46 results on '"Caitlin Cross-Barnet"'
Search Results
2. Black Marital Beginnings
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Katrina, Bell McDonald, primary and Caitlin, Cross-Barnet, additional
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- 2018
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3. Is Marriage for Black People?
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Katrina, Bell McDonald, primary and Caitlin, Cross-Barnet, additional
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- 2018
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4. A Long View of black Marriage
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Katrina, Bell McDonald, primary and Caitlin, Cross-Barnet, additional
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- 2018
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5. Sex, Money, and Beyond
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Katrina, Bell McDonald, primary and Caitlin, Cross-Barnet, additional
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- 2018
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6. A New Lens on Black Marriage
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Katrina, Bell McDonald, primary and Caitlin, Cross-Barnet, additional
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- 2018
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7. The Socio-Historical Unshackling of African-American Relationships
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Katrina, Bell McDonald, primary and Caitlin, Cross-Barnet, additional
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- 2018
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8. Men and Women, Husbands and Wives
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Katrina, Bell McDonald, primary and Caitlin, Cross-Barnet, additional
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- 2018
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9. Contemporary Black Marriage and Parenting
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Katrina, Bell McDonald, primary and Caitlin, Cross-Barnet, additional
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- 2018
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10. Marriage in Black
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Katrina, Bell McDonald, primary and Caitlin, Cross-Barnet, additional
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- 2018
- Full Text
- View/download PDF
11. Intensive Approaches to Prenatal Care May Reduce Risk of Gestational Diabetes
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Ian Hill, Kathryn Paez, Sarah Benatar, Graciela Castillo, Emily M. Johnston, Caitlin Cross-Barnet, and Jennifer Lucado
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medicine.medical_specialty ,Ethnic group ,030209 endocrinology & metabolism ,Prenatal care ,03 medical and health sciences ,Maternity care ,0302 clinical medicine ,Pregnancy ,Risk Factors ,Chart review ,Ethnicity ,medicine ,Humans ,Maternal Health Services ,030212 general & internal medicine ,business.industry ,Prenatal Care ,General Medicine ,medicine.disease ,United States ,Health equity ,Gestational diabetes ,Diabetes, Gestational ,Family medicine ,Female ,business ,Medicaid - Abstract
Objectives: To observe gestational diabetes mellitus (GDM) prevalence among participants receiving enhanced prenatal care through one of three care models: Birth Centers, Group Prenatal Care, and Maternity Care Homes. Materials and Methods: This study draws upon data collected from 2014 to 2017 as part of the Strong Start II evaluation and includes data from nearly 46,000 women enrolled across 27 awardees with more than 200 sites throughout the United States. Descriptive and statistical analyses utilized data from participant surveys completed upon entry to the program and a limited chart review. Results: A total of 6.3% of Strong Start participants developed GDM during their pregnancy. Rates varied significantly and substantially by model. After adjusting for participant risk factors, we find that Birth Center participants of all races and ethnicities experienced significantly lower rates of GDM than women of the same race/ethnicity in Maternity Care Homes. Conclusions: The lower rates of gestational diabetes among women receiving Birth Center prenatal care suggest the need for further investigation of how prenatal care approaches can reduce GDM and address health disparities.
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- 2021
12. Limits of prenatal care coordination for improving birth outcomes among Medicaid participants
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Caitlin Cross-Barnet, Sarah Benatar, Brigette Courtot, and Ian Hill
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Epidemiology ,Pregnancy ,Medicaid ,Cesarean Section ,Public Health, Environmental and Occupational Health ,Infant, Newborn ,Humans ,Premature Birth ,Birth Weight ,Female ,Prenatal Care ,Maternal Health Services ,United States - Abstract
Maternity Care Homes (MCHs) intend to address clinical and psychosocial needs for perinatal patients and are commonly implemented for Medicaid beneficiaries. Rigorous evidence supporting MCHs' effectiveness for improving birth outcomes is thin, but most studies consider only clinical and demographic factors from administrative data. To assess birth outcomes with controls for psychosocial variables known to affect them, this paper considers quantitative participant-level data from the Strong Start for Mothers and Newborns prenatal care initiative, with qualitative case study data to further contextualize results. From 2013 to 2017, Strong Start served over 45,000 Medicaid beneficiaries in 32 states, D.C., and Puerto Rico though MCHs, group prenatal care, or freestanding birth centers. Participant data included risks screens for food insecurity, depression, anxiety, pregnancy intention, and intimate partner violence, in addition to clinical and demographic information. After clinical, demographic and psychosocial risks were controlled in a regression model, Strong Start birth center participants showed significantly lower rates of preterm birth, low birthweight, and cesarean section relative to MCH participants (p .01). In group prenatal care, White participants showed lower rates of preterm birth (p .01) and Black participants showed lower rates of low birthweight (p .05) relative to MCH participants. Strong Start participants reported appreciation for MCH care managers' support, but community and clinical referrals often had long waiting lists or were inaccessible. Transformative care models focusing on provider continuity, relationship building, and patient activation may offer more promise for improving birth outcomes than supplementing medical models with care management and other resources.
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- 2022
13. Prenatal Depression: Assessment and Outcomes among Medicaid Participants
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Caitlin Cross-Barnet, Sarah Benatar, Ian Hill, and Emily M. Johnston
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Adult ,medicine.medical_specialty ,Health (social science) ,Adolescent ,Prenatal care ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,Ethnicity ,Prevalence ,Humans ,Medicine ,030212 general & internal medicine ,Psychiatry ,Depression (differential diagnoses) ,Depression ,Medicaid ,business.industry ,Health Policy ,Public health ,Pregnancy Outcome ,Public Health, Environmental and Occupational Health ,Prenatal Care ,medicine.disease ,United States ,030227 psychiatry ,Cross-Sectional Studies ,Spouse ,Premature Birth ,Domestic violence ,Gestation ,Female ,Pregnant Women ,business - Abstract
This study used bivariate and regression-adjusted analyses of participant-level survey and medical data to investigate prevalence of depression among pregnant Medicaid participants, correlates of depression, and the relationship between depression and pregnancy outcomes. The sample included Medicaid participants with a single gestation and valid depression data who were enrolled in Strong Start for Mothers and Newborns 2, a national preterm birth prevention program, from 2013 to 2017 (N = 37,287; 85% of total enrollment). Depression rates in Strong Start were high (27.5%). Depression was associated with being black; having other children, an unplanned pregnancy, or challenges accessing prenatal care; not having a co-resident spouse or partner; and experiencing intimate partner violence. After these and other risk factors were controlled for, depression remained associated with higher rates of preterm birth. Systematic screening and holistic approaches to prenatal care that address depression and associated risks could help reduce rates of preterm birth and other poor pregnancy outcomes.
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- 2020
14. Preeclampsia Risk and Prevention among Pregnant Medicaid Beneficiaries
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Brigette Courtot, Caitlin Cross-Barnet, Ian Hill, and Sarah Benatar
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Risk ,medicine.medical_specialty ,Cardiovascular health ,Mothers ,Preeclampsia ,Pre-Eclampsia ,Pregnancy ,medicine ,Ancillary care ,Humans ,Medical prescription ,Pregnancy outcomes ,Aspirin ,business.industry ,Medicaid ,Incidence (epidemiology) ,Public Health, Environmental and Occupational Health ,Infant, Newborn ,medicine.disease ,United States ,Family medicine ,Women's Health ,Female ,business ,medicine.drug - Abstract
Pregnancy-related hypertensive disorders can cause morbidity and mortality. Low-dose aspirin (LDA) reduces risk. This paper aims to assess Medicaid beneficiaries' risk factors for preeclampsia and their providers' clinical use of LDA in the federal Strong Start for Mothers and Newborns II initiative. Twenty-seven awardees with more than 200 care sites served almost 46,000 women. This mixed-methods analysis assesses rates of risks, incidence of pregnancy-related hypertensive disorders, and assessment of care teams' LDA knowledge and reported prescription practices. Many Strong Start participants had risk factors that merited LDA, but most practices reported inconsistent or non-existent prescribing. Use varied within the three care models and among all provider types. Ancillary care team members often had no knowledge of LDA's benefits, resulting in lost opportunities for educating patients and assessing adherence to LDA use. Clear policies and well-integrated care teams could increase evidence-based use, improve pregnancy outcomes, and promote women's lifelong cardiovascular health.
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- 2021
15. Midwifery and Birth Centers Under State Medicaid Programs: Current Limits to Beneficiary Access to a High‐Value Model of Care
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Brigette Courtot, Ian Hill, Jenny Markell, and Caitlin Cross-Barnet
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medicine.medical_specialty ,business.industry ,Obstetrics ,030503 health policy & services ,Health Policy ,Original Scholarship ,Public Health, Environmental and Occupational Health ,Context (language use) ,Prenatal care ,03 medical and health sciences ,0302 clinical medicine ,Unfunded mandate ,Natural Birth ,Medicine ,Managed care ,030212 general & internal medicine ,0305 other medical science ,business ,Psychosocial ,Medicaid ,Reimbursement ,health care economics and organizations - Abstract
Policy Points Birth center services must be covered under Medicaid per federal mandate, but reimbursement and other policy barriers prevent birth centers from serving more Medicaid patients. Midwifery care provided through birth centers improves maternal and infant outcomes and lowers costs for Medicaid beneficiaries. Birth centers offer an array of birth options and have resources to care for patients with medical and psychosocial risks. Addressing the barriers identified in this study would promote birth centers' participation in Medicaid, leading to better outcomes for Medicaid-covered mothers and newborns and significant savings for the Medicaid program. Context Midwifery care, particularly when offered through birth centers, has shown promise in both improving pregnancy outcomes and containing costs. The national evaluation of Strong Start for Mothers and Newborns II, an initiative that tested enhanced prenatal care models for Medicaid beneficiaries, found that women receiving prenatal care at Strong Start birth centers experienced superior birth outcomes compared to matched and adjusted counterparts in typical Medicaid care. We use qualitative evaluation data to investigate birth centers' experiences participating in Medicaid, and identify policies that influence Medicaid beneficiaries' access to midwives and birth centers. Methods We analyzed data from more than 200 key informant interviews and 40 focus groups conducted during four case study rounds; a phone-based survey of Medicaid officials in Strong Start states; and an Internet-based survey of birth center sites. We identified themes related to access to midwives and birth centers, focusing on influential Medicaid policies. Findings Medicaid beneficiaries chose birth center care because they preferred midwife providers, wanted a more natural birth experience, or in some cases sought certain pain relief methods or birth procedures not available at hospitals. However, Medicaid enrollees currently have less access to birth centers than privately insured women. Many birth centers have difficulty contracting with managed care organizations and participating in Medicaid value-based delivery system reforms, and birth center reimbursement rates are sometimes too low to cover the actual cost of care. Some birth centers significantly limit Medicaid business because of low reimbursement rates and threats to facility sustainability. Conclusions Medicaid beneficiaries do not have the same access to maternity care providers and birth settings as their privately insured counterparts. Medicaid policy barriers prevent some birth centers from serving more Medicaid patients, or threaten the financial sustainability of centers. By addressing these barriers, more Medicaid beneficiaries could access care that is associated with positive birth outcomes for mothers and newborns, and the Medicaid program could reap significant savings.
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- 2020
16. Improving Birth Outcomes And Lowering Costs For Women On Medicaid: Impacts Of 'Strong Start For Mothers And Newborns'
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Lisa, Dubay, Ian, Hill, Bowen, Garrett, Fredric, Blavin, Emily, Johnston, Embry, Howell, Justin, Morgan, Brigette, Courtot, Sarah, Benatar, and Caitlin, Cross-Barnet
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Cesarean Section ,Medicaid ,Pregnancy ,Infant, Newborn ,Humans ,Infant ,Mothers ,Premature Birth ,Female ,Maternal Health Services ,Prenatal Care ,United States - Abstract
The federal Strong Start for Mothers and Newborns initiative supported alternative approaches to prenatal care, enhancing service delivery through the use of birth centers, group prenatal care, and maternity care homes. Using propensity score reweighting to control for medical and social risks, we evaluated the impacts of Strong Start's models on birth outcomes and costs by comparing the experiences of Strong Start enrollees to those of Medicaid-covered women who received typical prenatal care. We found that women who received prenatal care in birth centers had lower rates of preterm and low-birthweight infants, lower rates of cesarean section, and higher rates of vaginal birth after cesarean than did the women in the comparison groups. Improved outcomes were achieved at lower costs. There were few improvements in outcomes for participants who received group prenatal care, although their costs were lower in the prenatal period, and no improvements in outcomes for participants in maternity care homes.
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- 2020
17. Twin Births in Medicaid: Prevalence, Outcomes, Utilization, and Cost in Four States, 2014-2015
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Caitlin Cross-Barnet, Paul G. Johnson, and Embry Howell
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medicine.medical_specialty ,Epidemiology ,Population ,Twins ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Intensive care ,Health care ,medicine ,Prevalence ,Humans ,Maternal Health Services ,030212 general & internal medicine ,education ,health care economics and organizations ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,Singleton ,Medicaid ,Public health ,Incidence (epidemiology) ,Public Health, Environmental and Occupational Health ,Pregnancy Outcome ,Obstetrics and Gynecology ,Gestational age ,Health Care Costs ,United States ,Pediatrics, Perinatology and Child Health ,Female ,business ,Demography - Abstract
Twin births have increased in prevalence. Twin births are more likely to have poorer outcomes than singleton births and are more costly. However, although Medicaid paid for approximately half of U.S. births in 2016, little is known specifically about the incidence of twin births and related costs for Medicaid beneficiaries. This paper seeks to expand the knowledge of twin births covered by Medicaid. We obtained data for singleton (N = 115,568) and twin (N = 3775) Medicaid-covered births in selected geographic areas of four states in 2014 and 2015. States provided linked birth certificates to Medicaid claims data for mothers and infants. We compared health care utilization and Medicaid costs for twins to singletons in the same geographic areas. The prevalence of Medicaid twins in the selected areas of these four states was 3.2% of births, identical to the rate of twins nationwide. Two thirds of Medicaid twins were born preterm, and average gestational age was 34.8 weeks. Mothers of twins had higher rates of C-Sect. (73.6% vs. 32.0% for singletons) and of neonatal intensive care use (45.2% vs. 11.1%). The average length of delivery stay for twins was 12.3 days, vs. 4.1, and the rate of hospital readmissions was almost twice as high. The total cost for mother and infant over the prenatal, delivery, and post-natal period for a pair of twins was $48,479, over two and a half times as high as for singleton births ($18,032). However, when considering the average cost of a single twin vs. a singleton birth, the cost differential is less ($24,239 vs. $18,032, or a ratio of 1.34). Medicaid twins are a fragile population with poorer outcomes and higher service use than singleton infants. Twins contribute substantially to the Medicaid cost of maternity and newborn care. A variety of strategies can be used to improve twin outcomes and reduce costs.
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- 2020
18. Inequality and Innovation: Barriers and Facilitators to 17P Administration to Prevent Preterm Birth among Medicaid Participants
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Ian Hill, Brigette Courtot, Morgan Cheeks, Emily M. Johnston, Caitlin Cross-Barnet, and Sarah Benatar
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Adult ,medicine.medical_specialty ,Scope of practice ,Epidemiology ,Population ,Psychological intervention ,Mothers ,Prenatal care ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Intervention (counseling) ,17 alpha-Hydroxyprogesterone Caproate ,Hydroxyprogesterones ,Humans ,Medicine ,030212 general & internal medicine ,Healthcare Disparities ,education ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Medicaid ,business.industry ,Public health ,Puerto Rico ,Infant, Newborn ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Prenatal Care ,United States ,Health equity ,Socioeconomic Factors ,Family medicine ,District of Columbia ,Pediatrics, Perinatology and Child Health ,Premature Birth ,Female ,business - Abstract
Objectives Strategies to prevent preterm birth are limited. 17 Alpha-Hydroxyprogesterone Caproate (17P) injections have been shown to be effective, but the intervention is under-used. This mixed methods study investigates barriers and facilitators to 17P administration among Medicaid and CHIP participants enrolled in Strong Start for Mothers and Newborns, a federal preterm birth prevention program. Methods Twenty-seven awardees with more than 200 sites in 30 states, the District of Columbia, and Puerto Rico enrolled approximately 46,000 women in Strong Start from 2013 to 2016. Participant data, including data on preterm birth and 17P, was collected for each woman. Intensive interviews (n = 211) conducted with Strong Start program staff and providers (n = 314) included questions about 17P provision. Results Of women whose data included a valid response regarding 17P initiation, 3919 had a prior preterm birth and current singleton pregnancy; 14.95% received 17P. Barriers to 17P administration include late entry to prenatal care, administrative burden of preauthorization, cost risks to providers, limits in scope of practice for non-physician providers, and social barriers among participants. Facilitators for provision include streamlined work flows and the option of home administration. Conclusions for Practice A universal insurance authorization process could mitigate many barriers to 17P use. Providers need continuing education regarding the effectiveness of 17P, and expanding scope of practice for non-physician prenatal care providers would increase access. Targeted program interventions can help to overcome social barriers Medicaid participants face in accessing care. Streamlined work processes and the option of home health services are two effective program-based facilitators for providing 17P to a Medicaid population.
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- 2018
19. Facilitators and Barriers to Healthy Pregnancy Spacing among Medicaid Beneficiaries: Findings from the National Strong Start Initiative
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Brigette Courtot, Jenny Markell, Caitlin Cross-Barnet, Sarah Benatar, Morgan Cheeks, and Ian Hill
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Adult ,medicine.medical_specialty ,Health (social science) ,Mothers ,Sex Education ,Prenatal care ,Medicare ,Centers for Medicare and Medicaid Services, U.S ,Young Adult ,03 medical and health sciences ,Birth Intervals ,0302 clinical medicine ,Pregnancy ,Maternity and Midwifery ,medicine ,Humans ,030212 general & internal medicine ,Qualitative Research ,030219 obstetrics & reproductive medicine ,Medicaid ,business.industry ,Medical record ,Postpartum Period ,Infant, Newborn ,Public Health, Environmental and Occupational Health ,Infant ,Obstetrics and Gynecology ,Prenatal Care ,Focus Groups ,medicine.disease ,Focus group ,United States ,Family planning ,Family Planning Services ,Family medicine ,Premature Birth ,Female ,business ,Postpartum period ,Qualitative research - Abstract
Background Closely spaced, unintended pregnancies are common among Medicaid beneficiaries and create avoidable risks for women and infants, including preterm birth. The Strong Start for Mothers and Newborns Initiative, a program of the Center for Medicare and Medicaid Innovation, intended to prevent preterm birth through psychosocially based enhanced prenatal care in maternity care homes, group prenatal care, and birth centers. Comprehensive care offers the opportunity for education and family planning to promote healthy pregnancy spacing. Methods As of March 30, 2016, there were 42,138 women enrolled in Strong Start and 23,377 women had given birth. Individual-level data were collected through three participant survey instruments and a medical chart review, and approximately one-half of women who had delivered (n = 10,374) had nonmissing responses on a postpartum survey that asked about postpartum family planning. Qualitative case studies were conducted annually for the first 3 years of the program and included 629 interviews with staff and 122 focus groups with 887 Strong Start participants. Results Most programs tried to promote healthy pregnancy spacing through family planning education and provision with some success. Group care sites in particular established protocols for patient-centered family planning education and decision making. Despite program efforts, however, barriers to uptake remained. These included state and institutional policies, provider knowledge and bias, lack of protocols for timing and content of education, and participant issues such as transportation or cultural preferences. Conclusions The Strong Start initiative introduced a number of successful strategies for increasing women's knowledge regarding healthy pregnancy spacing and access to family planning. Multiple barriers can impact postpartum Medicaid participants' capacity to plan and space pregnancies, and addressing such issues holistically is an important strategy for facilitating healthy interpregnancy intervals.
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- 2018
20. A Qualitative Study of Black Married Couples’ Relationships With Their Extended Family Networks
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Caitlin Cross-Barnet, Noelle M. St. Vil, and Katrina Bell McDonald
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050402 sociology ,0504 sociology ,050902 family studies ,05 social sciences ,Extended family ,0509 other social sciences ,Psychology ,Social Sciences (miscellaneous) ,Developmental psychology ,Qualitative research - Abstract
Historically extended family networks have been identified as contributing to the resiliency of Black families. However, little is known about how extended family networks impact the lives of Black married couples. What we do know largely stems from quantitative research. Using a thematic analysis of qualitative interviews, we examine extended family network relationships among 47 Black couples from the Contemporary Black Marriage Study who had been married for more than 5 years. Black married couples’ relationship with extended family networks affects the marriage through the following acts: (a) extended family living, (b) childcare, (c) advice and emotional support, and (d) interfamilial conflict. The four themes influenced Black marriages in various ways. This study has implications for social workers working with married couples.
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- 2018
21. Strategies to Promote Postpartum Visit Attendance Among Medicaid Participants
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Diana Rodin, Sharon Silow-Carroll, Brigette Courtot, Ian Hill, and Caitlin Cross-Barnet
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Postnatal Care ,medicine.medical_specialty ,Prenatal care ,Health Promotion ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Depression (differential diagnoses) ,Qualitative Research ,Reproductive health ,business.industry ,Medicaid ,Postpartum Period ,Attendance ,Infant, Newborn ,Prenatal Care ,General Medicine ,Continuity of Patient Care ,Focus Groups ,Focus group ,United States ,030227 psychiatry ,Incentive ,Family medicine ,Survey data collection ,Female ,business ,Program Evaluation - Abstract
Background: Postpartum care is important for promoting maternal and infant health and well-being. Nationally, less than 60% of Medicaid-enrolled women attend their postpartum visit. The Strong Start for Mothers and Newborns II Initiative, an enhanced prenatal care program, intended to improve birth outcomes among Medicaid beneficiaries, enrolled 45,599 women, and included a variety of approaches to increasing engagement in postpartum care. Methods: This study analyzes qualitative case studies that include coded notes from 739 interviews with 1,074 key informants and 133 focus groups with 951 women; 4 years of annual memos capturing activities by each of 27 awardees and 24 Birth Center sites; and a review of interview and survey data from Medicaid officials in 20 states. Results: Strong Start prenatal care included education and support regarding postpartum care and concerns. Key informants identified Strong Start services and other strategies they perceived as increasing access to postpartum care, including provider and/or care coordinator continuity across prenatal, delivery, and postpartum visits; efforts to address information gaps and link women to appropriate resources; enhancing services to meet needs such as treatment for depression; addressing barriers related to transportation and childcare; and aligning incentives to encourage prioritization of postpartum care among patients and providers. They also identified ongoing barriers to postpartum visit attendance. Conclusions: Postpartum care is essential to maternal and infant health. Medicaid enrolls many high-risk women and is the largest payer for postpartum care. Using lessons from Strong Start, providers who serve Medicaid-enrolled women can advance strategies to improve postpartum visit access and attendance.
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- 2019
22. Key Considerations for Implementing Group Prenatal Care: Lessons from 60 Practices
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Margaret Kirkegaard, Sharon Silow-Carroll, Brigette Courtot, Caitlin Cross-Barnet, Ian Hill, and Jodi Pekkala
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Attitude of Health Personnel ,Psychological intervention ,Graduate medical education ,Prenatal care ,Peer support ,Midwifery ,Grounded theory ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Pregnancy ,Maternity and Midwifery ,Humans ,030212 general & internal medicine ,Qualitative Research ,Patient Care Team ,030219 obstetrics & reproductive medicine ,Health Plan Implementation ,Obstetrics and Gynecology ,Prenatal Care ,Focus Groups ,Focus group ,Female ,Psychology ,Medicaid ,Psychosocial - Abstract
Introduction Group prenatal care combines clinical care with peer support and education. Research has indicated neutral or positive results for group care when compared with traditional individual prenatal visits. A national initiative, Strong Start II, was implemented to determine if specific prenatal care interventions such as group prenatal care can reduce the rate of preterm birth, improve health outcomes, and lower costs. This study explored barriers to implementation and sustainability and strategies for overcoming barriers and sustaining the model. Methods Results from prenatal care provider-level qualitative case studies for the independent evaluation of Strong Start were examined. Case studies for sites implementing group prenatal care were based on a total of 313 interviews with 441 Strong Start key informants (eg, prenatal care providers, project staff, and health administrators involved in group care) and 53 focus groups with 428 Strong Start participants from 2013 to 2016. Supplemental interviews with 25 additional stakeholders were also conducted. Case study data were queried using content analysis followed by a grounded theory-based analysis of these findings. Results Barriers to implementation existed at patient, provider, administrator, system, and funding levels and included inflexible appointment times, lack of childcare, lack of appropriate meeting space, new scheduling and training needs, meeting requirements of graduate medical education programs, prenatal care provider and administrator reluctance to adopt new practices, and Medicaid payment policies. Sites newly implementing group prenatal care had varying degrees of success sustaining their programs. Both new and established sites identified provider champions and opt-out enrollment approaches as critical for maintaining buy-in. Discussion Successful implementation of group prenatal care depends on systematic strategies at the practice, payer, provider, patient, and policy levels to implement, reimburse for, and sustain the model. Strategies for overcoming barriers can assist practices in offering this transformative approach, including practices with graduate medical education programs or those serving women with clinical, demographic, or psychosocial risk factors for preterm birth.
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- 2019
23. What do women in Medicaid say about enhanced prenatal care? Findings from the national Strong Start evaluation
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Ian Hill, Caitlin Cross-Barnet, Brigette Courtot, Sarah Thornburgh, and Sarah Benatar
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Adult ,medicine.medical_specialty ,Maternal-Child Health Services ,Breastfeeding ,Mothers ,Prenatal care ,Birthing Centers ,Centers for Medicare and Medicaid Services, U.S ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Pregnancy ,Risk Factors ,medicine ,Humans ,030212 general & internal medicine ,Qualitative Research ,030219 obstetrics & reproductive medicine ,business.industry ,Medicaid ,Postpartum Period ,Infant, Newborn ,Obstetrics and Gynecology ,Prenatal Care ,Focus Groups ,medicine.disease ,Focus group ,United States ,Family planning ,Patient Satisfaction ,Family medicine ,Premature Birth ,Female ,business ,Psychosocial ,Patient education - Abstract
Background Medicaid pays for approximately half of United States births, yet little research has explored Medicaid beneficiaries' perspectives on their maternity care. Typical maternity care in the United States has been criticized as too medically focused while insufficiently addressing psychosocial risks and patient education. Enhanced care strives for a more holistic approach. Methods The perspectives of participants in the Strong Start for Mothers and Newborns II initiative, which provided enhanced prenatal care to women covered by Medicaid or the Children's Health Insurance Program (CHIP) during pregnancy through Birth Centers, Group Prenatal Care, and Maternity Care Homes, are evaluated. Strong Start intended to improve care quality and birth outcomes while lowering costs. We analyzed data from 133 focus groups with 951 pregnant or postpartum women who participated in Strong Start from 2013 to 2017. Results The majority of focus group participants said that Strong Start's enhanced care offered numerous important benefits over typical maternity care, including considerably more focus on women's psychosocial risk factors and need for education. They praised increased support; nutrition, breastfeeding, and family planning education; community referrals; longer time with practitioners; and involvement of partners in their care. Maternity Care Home participants, however, occasionally voiced concerns over lack of practitioner continuity and short clinical appointments, whereas Group Prenatal Care participants sometimes said they could not attend visits because of lack of childcare. Conclusions Medicaid and CHIP beneficiaries reported positive experiences with Strong Start care. If more Medicaid practitioners could adopt aspects of the prenatal care approaches that women praised most, it is likely that women's risk factors could be more effectively addressed and their overall care experiences could be improved.
- Published
- 2018
24. BARRIERS AND FACILITATORS TO DEPRESSION SCREENING IN OLDER ADULTS: A QUALITATIVE STUDY
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Erin M. Colligan, Caitlin Cross-Barnet, Jennifer T. Lloyd, and Jessica McNeely
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Male ,medicine.medical_specialty ,Health (social science) ,genetic structures ,media_common.quotation_subject ,Social Stigma ,Beneficiary ,Stigma (botany) ,Medicare ,Health Professions (miscellaneous) ,03 medical and health sciences ,Abstracts ,0302 clinical medicine ,Quality of life (healthcare) ,Honesty ,medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,Life-span and Life-course Studies ,Depression (differential diagnoses) ,Qualitative Research ,media_common ,Aged ,Aged, 80 and over ,Physician-Patient Relations ,030214 geriatrics ,Depression ,Focus Groups ,Middle Aged ,Depression screening ,Focus group ,United States ,030227 psychiatry ,Psychiatry and Mental health ,Mental Health ,Caregivers ,Family medicine ,Grounded Theory ,Quality of Life ,Female ,Geriatrics and Gerontology ,Pshychiatric Mental Health ,Psychology ,Gerontology ,030217 neurology & neurosurgery ,Clinical psychology ,Qualitative research - Abstract
Nearly thirteen percent of adults aged 65 and older experience symptoms of depression. Despite the wide availability of effective treatments, depression in older adults remains underdiagnosed and undertreated. Depression is associated with loss in functional status and quality of life, and is a leading cause of loss in quality-adjusted life years in older adults. In order to better understand facilitators and barriers to depression screening for older adults, we conducted 43 focus groups with 106 providers and 247 beneficiaries or proxies: 13 focus groups with Medicare providers, 28 with older Medicare beneficiaries, and 2 with caregivers of older Medicare beneficiaries. There was widespread consensus among patient and provider focus group participants that depression screening was important. However, several barriers interfered with effective depression screening, including stigma, lack of resources for treatment referrals, and lack of time during medical encounters. Having an established relationship with and trust in a provider was the primary facilitator for depression screening. Providers that took the time to put their patients at ease and used lay language rather than clinical terms seemed to have more success getting their patients to open up about depression. Respondents stressed the need for providers to be attentive, concerned, non-judgmental, and respectful. Based on these findings, using person-centered approaches that build positive communication and trust between patients and providers could be an effective strategy for improving depression screening. Better screening can lead to higher rates of diagnosis and ultimately treatment of depression and enhanced quality of life in older adults.
- Published
- 2018
25. Living Together Apart : vivre ensemble séparés. Une comparaison France – États-Unis
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Claude Martin, Andrew Cherlin, and Caitlin Cross-Barnet
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- 2016
26. It’s All about the Children: An Intersectional Perspective on Parenting Values among Black Married Couples in the United States
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Katrina Bell McDonald and Caitlin Cross-Barnet
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Intersectionality ,Poverty ,media_common.quotation_subject ,Perspective (graphical) ,Immigration ,General Social Sciences ,Gender studies ,families ,Black/African American ,Social class ,United States ,Race (biology) ,Political science ,Marital status ,lcsh:H1-99 ,lcsh:Social sciences (General) ,social class ,intersectionality ,immigration ,Demography ,media_common ,Diversity (politics) - Abstract
Black families in the United States are usually studied from a deficit perspective that primarily considers single parents in poverty. There is, however, considerable diversity among American Black families in terms of social class, immigration status, marital status, and parenting values and practices. Using data from the Contemporary Black Marriage Study, a study of young married couples who are native-born Black, African immigrants, or Caribbean immigrants, this research examines childbearing and parenting values from an intersectional perspective. A sample of whites is included for comparison purposes. The research considers impacts of social class, immigration, gender, and race as well as structural influences. Diversity exists both within and among social and demographic groups.
- Published
- 2015
27. Pregnant women with opioid use disorder and their infants in three state Medicaid programs in 2013-2016
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Paul G. Johnson, Lisa Clemans-Cope, Justin Morgan, Caitlin Cross-Barnet, Nikhil Holla, Embry Howell, J. Alice Thompson, Victoria Lynch, and Ian Hill
- Subjects
Adult ,medicine.medical_specialty ,Prenatal care ,Toxicology ,Pregnancy ,Health care ,Medicine ,Humans ,Pharmacology (medical) ,health care economics and organizations ,Pharmacology ,business.industry ,Medicaid ,Infant, Newborn ,Infant ,Opioid use disorder ,medicine.disease ,Opioid-Related Disorders ,United States ,Substance abuse ,Pregnancy Complications ,Psychiatry and Mental health ,Low birth weight ,Family medicine ,Prenatal Exposure Delayed Effects ,Female ,medicine.symptom ,business ,Neonatal Abstinence Syndrome ,Methadone ,medicine.drug - Abstract
Background Maternal opioid use disorder (OUD) has serious consequences for maternal and infant health. Analysis of Medicaid enrollee data is critical, since Medicaid bears a disproportionate share of costs. Methods This study analyzes linked maternal and infant Medicaid claims data and infant birth records in three states in the year before and after a delivery in 2014–2015 (2013–2016) examining health, health care use, treatment, and neonatal outcomes. Diagnosis and procedure codes identify OUD and other substance use disorders (SUDs). Results In the year before and after delivery, 2.2 percent of the sample had an OUD diagnosis, and 5.9 percent had a SUD diagnosis other than OUD. Of the women with OUD, 72.8% had treatment for a SUD in the year before and after delivery, but most had none in an average enrolled month, and only 8.8% received any methadone treatment in a given month. Pregnant women with OUD had delayed and lower rates of prenatal care compared to women with other substance use disorders (SUDs). Infants of mothers with OUD did not differ from infants of mothers with other SUDs in rate of preterm or low birth weight but had higher NICU admission rates and longer birth hospitalizations. Health care costs for women with an OUD were higher than those with other SUDs. Conclusions There is an urgent need for comprehensive, evidence-based OUD treatment integrated with maternity care. To fill critical gaps in care, workforce and infrastructure innovations can facilitate delivery of preventive and treatment services coordinated across settings.
- Published
- 2018
28. A Framework for Rigorous Qualitative Research as a Component of Mixed Method Rapid-Cycle Evaluation
- Author
-
Sarah Ruiz, Rachel Friedman Singer, Caitlin Cross-Barnet, Christina Rotondo, Megan Skillman, and Adil Moiduddin
- Subjects
Research design ,Medical Assistance ,030504 nursing ,Management science ,Computer science ,business.industry ,Public Health, Environmental and Occupational Health ,Qualitative property ,Rapid assessment ,Test (assessment) ,03 medical and health sciences ,0302 clinical medicine ,Research Design ,Component (UML) ,Health care ,Humans ,030212 general & internal medicine ,Health Services Research ,0305 other medical science ,business ,Qualitative Research ,Coding (social sciences) ,Qualitative research - Abstract
As federal, state, and local governments continue to test innovative approaches to health care delivery, the ability to produce timely and reliable evidence of what works and why it works is crucial. There is limited literature on methodological approaches to rapid-cycle qualitative research. The purpose of this article is to describe the advantages and limitations of a broadly applicable framework for in-depth qualitative analysis placed within a larger rapid-cycle, multisite, mixed-method evaluation. This evaluation included multiple cycles of primary qualitative data collection and quarterly and annual reporting. Several strategies allowed us to be adaptable while remaining rigorous; these included planning for multiple waves of qualitative coding, a hybrid inductive/deductive approach informed by a cross-program evaluation framework, and use of a large team with specific program expertise. Lessons from this evaluation can inform researchers and evaluators functioning in rapid assessment or rapid-cycle evaluation contexts.
- Published
- 2018
29. Facilitators and barriers to optimal preventive service use among providers and older patients
- Author
-
Erin M. Colligan, Caitlin Cross-Barnet, Larisa M. Strawbridge, Jessica McNeely, and Jennifer T. Lloyd
- Subjects
Male ,Health Knowledge, Attitudes, Practice ,Time Factors ,Health Personnel ,Beneficiary ,Qualitative property ,Preventive service ,Medicare ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Older patients ,Surveys and Questionnaires ,Health care ,Preventive Health Services ,Health insurance ,Humans ,030212 general & internal medicine ,Early Detection of Cancer ,Aged ,business.industry ,Patient Protection and Affordable Care Act ,Focus Groups ,Middle Aged ,Focus group ,Waiver ,United States ,Female ,Business ,Gerontology ,030217 neurology & neurosurgery - Abstract
Preventive service use remains low among Medicare beneficiaries despite the Affordable Care Act's waiver of coinsurance. This study sought to understand barriers and facilitators to preventive service provision, access, and uptake. We used a mixed methods approach synthesizing quantitative survey and qualitative focus group data. Self-reported utilization of and factors related to preventive services were explored using quantitative data from the 2012 Medicare Current Beneficiary Survey. Qualitative data from 16 focus groups conducted in 2016 with a range of providers, health advocates, and Medicare beneficiaries explored perspectives on preventive service use. Providers indicated time and competing priorities as factors for not offering patients a full range of preventive services, while beneficiaries reported barriers related to knowledge, perception, and trust. Current healthcare reform efforts incorporating team-based care, nurses and other non-physician providers, and coordinated electronic health records could support enhanced use of preventive services if fully implemented and utilized.
- Published
- 2018
- Full Text
- View/download PDF
30. Prescription Drug Use and Cost Trends Among Medicaid-Enrolled Children with Disruptive Behavioral Disorders
- Author
-
Lirong Zhao, Caitlin Cross-Barnet, and Vetisha L. Mcclair
- Subjects
Adult ,Male ,medicine.medical_specialty ,Health (social science) ,Prescription drug ,Prescription Drugs ,Adolescent ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Age Distribution ,Health care ,medicine ,Ethnicity ,Humans ,0501 psychology and cognitive sciences ,Medical prescription ,Sex Distribution ,Child ,health care economics and organizations ,Retrospective Studies ,business.industry ,Medicaid ,Health Policy ,Public health ,05 social sciences ,Public Health, Environmental and Occupational Health ,Infant ,Mental health ,Drug Utilization ,United States ,030227 psychiatry ,Health psychology ,Prescription costs ,Attention Deficit and Disruptive Behavior Disorders ,Family medicine ,Child, Preschool ,Female ,business ,050104 developmental & child psychology ,Antipsychotic Agents - Abstract
Disruptive behavior disorders (DBDs) are the most common mental health conditions in children. These conditions profoundly affect healthcare utilization and costs. Service use, costs, and diagnostic trends among pediatric Medicaid beneficiaries provide information regarding healthcare quality and potential for smarter spending. Using nationwide Medicaid administrative data, this study investigates diagnoses, prescription drug fills, and payments in 49 states and D.C. from 2006 to 2009 in Medicaid beneficiaries age 20 and under. Psychotherapeutic drug prescriptions and payments were calculated as a proportion of prescription totals. Results were considered by age, gender, race, and state. The results show a trend of increasing DBD diagnosis. Among prescription claims for children with diagnosed DBD, psychotherapeutic drug claims represented 30-40% of prescription claims but over half of prescription costs. This study indicates increasing clinical and financial needs for Medicaid-enrolled children with DBDs. Medicaid could potentially foster reforms in pediatric DBD treatments, particularly regarding medication use.
- Published
- 2018
31. Marriage in Black : The Pursuit of Married Life Among American-born and Immigrant Blacks
- Author
-
Katrina Bell McDonald, Caitlin Cross-Barnet, Katrina Bell McDonald, and Caitlin Cross-Barnet
- Subjects
- Married people--United States, African American couples, African Americans--Social conditions, Marriage--United States
- Abstract
Despite the messages we hear from social scientists, policymakers, and the media, black Americans do in fact get married—and many of these marriages last for decades. Marriage in Black offers a progressive perspective on black marriage that rejects talk of black relationship'pathology'in order to provide an understanding of enduring black marriage that is richly lived. The authors offer an in-depth investigation of details and contexts of black married life, and seek to empower black married couples whose intimate relationships run contrary to common—but often inaccurate—stereotypes. Considering historical influences from Antebellum slavery onward, this book investigates contemporary married life among more than 60 couples born after the passage of the Civil Rights Act. Husbands and wives tell their stories, from how they met, to how they decided to marry, to what their life is like five years after the wedding and beyond. Their stories reveal the experiences of the American-born and of black immigrants from Africa or the Caribbean, with explorations of the'ideal'marriage, parenting, finances, work, conflict, the criminal justice system, religion, and race. These couples show us that black family life has richness that belies common stereotypes, with substantial variation in couples'experiences based on social class, country of origin, gender, religiosity, and family characteristics.
- Published
- 2018
32. Innovative Home Visit Models Associated With Reductions In Costs, Hospitalizations, And Emergency Department Use
- Author
-
Christina Rotondo, Erin M. Colligan, Katherine Giuriceo, Caitlin Cross-Barnet, Lynne Page Snyder, and Sarah Ruiz
- Subjects
Special populations ,education ,Primary care ,Medicare ,03 medical and health sciences ,0302 clinical medicine ,Cost Savings ,Medicine ,Humans ,030212 general & internal medicine ,health care economics and organizations ,Primary Health Care ,business.industry ,030503 health policy & services ,Health Policy ,Multicomponent interventions ,Fee-for-Service Plans ,Emergency department ,medicine.disease ,United States ,Cost savings ,Hospitalization ,House Calls ,Home visits ,Female ,Medical emergency ,Health Expenditures ,0305 other medical science ,business ,Emergency Service, Hospital - Abstract
While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits. Two models achieved significant reductions in Medicare expenditures, and three models reduced utilization in the form of emergency department visits, hospitalizations, or both for beneficiaries relative to comparators. These findings present a strong case for the potential value of home visits by practice-extender teams to reduce Medicare expenditures and service use in a particularly vulnerable and costly segment of the Medicare population.
- Published
- 2017
33. Innovative Oncology Care Models Improve End-Of-Life Quality, Reduce Utilization And Spending
- Author
-
Michelle Spafford, Erin R. Ewald, Erin M. Colligan, Shriram Parashuram, Sarah Ruiz, and Caitlin Cross-Barnet
- Subjects
Medical home ,Oncology ,Male ,medicine.medical_specialty ,Palliative care ,Life quality ,Medical Oncology ,Medicare ,03 medical and health sciences ,0302 clinical medicine ,Ambulatory care ,Cost Savings ,Internal medicine ,Patient-Centered Care ,Health care ,medicine ,Humans ,Patient Navigation ,030212 general & internal medicine ,health care economics and organizations ,Aged ,Retrospective Studies ,business.industry ,Health Policy ,Palliative Care ,Emergency department ,United States ,Hospitalization ,Hospice Care ,030220 oncology & carcinogenesis ,Family medicine ,Quality of Life ,Female ,business ,Emergency Service, Hospital ,Medicaid ,End-of-life care - Abstract
Three models that received Health Care Innovation Awards from the Centers for Medicare and Medicaid Services (CMS) aimed to reduce the cost and use of health care services and improve the quality of care for Medicare beneficiaries with cancer. Each emphasized a different principle: the oncology medical home, patient navigation, or palliative care. Comparing participants in each model who died during the study period to matched comparators, we found that the oncology medical home and patient navigation models were associated with decreased costs in the last ninety days of life ($3,346 and $5,824 per person, respectively) and fewer hospitalizations in the last thirty days of life (fifty-seven and forty per 1,000 people, respectively). The patient navigation model was also associated with fewer emergency department visits in the last thirty days of life and increased hospice enrollment in the last two weeks of life. These promising results can inform new initiatives for cancer patients, such as the CMS Oncology Care Model.
- Published
- 2017
34. Physician Engagement Strategies in Care Coordination: Findings from the Centers for Medicare & Medicaid Services’ Health Care Innovation Awards Program
- Author
-
Erin M. Colligan, Rachel Friedman Singer, Christina Rotondo, Adil Moiduddin, Caitlin Cross-Barnet, Megan Skillman, Katherine Giuriceo, Lynne Page Snyder, Sarah Ruiz, and Roy Ahn
- Subjects
Medicare/medicaid ,Psychological intervention ,Qualitative property ,Centers for Medicare and Medicaid Services, U.S ,Interviews as Topic ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Physicians ,Health care ,Medicine ,Humans ,030212 general & internal medicine ,Physician's Role ,Care Coordination and Teamwork ,Data collection ,business.industry ,030503 health policy & services ,Health Policy ,Principal (computer security) ,Continuity of Patient Care ,Organizational Innovation ,United States ,Outreach ,Thematic analysis ,0305 other medical science ,business ,Delivery of Health Care - Abstract
Objective To identify roles physicians assumed as part of new health care delivery models and related strategies that facilitated physician engagement across 21 Health Care Innovation Award (HCIA) programs. Data Sources Site-level in-depth interviews, conducted from 2014 to 2015 (N = 672) with program staff, leadership, and partners (including 95 physicians) and direct observations. Study Design NORC conducted a mixed-method evaluation, including two rounds of qualitative data collected via site visits and telephone interviews. Data Collection/Extraction Methods We used qualitative thematic coding for data from 21 programs actively engaging physicians as part of HCIA interventions. Principal Findings Establishing physician champions and ensuring an innovation-values fit between physicians and programs, including the strategies programs employed, facilitated engagement. Among engagement practices identified in this study, tailoring team working styles to meet physician preferences and conducting physician outreach and education were the most common successful approaches. Conclusions We describe engagement strategies derived from a diverse range of programs. Successful programs considered physicians' values and engagement as components of process and policy, rather than viewing them as exogenous factors affecting innovation adoption. These types of approaches enabled programs to accelerate acceptance of innovations within organizations.
- Published
- 2016
35. Correction to: Inequality and Innovation: Barriers and Facilitators to 17P Administration to Prevent Preterm Birth among Medicaid Participants
- Author
-
Caitlin Cross-Barnet, Sarah Benatar, Brigette Courtot, Ian Hill, Emily Johnston, and Morgan Cheeks
- Subjects
Epidemiology ,Pediatrics, Perinatology and Child Health ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology - Abstract
The original version of this article unfortunately contained a mistake in the order of authors. The co-author "Sarah Benatar" should be the second author and "Brigette Courtot" should be the third author of the article.
- Published
- 2018
36. Long-Term Breastfeeding Support: Failing Mothers in Need
- Author
-
Susan M. Gross, David M. Paige, Caitlin Cross-Barnet, Marycatherine Augustyn, and Amy K. Resnik
- Subjects
Adult ,Postnatal Care ,Surgeon general ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Adolescent ,Epidemiology ,Breastfeeding ,Mothers ,Health Promotion ,Interviews as Topic ,Young Adult ,Social support ,Patient Education as Topic ,Nursing ,Pregnancy ,Surveys and Questionnaires ,Humans ,Medicine ,Misinformation ,Qualitative Research ,Quality of Health Care ,Maryland ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Infant ,Social Support ,Obstetrics and Gynecology ,Public Assistance ,Hospitals ,Breast Feeding ,Pediatrics, Perinatology and Child Health ,Female ,business ,Breast feeding ,Qualitative research - Abstract
This qualitative study analyzes mothers' reports of breastfeeding care experiences from pregnancy through infancy. Most research on medical support for breastfeeding examines a specific practice or intervention during an isolated phase of care. Little is know about how mothers experience breastfeeding education and support from the prenatal period through their child's first year. A convenience sample of 75 black and white WIC participants with infants was recruited at three Maryland WIC agencies. In-depth interviews covered mothers' comprehensive experiences of breastfeeding education and support from pregnancy through the interview date. Most mothers received education or support from a medical professional prenatally, at the hospital, or during the child's infancy, but most also reported receiving no education or support at one or more of these stages. Mothers often felt provided education and support was cursory and inadequate. Some mothers received misinformation or encountered practitioners who were hostile or indifferent to breastfeeding. Mothers were not given referrals to available resources, even after reporting breastfeeding challenges. Mothers received inconsistent messages regarding breastfeeding within and across institutions. Mothers need consistent, sustained information and support to develop and meet personal breastfeeding goals. Medical professionals should follow guidelines issued by their own organizations as well as those from the US Surgeon General, Healthy People 2020, and the Baby Friendly Hospital Initiative. Prenatal, postnatal, and pediatric care providers should coordinate to provide consistent messages and practices within and across sites of care.
- Published
- 2012
37. Bound by Children: Intermittent Cohabitation and Living Together Apart
- Author
-
Caitlin Cross-Barnet, Andrew J. Cherlin, and Linda M. Burton
- Subjects
Child rearing ,Family structure ,media_common.quotation_subject ,Shared parenting ,social sciences ,behavioral disciplines and activities ,Article ,Education ,Developmental psychology ,Interpersonal relationship ,Cohabitation ,Developmental and Educational Psychology ,Parenting styles ,Psychology ,Social psychology ,Social Sciences (miscellaneous) ,Diversity (politics) ,media_common - Abstract
In this article, we examine variations in low-income mothers' patterns of intermittent cohabitation and the voluntary and involuntary nature of these unions. Intermittent cohabitation involves couples living together and separating in repeating cycles. Using Three-City Study ethnographic data, we identified 45 low-income mothers involved in these arrangements, 18 of whom resided with their children's fathers occasionally while saying that they were not in a cohabiting relationship. We term such relationships living together apart (LTA). Data analysis revealed that distinct patterns of voluntary and involuntary separations and reunifications characterized intermittent cohabitation and LTA and that these relationships were shaped by the bonds that shared parenting created and the economic needs of both parents. We argue that these dimensions may explain some disparate accounts of cohabitation status in low-income populations. They also demonstrate previously unexplored diversity in cohabiting relationships and suggest further questioning contemporary definitions of families.
- Published
- 2011
38. Promises They Can Keep: Low-Income Women’s Attitudes Toward Motherhood, Marriage, and Divorce
- Author
-
Andrew J. Cherlin, Linda M. Burton, Raymond Garrett-Peters, and Caitlin Cross-Barnet
- Subjects
Poverty ,Human factors and ergonomics ,Poison control ,Proposition ,Suicide prevention ,Article ,Occupational safety and health ,Arts and Humanities (miscellaneous) ,Anthropology ,Injury prevention ,Survey data collection ,Psychology ,Social psychology ,Social Sciences (miscellaneous) - Abstract
Using survey data on low-income mothers in Boston, Chicago, and San Antonio (n = 1,722) supplemented with ethnographic data, we test 3 propositions regarding mothers’ attitudes toward childbearing, marriage, and divorce. These are drawn from Edin & Kefalas (2005) but have also arisen in other recent studies. We find strong support for the proposition that childbearing outside of marriage carries little stigma, limited support for the proposition that women prefer to have children well before marrying, and almost no support for the proposition that women hesitate to marry because they fear divorce. We suggest that mothers’ attitudes and preferences in these 3 domains do not support the long delay between childbearing and marriage that has been noted in the literature. Throughout, we are able to study attitudes among several Hispanic groups as well as among African Americans and non-Hispanic Whites.
- Published
- 2008
39. Living Together Apart in France and the United States
- Author
-
Claude, Martin, Andrew, Cherlin, and Caitlin, Cross-Barnet
- Subjects
Article - Abstract
Union formation involves a number of stages, as does union dissolution, and new couples often spend an initial period in a non-cohabiting intimate relationship. Yet while certain couples never share the same dwelling, “living apart together”1 has not developed widely as a long-term lifestyle option. Claude Martin in France, and Andrew Cherlin and Caitlin Cross-Barnet in the United States have studied a symmetrical phenomenon, that of couples who continue to live together while considering themselves to be separated. In this article, they draw together their analyses to describe an arrangement which, while marginal, reveals situations where residential separation is not possible, either because of the need to keep up appearances, often for the children’s sake, or because total separation is too frightening or living in separate homes is unaffordable. Beyond the differences between the two countries and the two survey fields, the authors analyse the ways in which persons who “live together apart” describe their loveless relationship that has led to explicit conjugal separation within a shared home.
- Published
- 2014
40. Blue-Chip Black: Race, Class, and Status in the New Black Middle Class - by Karyn R. Lacy
- Author
-
Caitlin Cross-Barnet and Katrina Bell McDonald
- Subjects
Class (set theory) ,Middle class ,Arts and Humanities (miscellaneous) ,Anthropology ,media_common.quotation_subject ,Sociology ,Black race ,Social Sciences (miscellaneous) ,Genealogy ,media_common - Published
- 2009
41. Early postpartum: a critical period in setting the path for breastfeeding success
- Author
-
Linda Kelly, Amy K. Resnik, David M. Paige, Caitlin Cross-Barnet, Marycatherine Augustyn, Joy Nanda, and Susan M. Gross
- Subjects
Adult ,medicine.medical_specialty ,Lactation consultant ,Breastfeeding ,Mothers ,Certification ,Pediatrics ,Nursing ,Standard care ,Pregnancy ,parasitic diseases ,Maternity and Midwifery ,Hospital discharge ,Medicine ,Humans ,Maternal Health Services ,Maternal Behavior ,Maryland ,business.industry ,Health Policy ,Critical Period, Psychological ,Postpartum Period ,Infant, Newborn ,Obstetrics and Gynecology ,Infant ,Breast Feeding ,Cross-Sectional Studies ,Socioeconomic Factors ,Family medicine ,Female ,Supplemental nutrition ,business ,Early postpartum - Abstract
In the United States, most mothers who initiate breastfeeding will either stop or begin supplementing with formula before their infants are 3 months old. Routine breastfeeding education and support following hospital discharge are critical to breastfeeding success. The purpose of this article is to identify this critical period for supporting and reinforcing breastfeeding.We will use data from participants enrolled in the Maryland State Program of the U.S. Department of Agriculture's Supplemental Nutrition Program for Women, Infants, and Children (WIC). This cross-sectional study will explore whether breastfeeding patterns during the period between birth and postnatal WIC certification differ by participation in a local WIC agency that provides breastfeeding peer counselor support (PC) versus two comparison groups, the lactation consultant (LC) and standard care (SC) groups.During 2007, 33,582 infants were enrolled in the Maryland State WIC program. Infant breastfeeding status was categorized as exclusively breastfeeding, partially breastfeeding, or not breastfeeding. At certification, 30.4% of infants were breastfeeding, 25.3% had been breastfed but had stopped before certification in WIC, and 44.3% never breastfed. The breastfeeding initiation rate was higher for the PC group compared with the LC and SC groups (61.6% vs. 54.4% and 47.6%, respectively; p 0.001). Participants in the PC group were more likely to certify as exclusively and partially breastfeeding compared with the LC and SC groups (36.0% vs. 24.8% and 25.3%, respectively; p 0.001).Our analysis identifies a window of opportunity during which targeted contact with breastfeeding mothers could enhance longer-term breastfeeding rates.
- Published
- 2011
42. The differential impact of WIC peer counseling programs on breastfeeding initiation across the state of Maryland
- Author
-
Caitlin Cross-Barnet, David M. Paige, Joy Nanda, Marycatherine Augustyn, Amy K. Resnik, and Susan M. Gross
- Subjects
Program evaluation ,Adult ,Counseling ,Male ,Pediatrics ,medicine.medical_specialty ,Lactation consultant ,Adolescent ,Breastfeeding ,Mothers ,Peer Group ,Odds ,Young Adult ,Odds Ratio ,Medicine ,Humans ,Infant feeding ,Poverty ,Reference group ,Maryland ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Infant ,Social Support ,Public Assistance ,Middle Aged ,Health promotion ,Breast Feeding ,Cross-Sectional Studies ,Logistic Models ,Female ,business ,Breast feeding ,Demography ,Program Evaluation - Abstract
This cross-sectional study examines Maryland’s women, infants, and children (WIC) breastfeeding initiation rates by program participation. The authors report on data regarding demographic and health characteristics and infant feeding practices for infants (n = 18 789) newly WIC-certified from January 1, 2007 to June 30, 2007. The authors compared self-reported, breastfeeding initiation rates for 3 groups: peer counselor (PC-treatment group) and two comparison groups, lactation consultant (LC), and standard care group (SCG). Reported breastfeeding initiation at certification was 55.4%. Multiple logistic regression analysis, controlling for relevant maternal and infant characteristics, showed that the odds of breastfeeding initiation were significantly greater among PC-exposed infants (OR [95% CI] 1.27 [1.18, 1.37]) compared to the reference group of SCG infants, but not significantly different between LC infants (1.04 [0.96, 1.14]) and the SCG. LC and SCG infants had similar odds of breastfeeding initiation. In the Maryland WIC program, breastfeeding initiation rates were positively associated with peer counseling. J Hum Lact. 25(4):435-443.
- Published
- 2009
43. Living Together Apart in France and the United States
- Author
-
Claude Martin, Andrew Cherlin, and Caitlin Cross-Barnet
- Subjects
cohabitation, divorce, France, United States, living together apart - Abstract
Using data from exploratory surveys conducted in parallel in the United States and France among two different socioeconomic groups, this article examines why certain couples continue to share the same home after their relationship has broken down. The authors explore how the specific features of these contemporary living arrangements differ from similar situations in the past, and propose several hypotheses about the current signification of cohabitation and the family bond (as a combination of conjugal and parenting ties). Despite very different conceptions of marriage and cohabitation in the two countries, these situations of ?living together apart? (LTA) and the meaning of such LTA relationships for the persons concerned are quite similar on both sides of the Atlantic. The testimonies of LTA couples show how their conjugal trajectories are shaped by financial and material constraints, limiting access to marriage or to divorce. The respondents consider that living together apart enables both partners to fulfil their parenting role, the father especially, and protects the children from the financial consequences of divorce, especially in a social context of economic crisis.
- Published
- 2011
44. Improving Birth Outcomes And Lowering Costs For Women On Medicaid: Impacts Of 'Strong Start For Mothers And Newborns'.
- Author
-
Dubay L, Hill I, Garrett B, Blavin F, Johnston E, Howell E, Morgan J, Courtot B, Benatar S, and Cross-Barnet C
- Subjects
- Cesarean Section, Female, Humans, Infant, Infant, Newborn, Medicaid, Mothers, Pregnancy, Prenatal Care, United States, Maternal Health Services, Premature Birth
- Abstract
The federal Strong Start for Mothers and Newborns initiative supported alternative approaches to prenatal care, enhancing service delivery through the use of birth centers, group prenatal care, and maternity care homes. Using propensity score reweighting to control for medical and social risks, we evaluated the impacts of Strong Start's models on birth outcomes and costs by comparing the experiences of Strong Start enrollees to those of Medicaid-covered women who received typical prenatal care. We found that women who received prenatal care in birth centers had lower rates of preterm and low-birthweight infants, lower rates of cesarean section, and higher rates of vaginal birth after cesarean than did the women in the comparison groups. Improved outcomes were achieved at lower costs. There were few improvements in outcomes for participants who received group prenatal care, although their costs were lower in the prenatal period, and no improvements in outcomes for participants in maternity care homes.
- Published
- 2020
- Full Text
- View/download PDF
45. Innovative Home Visit Models Associated With Reductions In Costs, Hospitalizations, And Emergency Department Use.
- Author
-
Ruiz S, Snyder LP, Rotondo C, Cross-Barnet C, Colligan EM, and Giuriceo K
- Subjects
- Fee-for-Service Plans economics, Female, Health Expenditures, Hospitalization, House Calls economics, Humans, Medicare economics, Primary Health Care statistics & numerical data, United States, Cost Savings, Emergency Service, Hospital statistics & numerical data, House Calls statistics & numerical data
- Abstract
While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits. Two models achieved significant reductions in Medicare expenditures, and three models reduced utilization in the form of emergency department visits, hospitalizations, or both for beneficiaries relative to comparators. These findings present a strong case for the potential value of home visits by practice-extender teams to reduce Medicare expenditures and service use in a particularly vulnerable and costly segment of the Medicare population., (Project HOPE—The People-to-People Health Foundation, Inc.)
- Published
- 2017
- Full Text
- View/download PDF
46. Innovative Oncology Care Models Improve End-Of-Life Quality, Reduce Utilization And Spending.
- Author
-
Colligan EM, Ewald E, Ruiz S, Spafford M, Cross-Barnet C, and Parashuram S
- Subjects
- Aged, Emergency Service, Hospital statistics & numerical data, Female, Hospitalization economics, Humans, Male, Medicare economics, Palliative Care statistics & numerical data, Patient Navigation, Retrospective Studies, United States, Cost Savings economics, Hospice Care statistics & numerical data, Medical Oncology organization & administration, Patient-Centered Care organization & administration, Quality of Life
- Abstract
Three models that received Health Care Innovation Awards from the Centers for Medicare and Medicaid Services (CMS) aimed to reduce the cost and use of health care services and improve the quality of care for Medicare beneficiaries with cancer. Each emphasized a different principle: the oncology medical home, patient navigation, or palliative care. Comparing participants in each model who died during the study period to matched comparators, we found that the oncology medical home and patient navigation models were associated with decreased costs in the last ninety days of life ($3,346 and $5,824 per person, respectively) and fewer hospitalizations in the last thirty days of life (fifty-seven and forty per 1,000 people, respectively). The patient navigation model was also associated with fewer emergency department visits in the last thirty days of life and increased hospice enrollment in the last two weeks of life. These promising results can inform new initiatives for cancer patients, such as the CMS Oncology Care Model., (Project HOPE—The People-to-People Health Foundation, Inc.)
- Published
- 2017
- Full Text
- View/download PDF
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