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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A NICE Delivery — The Cross-Atlantic Divide over Treatment Intensity in Childbirth
This is a great excerpt from Neel Shah’s NEJM article…
“That’s why I personally never perform cesarean sections that are unnecessary: if the baby initially has low Apgar scores, I’m convinced I did the cesarean just in time; if the baby initially has great Apgar scores, I still did the cesarean just in time. Without a counterfactual, and with limited data to guide me (generally speaking, pregnant women are not excited about becoming experimental subjects), I can believe that my decision making is always accurate.
Or is it?”
Are hospitals the safest place for healthy women to have babies? An obstetrician thinks twice
“In parts of the world where women do not have access to skilled birth attendants, large numbers of mothers and babies die from preventable causes. Even for the healthiest among us, walking into the woods to have your baby would be unwise. Still, much of the developed world offers only one pragmatic alternative: the hospital. For more than a half-century, we have believed that spending many hours, if not days, in a hospital bed with a smattering of ultrasound gel, clips, wires, heart tones, random beeps and routine alarms is the safest way to have a baby.
Many of the patients I care for benefit from my surgical training. I get to save lives while also sharing in one of the most profoundly joyous moments that families experience. But obstetricians like me may be hardwired to operate, and too many operations are harmful to patients. One strategy to fix this might be to change our wiring. Another may be the British way: for patients to stay away from obstetricians altogether – at least until you need one.”
Amy Tuteur responded on the TimeIdeas blog by putting words in current Harvard OB-GYN Neel Shah’s mouth:
“The real question Dr. Shah appears to be asking is: are home births safe enough that we should save money by encouraging them?”
[While that doesn’t actually appear to be a question that Dr. Shah is asking in these articles, it is a good question in my opinion from a patient safety perspective. Cost issues aside, is home birth in particular as it stands today as an un-institution in the U.S. as safe, integrated and regulated in all states as it should be before promoting it as an alternative to giving birth in a hospital? It’s a solid stand-alone question.]
Measuring Gestational Age in Vital Statistics Data: Transitioning to the Obstetric Estimate
Beginning with the 2014 data year, the National Center for Health Statistics is transitioning to a new standard for estimating the gestational age of a newborn. The new measure, the obstetric estimate of gestation at delivery (OE), replaces the measure based on the date of the last normal menses (LMP). This transition is being made because of increasing evidence of the greater validity of the OE compared with the LMP-based measure
Swept under the carpet: The psychological side of maternal health
In high-income countries, as many as 10 to 15 percent of women experience depression, anxiety, or other non-psychotic mental health challenges during pregnancy or the year after giving birth. In developing countries, the chances rise to 16 percent of pregnant women and 20 percent of postnatal women, according to Jane Fisher, professor of women’s health at Monash University in Melbourne, Australia.
HOW DO YOU GET CLINICAL VALIDATION FROM PATIENT-GENERATED AND OPEN HEALTH DATA IN OBSTETRIC CARE?
Session at Health Datapalooza 2015 on an OB care study (http://healthdatapalooza.org/detailed-agenda/)
This presentation will be two pronged. First, it will include a brief overview of our initial study at George Washington University and its results. Second will be a panel featuring Doctors Jill Krapf, Kathyrn Marko, and Andrew Meltzer, clinicians at the George Washington University, who were the principal investigators. In our study, more than 150 expectant mothers were recruited for the program and subsets of those patients were provided with the full Babyscripts experience that included connected devices. We found that Babyscripts enhances patient satisfaction with their prenatal care, improves patient compliance, and engagement and could potentially decrease healthcare costs by avoiding unnecessary visits for low-risk patients. Our goal for this session is to demonstrate the active collaboration that is required between clinicians, entrepreneurs, and technologists to leverage this new paradigm of health data in clinical care and commercialize digital healthcare solutions.
Moderator: Anish Sebastian, Babyscripts
Panelists: Jill Krapf, MD, The George Washington University; Katie Marko, MD, FACOG, The George Washington University School of Medicine and Health Sciences; Andrew Meltz, MD, 1EQ
Woman Forced Into Episiotomy Fights Back With Lawsuit
“I do civil rights work and this is a civil rights case, and it’s pretty outrageous that she would be so treated by a physician when she clearly was not consenting to an episiotomy,” Merin tells Yahoo Parenting. “The physician acted in total disregard of the patient’s interest — either because he practices backward medicine…or because it was just heartless for some other reason.”
Castlight Health Releases U.S. Healthcare Affordability Index
Castlight Health, Inc. … today announced the release of a new study designed to illustrate the relative affordability of U.S. regions for employers and their employees. The U.S. Healthcare Affordability Index examines the correlations between annual wage and healthcare cost changes year-over-year from 2013 to 2014 in 35 U.S. cities and metro regions. This year’s Index shows an alarming trend of rising healthcare costs across the country.
Sorry, Captain there’s no transparency in medical pricing
“In my view, high deductible plans are a pretty crude instrument to encourage cost consciousness and price transparency.”
Easy Access to Info on Costs of Medical Procedures Remains Key Provision of Bill (New Jersey)
A continuing legislative battle over whether and how limits should be placed on payments to doctors and hospitals outside of patients’ insurance networks could lead to greater transparency in the form of a state Healthcare Price Index, according to the most recent revisions of a proposed bill.
Interestingly, the price index – which sponsors insist must be part of the legislation – is opposed by both healthcare provider and insurers, albeit for different reasons.
The legislation, which aims to prevent surprise bills for emergency and involuntary treatments outside of patients’ insurance networks could undergo more changes as legislators steer it toward an end-of-June finish line
Medicare reveals big gap in Illinois hospital pricing
Patients often don’t see hospital charges, hospital officials and health care experts say. Those who are insured typically share the cost with their insurance provider. Some uninsured Illinois residents are protected by law from high charges if they qualify based on income.
“Illinois hospitals are committed to and working on improving price transparency that will provide the most meaningful and useful information for patients,” Danny Chun, vice president of corporate communication and marketing at the Naperville-based Illinois Hospital Association, said in a statement.
State of Breastfeeding Coverage: Health Plan Violations of the Affordable Care Act
This report goes in-depth into coverage of the ACA’s breastfeeding benefits and found that women face widespread barriers to getting coverage of breastfeeding support and supplies.