Background Perinatal quality improvement lacks valid tools to measure adverse hospital experiences disproportionately impacting Black mothers and birthing people. Measuring and mitigating harm requires using a framework that centers the lived experiences of Black birthing people in evaluating inequitable care, namely, obstetric racism. We sought to develop a valid patient‐reported experience measure (PREM) of Obstetric Racism© in hospital‐based intrapartum care designed for, by, and with Black women as patient, community, and content experts. Methods PROMIS© instrument development standards adapted with cultural rigor methodology. Phase 1 included item pool generation, modified Delphi method, and cognitive interviews. Phase 2 evaluated the item pool using factor analysis and item response theory. Results Items were identified or written to cover 7 previously identified theoretical domains. 806 Black mothers and birthing people completed the pilot test. Factor analysis concluded a 3 factor structure with good fit indices (CFI = 0.931‐0.977, RMSEA = 0.087‐0.10, R2 > .3, residual correlation < 0.15). All items in each factor fit the IRT model and were able to be calibrated. Factor 1, “Humanity,” had 31 items measuring experiences of safety and accountability, autonomy, communication, and empathy. A 12‐item short form was created to ease respondent burden. Factor 2, “Racism,” had 12 items measuring experiences of neglect and mistreatment. Factor 3, “Kinship,” had 7 items measuring hospital denial and disruption of relationships between Black mothers and their child or support system. Conclusions The PREM‐OB Scale™ suite is a valid tool to characterize and quantify obstetric racism for use in perinatal improvement initiatives.
AIMS The unrelieved symptoms and side effects of often-aggressive cancer treatments can lead to poor outcomes. SyMon-SAYS was developed to minimize symptom management barriers and symptom burdens by routinely collecting and interpreting patient-reported outcomes in pediatric oncology ambulatory settings. This paper reports the preliminary results of the 16-week SyMon-SAYS trial. METHODS Children (ages 8-17) with cancer (on-therapy or within 6-M post-treatment) were randomly assigned to either intervention (IG; weeks 1-16 intervention) or waitlist (WG; weeks 1-8 waitlist, weeks 9-16 intervention) group. Children in the intervention phase reported on 9 symptoms (fatigue, sadness, itch, pain, worry, appetite, nausea, sleep, headache) weekly via an electronic medical record patient portal. Scores exceeding a pre-defined threshold triggered an alert to the treatment team. Parents completed a symptom management barriers questionnaire (SMBQ) at baseline, weeks 8 (primary time-point and analyzed in this paper) and 16. Mixed-effects models were used to evaluate symptom burden over time. RESULTS Data from 75 children (37 IG, 38 WG) were analyzed (mean age=13.3 years, 58.8% male, 74.7% white). Of them, 43.9% had leukemia, and 17.5% brain tumor. On average, the IG completed 11 (possible min=0 max=16) and the WG completed 5 (possible min=0 max=8) symptom checklists; of them, 60% triggered symptom alerts. Results of the mixed-effects models showed significantly (p< 0.05) improvement in fatigue, sadness, worry, appetite and headache. No significant changes were found on others. For SMBQ, IG parents reported significantly in favor of “enough time with my child's doctors/nurses to talk about symptoms” than WG parents from baseline to week 8. No significant differences between IG and WG over time on other SMBQ items. CONCLUSIONS Our preliminary findings showed SyMon-SAYS alleviated emotional related symptoms over time. Physical symptoms might be related more to disease severity and treatment intensity, which we plan to investigate when more data is available.
Research Objective Applying safety culture concepts – effective teamwork, psychological safety, engaged leadership, vigilance, and error reporting ‐ to the prevention of medical errors has seen broad support to reduce catastrophic outcomes (i.e., maternal mortality, hemorrhage, eclampsia, etc); however, their role in efforts to minimize overuse is less clear. This study aimed to evaluate safety culture on maternity units in relation to cesarean overuse, and examine whether it is independent of vaginal birth culture, which emphasizes evidence‐based low intervention care. Study Design 6 Likert‐style items measuring safety culture themes were developed based on previous qualitative interviews of nurse and physician maternity unit clinical leads and were appended to the validated Labor Culture Survey (LCS). Within the LCS, the vaginal birth unit microculture (VBM) scale consists of 8 Likert‐style items assessing unit norms around supporting vaginal birth. Birth certificate data and hospital characteristics were linked with hospitals and respondents' survey responses. Multivariate Poisson regression analyses were adjusted for hospital demographics and clinical risk profiles. Population Studied Nurses, midwives, and physicians providing intrapartum care at hospitals in Michigan participating in quality improvement efforts to reduce cesarean overuse. Principal Findings 3011 clinicians from 54 out of 57 participating hospitals completed the survey with a minimum unit response rate of 30% per hospital. Safety culture individual item scores showed significant association (p < 0.05) with cesarean delivery rates after adjustment for hospital demographics and clinical risk. Specifically, as agreement increased on the following safety culture items, cesarean delivery rate decreased: a) frequent treatment team communication to discuss supporting vaginal; b) team members have equal input in management decisions; c) team members feel safe and encouraged to speak up if a patient's chance of having a vaginal birth may be negatively affected by management decisions; d) hospital leadership is engaged in making change to support vaginal birth; e) individual feels personally responsible to maximize the patient's chance of having vaginal birth; and f) nurses feel encouraged to play an active role in making patient management decisions. A safety culture composite score demonstrated a strong association with reduction in cesarean rate by hospital [−16% (95% CI ‐0.30 to −0.03)], parallel to but lower in magnitude to VBM [−30% (95% CI ‐0.48 to −0.13)]. No significant interaction effect between mean VBM and safety culture of a hospital was found (p = 0.79), suggesting that the effect of VBM versus safety culture on the hospital cesarean delivery rate are independent. Conclusions Vaginal birth microculture remains the strongest predictor of cesarean delivery overuse; however, safety culture characteristics including teamwork, psychological safety, and communication demonstrate a strong association with lower cesarean delivery rates, which app...
Background and context: Cancer has been the leading cause of death in Taiwan since 1982. According the most updated cancer registry published by the Ministry of Health and Welfare, a total of 105,156 new cases (302/100,000 population) were diagnosed and 46,829 people (128/100,000 population) died of cancer which accounted for 28.6% of all deaths. Currently, around 500,000 people live with cancers in Taiwan. The Formosa Cancer Foundation (FCF) operates two Cancer Survivor Supportive Care Centers in Taipei and Kaohsiung cities which provide comprehensive, professional services to cancer survivors and their families. These centers regularly offer free medical, nutritional and psychological counseling, nutrition and transportation subsidies for low-income survivor households, critical emergency relief as well as hold a regular courses of body and mind rehabilitation to help cancer survivors successfully navigate their road to optimal recovery. As the number of cancer survivors needed supportive care services are rapidly increasing, the resources allocated for the services is not proportionately increased. Therefore, how to improve both the quantity and quality for the survivors' supportive care services becomes an essential issue. Aim: To ensure service standardization as well as to improve the quantity and quality of the supportive care services for the cancer survivors. Strategy/Tactics: FCF began the process necessary to certify its Survivor Supportive Care Service Quality Management System under ISO 9001 since 2015. Program/Policy process: To certify the FCF Survivor Supportive Care Service Quality Management System under ISO 9001:2015 by (1) Clearly defining the assessment and service goals (2) Systemized management and control of service delivery procedures (3) Regular collection and utilization of client-satisfaction data and comments (4) Systemized tracking and management of documents (5) Standard method for records storage and maintenance (6) Standardized procedures for managing and maintaining service facilities; and (7) Standardized procedures for evaluating and training staff. Outcomes: After implementation of the ISO 9001:2015 quality management system, FCF's overall service capacity has increased by 18-20%. Each service now covered by a standardized procedure, high levels of service quality and teamwork have been well maintained even under reduced staffing conditions. Survivors’ satisfaction with FCF services has risen significantly from an average of 4.0 prior to implementation of the quality management system to 4.7 afterward (full score: 5). The survivor´s family members also indicate strong satisfaction with FCF services. What was learned: Implementing the ISO 9001:2015 quality management system in the cancer survivor supportive care service has assisted FCF not only to increase the quality and quantity of its service deliveries but also to enhance the effectiveness of its professional team.
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