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4. Provider Attitudes on Regionalization of Maternity Care: A National Survey

Author

Easter, Sarah Rae, Gilmore, Kelly C., Schulkin, Jay, and Robinson, Julian N.

Subjects
Obstetricians -- Practice -- Surveys, Maternal health services -- Surveys, Regional medical programs -- Surveys, Hospitals, Voluntary -- Regional alliances, Obstetrics -- Surveys, Health care industry
Abstract

Objectives To explore provider perspectives surrounding national guidelines proposing regionalization of maternal care. Methods An 18-item survey focused on provider attitudes and practices surrounding regionalized maternity care was administered to a national sample of practicing obstetricians. We classified respondants reporting less than 500 annual deliveries at their hospital as low-volume providers and those practicing at hospitals performing 500 or more annual deliveries as high-volume providers. We compared responses according to hospital delivery volume using univariate analysis. Results Of the 497 physicians surveyed, 278 people responded (56%) with 229 currently practicing obstetrics. The median annual delivery volume amongst respondents was 200 (interquartile range 100-1900) with 146 (63.7%) practicing in low-volume delivery centers. The need for medical or surgical expertise was the most commonly reported indication for maternal transfer (19.7%) and independent of practice setting. Ninety-six percent of providers agreed with the concept of regionalization, but respondents in high-volume centers reported higher familiarity with the levels of maternal care paradigm compared to their low-volume counterparts (81.9% v. 62.3%, p < 0.01). Financial factors (60.3%), geography (48.9%), and access to care (43.2%) were the most cited major barriers to regionalization. High-volume providers endorsed geography as a major barrier more often than low-volume providers (57.8% v. 43.8%, p = 0.04). Conclusions for Practice Obstetricians may agree with the concept of regionalized maternity care but also identify significant barriers to its implementation. Early and frequent engagement of providers reflecting the diversity of delivery centers in a region is a simple but necessary step in any attempts to designate levels of maternal care., Author(s): Sarah Rae Easter [sup.1] , Kelly C. Gilmore [sup.2] , Jay Schulkin [sup.2] , Julian N. Robinson [sup.1] Author Affiliations: (1) grid.38142.3c, 000000041936754X, Division of Maternal-Fetal Medicine, Brigham and [...]

Published
2021
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9. We can achieve opioid-free analgesia after childbirth: Stop prescribing opioids after vaginal delivery and reduce their use after cesarean

Author

Holland, Erica and Robinson, Julian N.

Subjects
United States. Centers for Disease Control and Prevention, Prescription writing -- Usage, Pain management -- Usage, Opioids -- Usage, Cesarean section -- Usage, Medical schools, Ibuprofen, Acetaminophen, Analgesia, Health, American College of Obstetricians and Gynecologists
Abstract

Routine use of opioids after childbirth should be discontinued. Three practical strategies can help ObGyns reduce opioid prescriptions and adequately manage patients' pain. CASE New mother receives unneeded opioids after [...]

Published
2020

17. Response to Letter

Author

Easter, Sarah Rae, Robinson, Julian N., Menard, M. Kathryn, Creanga, Andreea A., Xu, Xinling, Little, Sarah E., and Bateman, Brian T.

Published
2020
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19. Peripartum Care for Mothers Diagnosed with Hepatitis B During Pregnancy: A Survey of Provider Practices

Author

Kwong, Allison J., Chang, Matthew S., Tuomala, Ruth E., Riley, Laura E., Robinson, Julian N., Mutinga, Muthoka L., and Andersson, Karin L.

Subjects
Health screening -- Usage, Public health -- Analysis, Vaccination -- Usage, Hepatitis B -- Diagnosis -- Care and treatment, Pregnancy -- Health aspects, Health care industry
Abstract

Objectives Hepatitis B (HBV) remains a significant public health burden, despite effective therapy. Routine HBV screening is recommended during pregnancy to reduce the risk of vertical transmission, but the rates of follow-up care peri-partum are low. The aim of this study was to evaluate physician practices and knowledge regarding HBV in women diagnosed perinatally. Methods A survey was distributed to obstetricians and midwives within the Partners HealthCare system at Brigham and Women's Hospital and Massachusetts General Hospital. Results Of 118 survey respondents (response rate 56%), 97% reported that they always tested for hepatitis B, and 77% referred new diagnoses of HBV during pregnancy to a HBV specialist for further care. Only 10% of respondents reported that there was formal referral mechanism in place to facilitate follow-up care for mothers diagnosed with hepatitis B infection. 91% of survey respondents selected hepatitis B surface antigen as the correct screening test, and 76% selected hepatitis B immune globulin with vaccination for the newborn as the correct prophylaxis regimen. Only 40 and 51% of respondents accurately identified serologies that were consistent with acute and chronic infection, respectively. Conclusions for Practice Routine screening for HBV in this population presents an important opportunity to identify cases and to reduce the public health burden of this disease. Providers were somewhat knowledgeable about HBV, but the lack of formal referral mechanism may explain why HBV follow-up is suboptimal in this healthcare system. Supplemental provider education and formal linkage to care programs may increase rates of follow-up HBV care., Author(s): Allison J. Kwong [sup.1] , Matthew S. Chang [sup.1] [sup.2] [sup.9] , Ruth E. Tuomala [sup.3] , Laura E. Riley [sup.4] , Julian N. Robinson [sup.3] , Muthoka L. [...]

Published
2018
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27. In Reply

Author

Panelli, Danielle M., Easter, Sarah Rae, Bibbo, Carolina, Robinson, Julian N., and Carusi, Daniela A.

Published
2018
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38. Prospective Risk of Stillbirth and Neonatal Complications in Twin Pregnancies: Systematic Review and Meta-analysis

Author

Cheong-See, Fiona, Schuit, Ewoud, Arroyo-Manzano, David, Khalil, Asma, Barrett, Jon, Joseph, K. S., Asztalos, Elizabeth, Hack, Karien, Lewi, Liesbeth, Lim, Arianne, Liem, Sophie, Norman, Jane E., Morrison, John, Combs, C. Andrew, Garite, Thomas J., Maurel, Kimberly, Serra, Vicente, Perales, Alfredo, Rode, Line, Worda, Katharina, Nassar, Anwar, Aboulghar, Mona, Rouse, Dwight, Thom, Elizabeth, Breathnach, Fionnuala, Nakayama, Soichiro, Russo, Francesca Maria, Robinson, Julian N., Dodd, Jodie M., Newman, Roger B., Bhattacharya, Sohinee, Tang, Selphee, Mol, Ben Willem J., Zamora, Javier, Thilaganathan, Basky, and Thangaratinam, Shakila

Published
2017
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41. Intrapartum ultrasound measurement of angle of progression at the onset of the second stage of labor for prediction of spontaneous vaginal delivery in term singleton pregnancies: a systematic review and meta-analysis

Author

Nassr, Ahmed A., primary, Berghella, Vincenzo, additional, Hessami, Kamran, additional, Bibbo, Carolina, additional, Bellussi, Federica, additional, Robinson, Julian N., additional, Marsoosi, Vajiheh, additional, Tabrizi, Reza, additional, Safari-Faramani, Roya, additional, Tolcher, Mary Catherine, additional, Shamshirsaz, Amir A., additional, Clark, Steven L., additional, Belfort, Michael A., additional, and Shamshirsaz, Alireza A., additional

Published
2022
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50. Spatiotemporal alignment of in utero BOLD-MRI series: Spatiotemporal Alignment of MRI series

Author

Madrid-MIT M+Vision Consortium, Massachusetts Institute of Technology. Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology. Computer Science and Artificial Intelligence Laboratory, Turk, Esra Abaci, Luo, Jie, Gagoski, Borjan, Pascau, Javier, Bibbo, Carolina, Robinson, Julian N, Grant, P Ellen, Adalsteinsson, Elfar, Golland, Polina, Malpica, Norberto, Madrid-MIT M+Vision Consortium, Massachusetts Institute of Technology. Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology. Computer Science and Artificial Intelligence Laboratory, Turk, Esra Abaci, Luo, Jie, Gagoski, Borjan, Pascau, Javier, Bibbo, Carolina, Robinson, Julian N, Grant, P Ellen, Adalsteinsson, Elfar, Golland, Polina, and Malpica, Norberto

Abstract

© 2017 International Society for Magnetic Resonance in Medicine Purpose: To present a method for spatiotemporal alignment of in-utero magnetic resonance imaging (MRI) time series acquired during maternal hyperoxia for enabling improved quantitative tracking of blood oxygen level-dependent (BOLD) signal changes that characterize oxygen transport through the placenta to fetal organs. Materials and Methods: The proposed pipeline for spatiotemporal alignment of images acquired with a single-shot gradient echo echo-planar imaging includes 1) signal nonuniformity correction, 2) intravolume motion correction based on nonrigid registration, 3) correction of motion and nonrigid deformations across volumes, and 4) detection of the outlier volumes to be discarded from subsequent analysis. BOLD MRI time series collected from 10 pregnant women during 3T scans were analyzed using this pipeline. To assess pipeline performance, signal fluctuations between consecutive timepoints were examined. In addition, volume overlap and distance between manual region of interest (ROI) delineations in a subset of frames and the delineations obtained through propagation of the ROIs from the reference frame were used to quantify alignment accuracy. A previously demonstrated rigid registration approach was used for comparison. Results: The proposed pipeline improved anatomical alignment of placenta and fetal organs over the state-of-the-art rigid motion correction methods. In particular, unexpected temporal signal fluctuations during the first normoxia period were significantly decreased (P < 0.01) and volume overlap and distance between region boundaries measures were significantly improved (P < 0.01). Conclusion: The proposed approach to align MRI time series enables more accurate quantitative studies of placental function by improving spatiotemporal alignment across placenta and fetal organs. Level of Evidence: 1. Technical Efficacy: Stage 1. J. MAGN. RESON. IMAGING 2017;46:403–412.

Published
2021

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