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BackgroundMaternal mortality is a public health crisis in the U.S., with no improvement in decades and worsening disparities during COVID-19. Social determinants of health (SDoH) shape risk for morbidity and mortality but maternal structural and SDoH are under-researched using population health data. To expand knowledge of those at risk for or who have experienced maternal morbidity and inform clinical, policy, and legislative action, creative use of and leveraging existing population health datasets is logical and needed.MethodsWe review a sample of population health datasets and highlight recommended changes to the datasets or data collection to better inform existing gaps in maternal health research.ResultsAcross each of the datasets we found insufficient representation of pregnant and postpartum individuals and provide recommendations to enhance these datasets to inform maternal health research.ConclusionsPregnant and postpartum individuals should be oversampled in population health data to facilitate rapid policy and program evaluation. Postpartum individuals should no longer be hidden within population health datasets. Individuals with pregnancies resulting in outcomes other than livebirth (e.g., abortion, stillbirth, miscarriage) should be included, or asked about these experiences.

Rationale: Organizing ICU interprofessional teams—nurses, physicians, and respiratory therapists—is high priority because of workforce crises, but how often clinicians work together (i.e., interprofessional familiarity) remains unexplored. Objectives: Determine if mechanically ventilated patients cared for by teams with greater familiarity have lower mortality, shorter duration of mechanical ventilation, and greater spontaneous breathing trial (SBT) implementation. Methods: Using electronic health records from five ICUs (2018–2019), we identified the interprofessional team that cared for each mechanically ventilated patient each shift, calculated familiarity, and modeled familiarity exposures separately on ICU mortality, duration of mechanical ventilation, and SBT implementation using encounter-level generalized linear regression models with a log-link, unit-level fixed effects adjusting for cofounders, including severity of illness. Measurements and Main Results: Familiarity was defined as how often clinicians worked together for all patients in an ICU (i.e., coreness) and for each patient (i.e., mean team value). Among 4,292 patients (4,485 encounters, 72,210 shifts), unadjusted mortality was 12.9%, average duration of mechanical ventilation was 2.32 days, and SBT implementation was 89%. An increase in coreness and mean team value, by the SD of each, was associated with lower probability of dying (coreness: adjusted marginal effect, −0.038; 95% confidence interval [−0.07 to −0.004]; mean team value: adjusted marginal effect, −0.0034 [−0.054 to −0.014]); greater probability of receiving SBT when eligible (coreness: 0.45 [0.007 to 0.083]; mean team value: 0.012 [−0.017 to 0.042]), and shorter duration of mechanical ventilation (coreness: −0.23 [−0.321 to −0.139]). Conclusions: Interprofessional familiarity was associated with improved outcomes; assignment models that prioritize familiarity might be a novel solution. [ABSTRACT FROM AUTHOR]

Effective interprofessional team function is integral to high-quality care in the intensive care unit (ICU). However, little is known about how familiarity develops among teams, which may be an important antecedent to effective team function and quality care. To examine team familiarity and how it impacts ICU team function and care, we conducted an ethnographic study in four ICUs (two medical ICUs, one mixed medical-surgical ICU, and one surgical ICU) in two community hospitals and one academic medical center. We conducted 57.5 h of observation, 26 shadowing experiences, and 26 interviews across the four ICUs sequentially. We used thematic analysis to examine familiarity among the team. We found that ICU team members become familiar with their team through interpersonal, relational interactions, which involved communication, time working together, social interactions, trust, and respect. Our findings underscore the relational aspect of effective teams and demonstrate that time working together, social interactions, communication, developing trust, and respect are pathways to familiarity and optimal team function. Leveraging unique and creative ways to enhance the relational aspects of ICU teams could be an area for future research and lead to improved ICU outcomes. [ABSTRACT FROM AUTHOR]

Information sharing, a component of patient and family engagement (PFE), is an important process that may contribute to intensive care unit (ICU) quality of care. Yet, virtually no studies explore how the process of information sharing unfolds in the ICU from the interprofessional team and family member perspectives. To better understand the process of information sharing, we conducted ethnographic fieldwork in a 20-bed medical ICU, focusing on behaviors and interactions of the interprofessional team and family members (May 2016 – October 2016). We completed 17.5 observation hours, 6 shadowing sessions, and 12 semi-structured interviews with 17 total participants. We used thematic content analysis and iterative inductive coding to identify three themes about the information sharing process: 1) family factors (health literacy and past experience with the ICU environment) influence information sharing; 2) clinicians strategies can support engagement in the process of information sharing (assessing families' need for information, understanding a families' hope, using rounds as an opportunity for information sharing); 3) the process of information sharing allows for trust building between families and the ICU team. Our findings suggest that information sharing is a crucial process that may serve as a catalyst for effective patient and family engagement in the ICU. [ABSTRACT FROM AUTHOR]