliparous and >3 hours nulliparous women #givewomantime #Prevent1stCS #CAM2015
There is no absolute maximum for the #secondstage, allow for variation with progression #Prevent1stCS #CAM2015 http://ow.ly/KUj5M
Active phase arrest should be reserved for >6cm for >4 hours with adequate uterine activity #Prevent1stCS #CAM2015 http://ow.ly/KUj5L
Protracted latent phase >20 hrs #nulliparous >14 hrs #multiparous not a indication for cs #Prevent1stCS #CAM2015 http://ow.ly/KUj5J
Options for latent phase include time, #AROM or #oxytocin to achieve active labor #Prevent1stCS #CAM2015 http://ow.ly/KUj5I
6 cm is the new 4! Don’t call active labor protraction or arrest til adequate time elapsed! #Prevent1stCS #CAM2015 http://ow.ly/KUj5H
Each cs increases risk in next - #Prevent1stCS can improve outcomes for a lifetime #CAM2015 http://ow.ly/KUj5F
10 fold variation #cs across US from 7.1% to 69.9%- how does your hospital rate? #Prevent1stCS #CAM2015 http://ow.ly/KUj5E
Severe maternal morbidies increase risk #cs 3 fold- prevention and early treatment can help #Prevent1stCS #CAM2015 http://ow.ly/KUj5x
Experts agree #cesareanrate too high in US @mySMFM committed to lowering safely follow for tips #Prevent1stCS #CAM2015