Disparities in Chronic Conditions Among Women Hospitalized for Delivery in the United States, 2005–2014

Admon, Lindsay K.; Winkelman, Tyler N.A.; Moniz, Michelle H.; Davis, Matthew M.; Heisler, Michele; Dalton, Vanessa K.

doi:10.1097/aog.0000000000002357

Cited by 153 publications

(129 citation statements)

References 21 publications

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“…A study looking at data from the National Inpatient Sample data from 2005 to 2014 did not find any significant differences in chronic hypertension or other chronic conditions among hospitalized deliveries among rural versus urban zip codes [25]. Likewise, we did not see any significant difference in reporting of any preexisting conditions or hypertension between the two groups.…”

Section: Journal Of Clinical and Translational Sciencecontrasting

confidence: 70%

Pregnancy health in POWERMOM participants living in rural versus urban zip codes

Radin

Peters

Ariniello

et al. 2020

J. Clin. Trans. Sci.

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Background: Pregnant women living in rural locations in the USA have higher rates of maternal and infant mortality compared to their urban counterparts. One factor contributing to this disparity may be lack of representation of rural women in traditional clinical research studies of pregnancy. Barriers to participation often include transportation to research facilities, which are typically located in urban centers, childcare, and inability to participate during nonwork hours. Methods: POWERMOM is a digital research app which allows participants to share both survey and sensor data during their pregnancy. Through non-targeted, national outreach a study population of 3612 participants (591 from rural zip codes and 3021 from urban zip codes) have been enrolled so far in the study, beginning on March 16, 2017, through September 20, 2019. Results: On average rural participants in our study were younger, had higher pre-pregnancy weights, were less racially diverse, and were more likely to plan a home birth compared to the urban participants. Both groups showed similar engagement in terms of week of pregnancy when they joined, percentage of surveys completed, and completion of the outcome survey after they delivered their baby. However, rural participants shared less HealthKit or sensor data compared to urban participants. Discussion: Our study demonstrated the feasibility and effectiveness of enrolling pregnant women living in rural zip codes using a digital research study embedded within a popular pregnancy app. Future efforts to conduct remote digital research studies could help fill representation and knowledge gaps related to pregnant women.

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Section: Journal Of Clinical and Translational Sciencecontrasting

confidence: 70%

Pregnancy health in POWERMOM participants living in rural versus urban zip codes

Radin

Peters

Ariniello

et al. 2020

J. Clin. Trans. Sci.

View full text Add to dashboard Cite

show abstract

“…The study findings are subject to limitations of the study design and data source. First, each discharge record may not identify a unique woman . Second, hospital discharge data are primarily used for claims purposes and provide limited information on certain comorbid conditions such as obesity, tobacco use disorders, and other chronic conditions .…”

Section: Discussionmentioning

confidence: 99%

“…First, each discharge record may not identify a unique woman. 34 Second, hospital discharge data are primarily used for claims purposes and provide limited information on certain comorbid conditions such as obesity, tobacco use disorders, and other chronic conditions. 28 The under-ascertainment of comorbidities such as chronic conditions 14 in this administrative data set may explain, in part, the low c-statistic (area under the curve = 0.64) of the maternal comorbidity index.…”

Section: Discussionmentioning

confidence: 99%

Maternal comorbidity index and severe maternal morbidity during delivery hospitalizations in Texas, 2011‐2014

Salahuddin

Mandell

Lakey

et al. 2019

Birth

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Background Severe maternal morbidity (SMM) prevalence was 194.0 per 10 000 deliveries in Texas in 2015. Chronic, behavioral, and pregnancy‐induced conditions, as captured by a maternal comorbidity index, increase the risk for delivery‐related morbidity and mortality. The objective of the study was to examine the association between maternal comorbidity index and SMM among delivery hospitalizations in Texas. Methods Delivery‐related hospitalizations among Texan women aged 15‐49 years were identified using the 2011‐2014 Texas all‐payer inpatient hospitalization public use data files (n = 1 434 441). The primary outcome of interest was SMM, based on the Alliance for Innovation on Maternal Health's coding scheme. The exposure of interest was a maternal comorbidity index. Multivariable logistic regression model was used to examine the association between maternal comorbidity index and SMM. Results SMM prevalence remained consistent between 2011 and 2014 (196.0‐197.0 per 10 000 deliveries, P > .05; n = 1 434 441). Nearly 40% of delivery‐related hospitalizations had a maternal comorbidity index of at least 1, and the proportion of deliveries in the highest risk category of comorbidity index (≥5) increased by 12.0% from 2011 to 2014. SMM prevalence was highest among the youngest and oldest age groups. With each unit increase in maternal comorbidity index, the odds of SMM increase was 1.43 (95% CI 1.42‐1.43). Conclusions Maternal comorbidity index is associated with SMM; however, the low predictive power of the model suggests that other, unmeasured factors may influence SMM in Texas. These findings highlight a need to understand broader contextual factors (practitioner, facility, systems of care, and community) that may be associated with SMM to reduce maternal morbidity and mortality in Texas.

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“…The rate of physician consultation during midwifery care is highly dependent on local context but may be as high as 55% . With increasing rates of maternal chronic conditions and greater availability of fetal testing, rates of consultation may continue to remain high.…”

Section: Discussionmentioning

confidence: 99%

A Planning Checklist for Interprofessional Consultations for Women in Midwifery Care

Phillippi¹,

Holley²,

Thompson³

et al. 2018

J Midwife Womens Health

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Team-based, interprofessional models of maternity care can allow women to receive personalized care based on their health needs and personal preferences. However, involvement of multiple health care providers can fragment care and increase communication errors, which are a major cause of preventable maternal morbidity and mortality. In order to improve communication within one health system, a community-engaged approach was used to develop a planning checklist for the care of women who began care with midwives but developed risks for poor perinatal outcomes. The planning checklist was constructed using feedback from women, nurses, midwives, and physicians in one interprofessional, collaborative network. In feasibility testing during 50 collaborative visits, the planning checklist provided a prompt to generate a comprehensive plan for maternity care and elucidate the rationale for interventions to women and future health care providers. In interviews after implementation of the checklist within a new collaborative format of prenatal physician consultations, women were pleased with the information received, and nurses, midwives, and physicians were positive about improved communication. This tool, developed with stakeholder input, was easy to implement and qualitatively beneficial to satisfaction and health system function. This article details the creation, implementation, and qualitative evaluation of the planning checklist. The checklist is provided and can be modified to meet the needs of other health systems.

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Disparities in Chronic Conditions Among Women Hospitalized for Delivery in the United States, 2005–2014

Cited by 153 publications

References 21 publications

Pregnancy health in POWERMOM participants living in rural versus urban zip codes

Pregnancy health in POWERMOM participants living in rural versus urban zip codes

Maternal comorbidity index and severe maternal morbidity during delivery hospitalizations in Texas, 2011‐2014

A Planning Checklist for Interprofessional Consultations for Women in Midwifery Care

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