Search

BackgroundThe COVID-19 pandemic started a period of rapid transition to telehealth in obstetrical care delivery to maintain social distancing and curb the spread of the virus. The use of telehealth, such as telephone and video visits, remote imaging interpretation, and provider-to-provider consultations, increased in the early months of the pandemic to maintain access to prenatal and postpartum care. Although there is considerable literature on the use of telehealth in obstetrical care, there are limited data on widespread telehealth use among different practice types and patient populations during the pandemic and whether these are preferred technologies.ObjectiveThis study aimed to describe variations in telehealth use for obstetrical care among practices in North Carolina during the COVID-19 pandemic and to outline future preferences and needs for continued telehealth use. This study also aimed to delineate telehealth use among rural and micropolitan and metropolitan practices to better understand if telehealth use varied by practice location.Study designA web-based survey was distributed to practice managers of obstetrical practices in North Carolina from June 14, 2020 to September 14, 2020. Practice managers were contacted through assistance of the Community Care of North Carolina Pregnancy Medical Home program. Practice location was defined as rural, micropolitan, or metropolitan based on the county population. The survey assessed telehealth use before and during the COVID-19 pandemic, types of modalities used, and preferences for future use. Descriptive statistics were performed to describe survey responses and compare them by practice location.ResultsA total of 295 practice managers were sent a web-based survey and 98 practice managers responded. Responding practices represented 66 of 100 counties in North Carolina with 50 practices from rural and micropolitan counties and 48 practices from metropolitan counties. The most common type of provider reported by practice managers were general obstetrician and gynecologists (85%), and the most common practice type was county health departments (38%). Overall, 9% of practices reported telehealth use before the pandemic and 60% reported telehealth use during the pandemic. The most common type of telehealth modality was telephone visits. There were no significant differences in the uptake of telehealth or in the modalities used by practice location. A total of 40% of practices endorsed a preference for continued telehealth use beyond the COVID-19 pandemic. The most commonly reported need for continuation of telehealth use was assistance with patient access to telehealth technologies (54%). There were no significant differences in the preferences for telehealth continuation or future needs by practice location.ConclusionTelehealth use increased among a variety of practice types during the pandemic with no variation observed by practice location in terms of modalities used, future preferences, or needs. This study assessed statewide uptake of and differences in obstetrical telehealth use during the early COVID-19 pandemic. With telehealth becoming an integral part of obstetrical care delivery, this survey has implications for anticipating the needs of practices and designing innovative solutions for providers and pregnant people beyond the COVID-19 pandemic.

Objectives To characterize the health and health care experiences of children in the U.S. Virgin Islands (USVI), assess differences by household poverty status, and provide comparisons to the general U.S. child population. Methods Data are from the 2011-2012 National Survey of Children's Health, which included 2342 USVI children, aged 0-17 years. Parent-reported measures of health status and health conditions, behavioral characteristics, and health care access and utilization were assessed. Weighted prevalence estimates were calculated and compared by household poverty status using Chi square tests. Results Overall, 31.3% of USVI children lived in households below 100% of the federal poverty level (FPL). Children in these low-income households were more likely to have public insurance (33.0% vs. 8.4%) and unmet health needs (11.6% vs. 6.3%) as compared to those in households with incomes [greater than or equal to] 100% FPL (all p < 0.01). They were also less likely to have a medical home (22.5% vs. 42.2%), including a usual source of sick care (p < 0.01). Compared with U.S. children in general, USVI children had lower rates of preventive medical visits, preventive dental visits, and care received in a medical home. Conclusions USVI children experience challenges in accessing and utilizing health care services, particularly those in low-income households, and fare worse than U.S. children on many of these measures. These findings will serve as a baseline comparison for an upcoming survey of maternal and child health to be conducted in eight U.S. territories including the USVI., Author(s): Catherine J. Vladutiu [sup.1] , Lydie A. Lebrun-Harris [sup.1] , Maria P. Carlos [sup.2] , Derval N. Petersen [sup.3] Author Affiliations: (Aff1) 0000 0004 0405 7557, grid.454842.b, Office of [...]

Objectives To estimate the rate of pregnancy-associated emergency care visits and identify maternal and pregnancy characteristics associated with high utilization of emergency care among pregnant Medicaid recipients in North Carolina. Methods A retrospective cohort study using linked Medicaid hospital claims and birth records of 107,207 pregnant Medicaid recipients who delivered a live-born infant in North Carolina between January 1, 2008 and December 31, 2009. Rates were estimated per 1000 member months of Medicaid coverage. High utilization was defined as [greater than or equal to] 4 visits. Emergency care visits included encounters in the emergency department or obstetric triage unit during pregnancy that did not result in hospital admission. Results During the study period, 57.5% of pregnant Medicaid recipients sought emergency care at least once during pregnancy. There were 171,909 emergency care visits with an overall rate of 202.3 visits per 1000 member months. Among the subset of pregnant women with Medicaid coverage for the majority of their pregnancy (n = 75,157), 18.1% were high utilizers. High emergency care utilization was associated with young age, black race, lower education, tobacco use, late preterm delivery, multifetal gestation, and having [greater than or equal to] 1 comorbidity. Threatened labor and abdominal pain were the leading indications for visits. Conclusion Utilization of hospital-based emergency care services was common in this cohort of pregnant Medicaid recipients. Additional research is needed to assess the drivers for accessing care through the emergency department, and to examine differences in pregnancy outcomes and health care costs between high and low utilizers., Author(s): Catherine J. Vladutiu [sup.1] [sup.2] , Elizabeth M. Stringer [sup.2] , Veni Kandasamy [sup.3] , Jill Ruppenkamp [sup.4] , M. Kathryn Menard [sup.2] Author Affiliations: (Aff1) 0000 0004 0405 [...]

Introduction CenteringPregnancy® is well-regarded as an innovative group model of prenatal care. In 2009, Georgia's Southwest Public Health District partnered with local obstetricians and medical centers to expand prenatal care access and improve perinatal outcomes for low-income women by implementing Georgia's first public health administered CenteringPregnancy program. This paper describes the successful implementation of CenteringPregnancy in a public health setting with no prior prenatal services; assesses the program's first 5-year perinatal outcomes; and discusses several key lessons learned. Methods Prenatal and hospital medical records of patients were reviewed for the time period from October 2009 through October 2014. Descriptive analyses were conducted to examine demographic and clinical characteristics of women initiating prenatal care and to assess perinatal outcomes among patients with singleton live births who attended at least three CenteringPregnancy sessions or delivered prior to attending the third session. Results Six hundred and six low-income women initiated prenatal care; 55.4 and 36.4% self-identified as non-Hispanic black and Hispanic, respectively. The median age was 23 years (IQR 20, 28). Nearly 69% initiated prenatal care in the first trimester. Perinatal outcomes were examined among 338 singleton live births. The 2010-2014 preterm birth rate (% of births < 37 weeks gestation at delivery) and low birth weight rate (% of births < 2500 g) were 9.1 and 8.9%, respectively. Nearly 77% of women initiated breastfeeding. Discussion CenteringPregnancy administered via public-private partnership may improve access to prenatal care and perinatal outcomes for medically underserved women in low-resource settings., Author(s): Jacqueline H. Grant [sup.1] [sup.2] , Katherine Handwerk [sup.1] , Karen Baker [sup.3] , VaLenia Milling [sup.3] , Sharonda Barlow [sup.3] , Catherine J. Vladutiu [sup.2] [sup.4] Author Affiliations: [...]

Objectives Statute for the Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program requires that states and territories receiving Program funding assess improvements for participating families across six areas that address maternal and child well-being. In 2015, the MIECHV Program performance measurement system was redesigned to allow for national-level analyses and cross-grantee comparisons. The new measures were aligned with other federal performance measures to help ensure context for program analyses. The number of measures was also reduced to lessen reporting burden. This paper describes the redesign process and resulting national performance measures. Methods The redesign process included holding listening sessions with stakeholders and experts; reviewing the findings from other home visiting performance initiatives; consulting with experts; soliciting and responding to public comment on draft measures; seeking clearance from the Office of Management and Budget; and specifying each measure with detailed eligibility criteria, the timing and frequency of assessments, and the window for data collection. Results The redesign resulted in a set of 19 measures that all MIECHV-funded home visiting programs began collecting in 2016. This is nearly half the number of measures that MIECHV awardees had been reporting prior to the redesign. The measures are aligned with other federal measures, including those used in Healthy People 2020 and those used for other maternal and child health programs. Conclusions for Practice Data reported by MIECHV Program awardees will be used to assess their performance, identify areas for targeted technical assistance to support continuous improvement, and ensure meaningful impacts for at-risk families., Author(s): Judith Labiner-Wolfe [sup.1] [sup.2] , Catherine J. Vladutiu [sup.1] , Kyle Peplinski [sup.1] , Carlos Cano [sup.1] , David Willis [sup.1] Author Affiliations: (Aff1) 0000 0004 0405 7557, grid.454842.b, [...]

Purpose In recognition of the importance of performance measurement and MCH epidemiology leadership to quality improvement (QI) efforts, a plenary session dedicated to this topic was presented at the 2014 CityMatCH Leadership and MCH Epidemiology Conference. This paper summarizes the session and provides two applications of performance measurement to QI in MCH. Description Performance measures addressing processes of care are ubiquitous in the current health system landscape and the MCH community is increasingly applying QI processes, such as Plan-Do-Study-Act (PDSA) cycles, to improve the effectiveness and efficiency of systems impacting MCH populations. QI is maximally effective when well-defined performance measures are used to monitor change. Assessment MCH epidemiologists provide leadership to QI initiatives by identifying population-based outcomes that would benefit from QI, defining and implementing performance measures, assessing and improving data quality and timeliness, reporting variability in measures throughout PDSA cycles, evaluating QI initiative impact, and translating findings to stakeholders. MCH epidemiologists can also ensure that QI initiatives are aligned with MCH priorities at the local, state and federal levels. Two examples of this work, one highlighting use of a contraceptive service performance measure and another describing QI for peripartum hemorrhage prevention, demonstrate MCH epidemiologists' contributions throughout. Challenges remain in applying QI to complex community and systems-level interventions, including those aimed at improving access to quality care. Conclusion MCH epidemiologists provide leadership to QI initiatives by ensuring they are data-informed and supportive of a common MCH agenda, thereby optimizing the potential to improve MCH outcomes., Author(s): Kristin M. Rankin[sup.1] , Loretta Gavin[sup.2] , John W. Moran[sup.3] , Charlan D. Kroelinger[sup.4] , Catherine J. Vladutiu[sup.5] , David A. Goodman[sup.4] , William M. Sappenfield[sup.6] Author Affiliations: (1) [...]

Purpose The impact of programs, policies, and practices developed by professionals in the field of maternal and child health (MCH) epidemiology is highlighted biennially by 16 national MCH agencies and organizations, or the Coalition for Excellence in MCH Epidemiology. Description In September 2014, multiple leading agencies in the field of MCH partnered to host the national CityMatCH Leadership and MCH Epidemiology Conference in Phoenix, Arizona. The conference offered opportunities for peer exchange; presentation of new scientific methodologies, programs, and policies; dialogue on changes in the MCH field; and discussion of emerging MCH issues relevant to the work of local, state, and national MCH professionals. During the conference, the National MCH Epidemiology Awards were presented to individuals, teams, institutions, and leaders for significantly contributing to the improved health of women, children, and families. Assessment During the conference, the Coalition presented seven deserving health researchers and research groups with national awards in the areas of advancing knowledge, effective practice, outstanding leadership, young professional achievement, and lifetime achievement. The article highlights the accomplishments of these national-level awardees. Conclusion Recognition of deserving professionals strengthens the field of MCH epidemiology, and sets the standard for exceptional research, mentoring, and practice., Author(s): Charlan D. Kroelinger[sup.1] , Catherine J. Vladutiu[sup.2] , Jessica R. Jones[sup.2] Author Affiliations: (1) National MCH Epidemiology Awards Selection Committee, Maternal and Child Health Epidemiology Program, Division of Reproductive [...]

Previous literature has highlighted that women who have a pregnancy affected by gestational hypertension or preeclampsia are at higher risk of cardiovascular disease (CVD) in later life. However, CVD is a composite of multiple outcomes, including coronary heart disease, heart failure, and stroke, and the risk of both CVD and hypertensive disorders of pregnancy varies by the population studied. We conducted a narrative review of the risk of cardiovascular outcomes for women with prior gestational hypertension and pre-eclampsia. Previous literature is summarized by country and ethnicity, with a higher risk of CVD and coronary heart disease observed after gestational hypertension and a higher risk of CVD, coronary heart disease and heart failure observed after pre-eclampsia in most of the populations studied. Only one study was identified in a low- or middle-income country, and the majority of studies were conducted in white or mixed ethnicity populations. We discuss potential interventions to mitigate cardiovascular risk for these women in different settings and highlight the need for a greater understanding of the epidemiology of CVD risk after gestational hypertension and pre-eclampsia outside of high-income, white populations. [ABSTRACT FROM AUTHOR]

Physical activity is associated with improved sleep quality and duration in the general population, but its effect on sleep in postpartum women is unknown. We examined cross-sectional and longitudinal associations between hours/week of self-reported domain-specific and overall moderate to vigorous physical activity (MVPA) and sleep quality and duration at 3- and 12-months postpartum among a cohort of 530 women in the Pregnancy, Infection, and Nutrition Postpartum Study. MVPA was not associated with sleep quality or duration at 3-months postpartum. At 12-months postpartum, a 1 h/week increase in recreational MVPA was associated with higher odds of good (vs. poor) sleep quality (odds ratio, OR 1.14; 95 % confidence interval, CI, 1.03-1.27) and a 1 h/week increase in child/ adult care MVPA was associated with lower odds of good (vs. poor) sleep quality (OR = 0.93; 95 % CI 0.88-0.99). A 1 h/week increase in child/adult care MVPA (OR 1.08, 95 % CI 1.00-1.16) was associated with higher odds of long sleep duration and 1 h/week increases in indoor household (OR 1.09, 95 % CI 1.01-1.18) and overall MVPA (OR 1.04, 95 % CI 1.01-1.07) were associated with higher odds of short (vs. normal) sleep duration. Comparing 3-months postpartum to 12-months postpartum, increased work MVPA was associated with good sleep quality (OR 2.40, 95 % CI 1.12-5.15) and increased indoor household MVPA was associated with short sleep duration (OR 1.85, 95 % CI 1.05-3.27) as measured at 12-months postpartum. Selected domains of MVPA and their longitudinal increases were associated with sleep quality and duration at 12-months postpartum. Additional research is needed to elucidate whether physical activity can improve postpartum sleep. Keywords Postpartum * Pregnancy * Cohort * Longitudinal * Leisure activity, Introduction Sleep disruption and deprivation occur frequently among postpartum women. In 2007, approximately 42 % of postpartum women in the United States reported rarely or never having a good night's [...]

Aim: This study aimed to examine the association between lifecourse factors and flourishing among children ages 1–5 years. Study design Using data from the combined 2016 and 2017 National Survey of Children's Health (N = 18 007 children aged 1–5 years), flourishing was defined as parent‐reported child's affection, resilience, curiosity about learning, and affect. Multivariable logistic regression modelled the associations between lifecourse factors and flourishing. These factors were identified according to the lifecourse health development model. Results: Approximately 63% of children aged 1–5 years were flourishing. Children who were female (vs. male, adjusted prevalence ratio [APR]: 1.06, 95% confidence interval [CI]: 1.00–1.11), White, non‐Hispanic (vs. Black, non‐Hispanic, APR: 1.13, 95% CI: 1.01–1.26), not having a special health care need (vs. special health care need, APR: 1.15, 95% CI: 1.03–1.26), not having an emotional, developmental or behavioural disorder (EBD) (vs. EBD, APR: 1.66, 95% CI:1.23–2.10), spoke English at home (vs. other language, APR: 1.30, 95% CI: 1.06–1.54), parents received emotional social support (vs. no emotional social support, APR: 1.11, 95% CI: 1.01–1.21) and who lived in a supportive neighbourhood (vs. not in supportive neighbourhood, APR: 1.12, 95% CI:1.05–1.18) were more likely to flourish. Children from households within 0%–99% of the federal poverty level (APR: 0.89, 95% CI: 0.79–0.98) were less likely to be flourishing compared with their counterparts from households within 400% of the federal poverty level. Conclusions: Findings indicate that several lifecourse factors are associated with young children's flourishing, including being female, White, non‐Hispanic, not having a special health care need or EBD, English as a primary language, parents receiving emotional social support, having neighbourhood support and a lower household income. Our findings promote the continuation of programmes supporting diverse and low‐income children's families and communities such as home visiting and Head Start, which provide avenues for bolstering children's health and development across the lifespan. [ABSTRACT FROM AUTHOR]