Severe Maternal Morbidity Associated with Hospital NICU Level in Washington State

2021 ◽  
Author(s):  
Laura Sienas ◽  
Catherine M. Albright ◽  
Suzan Walker ◽  
Jane Hitti
Keyword(s):  
Maternal Morbidity ◽  
Neonatal Intensive Care ◽  
Washington State ◽  
Severe Maternal Morbidity ◽  
Level Of Care ◽  
Transfusion Rate ◽  
Key Points ◽  
Level 1 ◽  
Present On Admission ◽  
Level 2

Objective Rising maternal mortality and severe maternal morbidity (SMM) rates have drawn increasing public health attention. We evaluated patterns of SMM across the Washington State Perinatal Regional Network, in which neonatal intensive care unit (NICU) levels correlate with maternal level of care. Study Design Retrospective cohort study using de-identified patient and hospital-level rates of SMM diagnoses and procedures for all women who delivered at 58 hospitals from October 2015 to September 2016. Data were obtained from the Washington State Comprehensive Hospital Abstract Reporting System, which includes inpatient diagnosis with associated Present on Admission flags, procedure, and discharge information derived from hospital billing systems. Deliveries were stratified by having or not having SMM. For each SMM diagnosis, POA rates were tabulated. Hospital SMM rates (all SMM, transfusion only, and SMM excluding transfusion) were grouped according to their NICU level of care (critical access [CA] and 1–4). Odds ratios and 95% confidence intervals (CI) were calculated. Results Of 76,961 deliveries, 908 women (1.2%) had any SMM including 533 with transfusion only and 375 with all other SMM diagnoses/procedures. Rates of SMM were highest at level 1 and level 4 hospitals at 1.3 and 1.5%, respectively. Level 1 and CA hospitals had the highest transfusion rate (1.0%), while level 2, 3, and 4 hospitals had progressively lower rates (0.8, 0.7, and 0.5%, respectively; p < 0.01). Level 4 hospitals had the highest rate of SMM diagnoses/procedures (1.0%). Among SMM diagnoses, the percentage with POA was lowest in level 1/CA hospitals (23%) and similar across level 2, 3, and 4 hospitals (39%). Conclusion SMM diagnoses occur most frequently at the centers providing the highest level of care, likely attributable to the regional referral system. However, transfusion rates are increased in level 1/CA hospitals. Efforts to decrease SMM should focus on equipping level 1/CA hospitals with tools to decrease maternal morbidity and improve referral systems. Key Points

Postpartum Severe Maternal Morbidity Among Mothers of Neonatal Intensive Care Unit Infants [20R]

2019 ◽  
Vol 133 (1) ◽  
pp. 196S-197S
Author(s):  
Alison M. Stuebe ◽  
Christine Tucker ◽  
Renee Ferrari ◽  
Sarah Verbiest ◽  
Virginia Pate ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Maternal Morbidity ◽  
Neonatal Intensive Care ◽  
Severe Maternal Morbidity

scholarly journals 264: Severe maternal morbidity associated with hospital NICU level in Washington State

2019 ◽  
Vol 220 (1) ◽  
pp. S189-S190
Author(s):  
Laura E. Sienas ◽  
Catherine Albright ◽  
Suzan Walker ◽  
Jane Hitti
Keyword(s):  
Maternal Morbidity ◽  
Washington State ◽  
Severe Maternal Morbidity

scholarly journals 245: Severe maternal morbidity associated with hypertensive disorders in Washington state

2019 ◽  
Vol 220 (1) ◽  
pp. S177-S178
Author(s):  
Catherine M. Albright ◽  
Laura Sienas ◽  
Suzan Walker ◽  
Jane Hitti
Keyword(s):  
Maternal Morbidity ◽  
Washington State ◽  
Severe Maternal Morbidity ◽  
Hypertensive Disorders

Routine Multidisciplinary Review of Severe Maternal Morbidity Is Associated with a Reduction in Preventable Cases of Severe Maternal Morbidity

2020 ◽  
Author(s):  
John A. Ozimek ◽  
Naomi Greene ◽  
Andrew Geller ◽  
Mark Zakowski ◽  
Melissa S. Wong ◽  
...  
Keyword(s):  
Maternal Morbidity ◽  
Review Process ◽  
Transition Period ◽  
Medical Center ◽  
The United States ◽  
Severe Maternal Morbidity ◽  
Multidisciplinary Research ◽  
Review Committee ◽  
Research Committee ◽  
Key Points

Objective Severe maternal morbidity (SMM) has increased by 45% in the United States and is estimated to affect up to 1.5% of all deliveries. Research has not yet been conducted that demonstrates a benefit to multidisciplinary review of SMM. The aim of our study was to determine if standardized, routine review of the cases of SMM by a multidisciplinary committee results in a reduction of potentially preventable cases of SMM. Study Design A retrospective cohort study of all women admitted for delivery at Cedars-Sinai Medical Center from March 1, 2012 to September 30, 2016. Our cohort was separated into two groups: a preintervention group composed of women admitted for delivery prior to the implementation of the obstetric Quality and Peer Review Committee (OBQPRC), and a postintervention group where the committee had been well established. Cases of confirmed SMM were presented to a multidisciplinary research committee, and the committee determined whether opportunities for improvement in care existed. The groups were compared with determine if there was a decreased incidence of preventable SMM following the implementation of the OBQPRC standardized review process. Results There were 30,319 deliveries during the study period; 13,120 deliveries in the preintervention group; and 13,350 deliveries in the postintervention group (2,649 deliveries during the transition period). There was no difference in the rate of SMM between the preintervention (125; 0.95%) and postintervention (129; 0.97%) groups, (p = 0.91). There was a significantly lower rate of opportunity for the improvement in care in the postintervention group (29.5%) compared with the preintervention group (46%; p = 0.005). Conclusion We demonstrated a significant reduction in the rate of potentially preventable SMM following the implementation of routine review of all SMM suggesting that this process plays an important role in improving maternal care and outcomes. Key Points

Presence of neonatal intensive care services at birth hospital and early intervention enrollment in infants ≤1500 g

2020 ◽  
Vol 48 (4) ◽  
pp. 402-410
Author(s):  
Semsa Gogcu ◽  
David Aboudi ◽  
Jordan Kase ◽  
Edmund LaGamma ◽  
Heather Lynn Brumberg
Keyword(s):  
Intensive Care ◽  
Early Intervention ◽  
Neonatal Intensive Care ◽  
Speech Therapy ◽  
Very Low Birth Weight ◽  
Community Level ◽  
Care Services ◽  
Level 1 ◽  
Therapeutic Services ◽  
Level 2

AbstractObjectiveTo determine whether the receipt of therapeutic services of very-low-birth-weight (VLBW; ≤1500 g) neonates inadvertently delivered at community Level 2 and 3 neonatal intensive care units (NICUs) compared with those born at a well-baby nursery (WBN; Level 1) differed.MethodsThis is a retrospective study of neonates who were born at Level 1 (WBN), 2, 3, and 4 NICUs and discharged from a Level 4 hospital (n = 529). All infants were evaluated at the Regional Neonatal Follow-up Program at 12 ± 1 months corrected gestational age (CA) and assessed for use of therapeutic services including: early intervention (EI), occupational therapy (OT), physical therapy (PT), speech therapy (ST), and special education (SE).ResultsCompared to infants born at community Level 2 and 3 NICU hospitals, those outborn at a community Level 1 WBN had significantly higher utilization of EI (90% vs. 62%) and PT (83% vs. 61%) at 12 months CA. This association persisted when controlling for covariates. Infants who required EI had significantly lower Bayley-III cognitive scores at 3 years of age.ConclusionVLBW infants outborn at WBN (Level 1) hospitals required more outpatient therapeutic services than those born at hospitals with NICU facilities. These results suggest that delivering at the appropriate community hospital level of care might be advantageous for long-term outcomes.

scholarly journals Electronic commerce in Ukraine: controversial aspects of legal and regulatory framework

2017 ◽  
pp. 119-126
Author(s):  
Zenoviy Zadorozhnyi
Keyword(s):  
Electronic Commerce ◽  
Subject Matter ◽  
Regulatory Framework ◽  
International Standards ◽  
National Legislation ◽  
Key Points ◽  
Level 3 ◽  
The Subject ◽  
Level 1 ◽  
Level 2

The subject matter of the research paper is legal and regulatory framework of electronic commerce in Ukraine. The article systematizes the current laws and regulations which govern business activities of e-commerce enterprises and their accounting policies in order to identify areas for further improvement. The methods of systematization and generalization are used in the research for considering a set of regulatory and legal acts applicable to e-commerce enterprises in Ukraine. The study highlights key points for improving legal and regulatory framework related to e-commerce enterprises. Business activities of e-commerce enterprises and principles of accounting basis are viewed as divided into three levels: level 1 – The Constitution of Ukraine and the Codes of Laws; level 2 – The Laws of Ukraine; level 3 – subordinate legislation. An analysis is carried out to determine regulatory and legal acts related to electronic commerce of each of the above-mentioned levels. It is proposed to make amendments and additions to certain regulatory and legal acts with the aim of eliminating obsolete con- cepts and harmonization of legislation. It is proved that one of the key points for improving e-commerce in Ukraine is bringing the national legislation related to electronic commerce into compliance with EU laws and international standards.

167 Severe maternal morbidity and black-white differences in Washington State

2021 ◽  
Vol 224 (2) ◽  
pp. S113
Author(s):  
Bharti Garg ◽  
Alyssa R. Hersh ◽  
Aaron B. Caughey ◽  
Rachel A. Pilliod
Keyword(s):  
Maternal Morbidity ◽  
Washington State ◽  
Severe Maternal Morbidity

ANALISIS KEMAMPUAN KOMUNIKASI MATEMATIS DALAM MENYELESAIKAN MASALAH STATISTIKA

2018 ◽  
Vol 5 (2) ◽  
pp. 7 ◽  
Author(s):  
Ahmad Aunur Rohman
Keyword(s):  
Level 1 ◽  
Level 2

Penelitian ini dimaksudkan untuk mengetahui bagaimana kemampuan komunikasi matematis mahasiswa terhadap pemahaman statistika. Data dalam penelitian ini berupa hasil pekerjaan tes tertulis tentang kemampuan komunikasi matematis dan wawancara terhadap subjek penelitian. Pengumpulan data diperoleh dengan tes dan wawancara. Uji keabsahan data yang digunakan adalah triangulasi. Data penelitan yang terkumpul dianalisis dengan analisis data non statistik yang terdiri dari tiga alur, yaitu reduksi data, penyajian data, dan penarikan kesimpulan/verifikasi data. Hasil penelitian menunjukkan bahwa 1) Terdapat 5 mahasiswa yang berada pada level 0 (sangat kurang baik); 2) 24 mahasiswa berada pada level 1 (kurang baik); 3) 6 mahasiswa berada pada level 2 (cukup baik); Penelitian ini diharapkan dapat memacu individu lain untuk melakukan penelitian yang lebih baik dan mendalam tentang kemampuan komunikasi matematis.

EVALUASI PELATIHAN DI PT. PUPUK KUJANG CIKAMPEK

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Lania Muharsih ◽  
Ratih Saraswati
Keyword(s):  
Training Evaluation ◽  
Work Productivity ◽  
Learning Behavior ◽  
Level 3 ◽  
Level 1 ◽  
Four Levels ◽  
A Company ◽  
Level 2 ◽  
Evaluation Sheet ◽  
Assessment Factor

This study aims to determine the training evaluation at PT. Kujang Fertilizer. PT. Pupuk Kujang is a company engaged in the field of petrochemicals. Evaluation sheet of PT. Fertilizer Kujang is made based on Kirkpatrick's theory which consists of four levels of evaluation, namely reaction, learning, behavior, and results. At level 1, namely reaction, in the evaluation sheet is in accordance with the theory of Kirkpatrick, at level 2 that is learning should be held pretest and posttest but only made scale. At level 3, behavior, according to theory, but on assessment factor number 3, quantity and work productivity should not need to be included because they are included in level 4. At level 4, that is the result, here is still lacking to get a picture of the results of the training that has been carried out because only based on answers from superiors without evidence of any documents.   Keywords: Training Evaluation, Kirkpatrick Theory.    Penelitian ini bertujuan mengetahui evaluasi training di PT. Pupuk Kujang. PT. Pupuk Kujang merupakan perusahaan yang bergerak di bidang petrokimia. Lembar evaluasi PT. Pupuk Kujang dibuat berdasarkan teori Kirkpatrick yang terdiri dari empat level evaluasi, yaitu reaksi, learning, behavior, dan hasil. Pada level 1 yaitu reaksi, di lembar evaluasi tersebut sudah sesuai dengan teori dari Kirkpatrick, pada level 2 yaitu learning seharusnya diadakan pretest dan posttest namun hanya dibuatkan skala. Pada level 3 yaitu behavior, sudah sesuai teori namun pada faktor penilaian nomor 3 kuantitas dan produktivitas kerja semestinya tidak perlu dimasukkan karena sudah termasuk ke dalam level 4. Pada level 4 yaitu hasil, disini masih sangat kurang untuk mendapatkan gambaran hasil dari pelatihan yang sudah dilaksanakan karena hanya berdasarkan dari jawaban atasan tanpa bukti dokumen apapun.   Kata kunci: Evaluasi Pelatihan, Teori Kirkpatrick.

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