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Background: Policymakers use clinical and cost-effectiveness evidence to support decisions about health service commissioning. In England, the National Institute for Health and Care Excellence (NICE) recommend that in cost-effectiveness analyses "effectiveness" is measured as quality-adjusted life years (QALYs), derived from health utility values. The impact of perinatal death (stillbirth/neonatal death) on parents' health utility is currently unknown. This knowledge would improve the robustness of cost-effectiveness evidence for policymakers. Objective: This study aimed to estimate the impact of perinatal death on parents' health utility. Methods: An online survey conducted with mothers and fathers in England who experienced a perinatal death. Participants reported how long ago their baby died and whether they/their partner subsequently became pregnant again. They were asked to rate their health on the EQ-5D-5L instrument (generic health measure). EQ-5D-5L responses were used to calculate health utility values. These were compared with age-matched values for the general population to estimate a utility shortfall (i.e. health loss) associated with perinatal death. Results: There were 256 survey respondents with a median age of 40 years (IQR 26–40). Median time since death was 27 months (IQR 8–71). The mean utility value of the sample was 0.774 (95% CI 0.752–0.796). Utility values in the sample were 13% lower than general population values (p < 0.05). Over 10 years, this equated to a loss of 1.1 QALYs. This reduction in health utility was driven by anxiety and depression. Conclusions: Perinatal death has important and long-lasting health impacts on parents. Mental health support following perinatal bereavement is especially important. [ABSTRACT FROM AUTHOR]

This article discusses a survey conducted on patient perspectives and reasons for using a patient portal messaging system in a family medicine department. The survey included 2,297 patients and found that the majority of patients agreed that the portal was an important part of their primary care experience. Patients reported using the portal to get in touch with someone who could answer their questions, reach a clinician to address health problems, and get health advice. The study highlights the convenience of messaging and the potential for messaging to replace traditional care, which could increase clinic and physician workload. The article suggests that future research should explore the unintended consequences of increased portal messaging and patient preferences for receiving care. [Extracted from the article]

Objectives: The quality and scope of perinatal bereavement care in the United States has been evaluated by surveying bereaved parents, but little is known about how care varies across hospitals. We sought to survey clinicians about stillbirth bereavement care practices at U.S. hospitals and to evaluate care by hospital birth volume. Methods: Using American Hospital Association data, we employed stratified random sampling to select 300 hospitals from all centers with at least 100 annual deliveries. Within each state, we divided all hospitals into size quartiles and randomly selected from each until we reached the goal number per state. We then identified a staff member knowledgeable about typical bereavement care on labor and delivery at each hospital and sent an on-line survey about care. We linked survey data with hospital characteristics and used summary statistics, Chi squared, and Fisher's Exact test to compare care by hospital birth volume. Results: We reached an eligible respondent at 429/551 hospitals and 396 of the 429 (73%) agreed to participate. We received 289 usable surveys for an overall response rate of 67%. Only one third of hospitals (n = 96, 33%) reported staff protected time for perinatal bereavement care. Of 17 bereavement topics, just six were routinely offered by at least two-thirds of the hospitals. Financial limitations and staff shortages were the most commonly identified barriers to care and were most pronounced at small-volume hospitals. Conclusions for Practice: This study offers a snapshot in bereavement care and identified important gaps for both large and small hospitals. Significance: What is already known on this subject?: While there have been efforts to improve hospital bereavement care for families after stillbirth, no researchers have surveyed U.S. hospital practices to assess current bereavement practices or how these practices vary across hospitals. What this study adds?: This study systematically sampled hospitals in all U.S. states to assess stillbirth bereavement care including memory-making, parental education, and barriers to optimal care and analyzed differences by hospital birth volume. The study found significant gaps including limited bereavement education about normal grief, mental health, impact on relationships, return to work, and the father's experience. [ABSTRACT FROM AUTHOR]

Purpose: Detroit experiences the highest preterm birth rate and some of the worst birth outcomes in the country. Women and children have extremely high levels of poverty and face numerous barriers to care including lack of trust and racial disparities in care and concrete barriers such as limited transportation and childcare, work hour conflicts, and lack of insurance. Description: We report on a unique model of patient care focused on providing patient-centered care and building trusting relationships. This model is encompassed in a new free, volunteer-run, faith-based clinic which offers prenatal, postpartum, and infant care. Assessment: In the first 2 years of operation, demand for services rose rapidly and there were stellar clinical outcomes, despite the fact that Luke patients are among the medically and socially highest risk populations in the nation. Conclusion: While marginalized populations have worse birth outcomes and far more infant deaths, making care accessible and responsive to patient needs while focusing on building patient relationships is an important strategy to improve outcomes. [ABSTRACT FROM AUTHOR]

Balancing home and work lives may influence, but does not fully explain, increased burnout among women.[5] Our findings of higher burnout and worse mental health among female physicians mirror those of other research.[1] While men and women both agreed female physicians have more home responsibilities, they disagreed on other burnout contributors among women physicians. Given human and economic risks of burnout in healthcare, we must identify the most stressful aspects of physician work, understand how these vary for men and women, and design interventions which better respond to individual needs. Prior studies show older age, good mental health, more children, and low home stress predict greater work satisfaction for women.[6] As women are more likely to have a partner working full-time, they face greater need for work flexibility and may have different priorities and strategies to mitigate job stress. [Extracted from the article]

Support groups can help individuals cope with difficult health situations but have been understudied for women with perinatal bereavement. An early study suggested those using internet support groups had high rates of positive depression screens, raising the question whether these users were more symptomatic than those in similar face-to-face support groups. We therefore conducted two convenience sample surveys of women bereaved by perinatal loss, one looking at use of online support groups and the other in-person support groups. The surveys identified demographics, use of peer support, potential confounders, and current depression symptoms using the Edinburgh Postnatal Depression Scale (EPDS). Four hundred sixteen women from 18 internet groups and 60 women from 13 in-person groups met inclusion criteria. Participants in both groups were predominantly Caucasian, highly educated, and had private insurance. Severe depression symptoms were similar in the two groups despite the different modalities. Women in both face-to-face or internet groups for pregnancy and perinatal loss demonstrated similar scores on depression screens. Women of color, poor, and less-educated women were starkly underrepresented in both types of groups, raising questions about knowledge of support options, barriers to use, preferences for bereavement support, and optimization of groups for a broader population. [ABSTRACT FROM AUTHOR]

Objectives Healthcare providers in low-resource settings confront high rates of perinatal mortality. How providers cope with such challenges can affect their well-being and patient care; we therefore sought to understand how physicians and midwives make sense of and cope with these deaths. Methods We conducted semi-structured interviews with midwives, obstetrician-gynecologists, pediatricians and trainee physicians at a large teaching hospital in Kumasi, Ghana. Interviews focused on participants' coping strategies surrounding perinatal death. We identified themes from interview transcripts using qualitative content analysis. Results Thirty-six participants completed the study. Themes from the transcripts revealed a continuum of control/self-efficacy and engagement with the deaths. Providers demonstrated a commitment to push on with their work and provide the best care possible. In select cases, they described the transformative power of attitude and sought to be agents of change. Conclusions Physicians and midwives in a low-resource country in sub-Saharan Africa showed remarkable resiliency in coping with perinatal death. Still, future work should focus on training clinicians in coping and strengthening their self-efficacy and engagement. [ABSTRACT FROM AUTHOR]

Fetal deaths account for nearly one percent of all births in the United States. The cost of hospital care associated with fetal deaths may be substantial. However, there is very limited data on the economic burden of fetal death. We conducted a retrospective medical chart review of stillbirths at three large hospitals in Michigan over a ten-year period and identified medical complications, hospital costs, and length of stay for these deliveries. Mothers with stillbirth were matched with mothers of the same age who delivered a live-born infant at the same hospital during the same year. Our final sample was comprised of 533 stillbirths and 1,053 matched live births. Average hospital cost for stillbirth was $7,495 (±7,015) and the average length of stay was 2.8 days (±2.8). Having a serious maternal medical complication was associated with higher costs and longer length of stay among women with stillbirth. Early stillbirths between 20 and 28 weeks gestational age, epidural/spinal/general anesthesia, and cesarean delivery were also associated with longer length of stay. Average hospital costs for women with stillbirth were more than $750 higher than women with live births but length of stay was not significantly different between the two. This study suggests that stillbirths were associated with substantial maternal hospital costs. Future research examining the economic impact of stillbirths beyond labor and delivery such as increased costs associated with additional testing and care in subsequent pregnancies will help better understand the overall economic impact of stillbirths. [ABSTRACT FROM AUTHOR]