Directly Measured Costs of Severe Maternal Morbidity Events during Delivery Admission Compared with Uncomplicated Deliveries

Objective To estimate the actual excess costs of care for delivery admissions complicated by severe maternal morbidity (SMM) compared with uncomplicated deliveries. Study Design This is a retrospective cohort study of all deliveries between October 2015 and September 2018 at a single tertiary academic center. Pregnant individuals ≥ 20 weeks' gestation who delivered during a hospital admission (i.e., a “delivery admission”) were included. The primary exposure was SMM, as defined by Centers for Disease Control and Prevention (CDC) criteria, CDC criteria excluding blood transfusion, or by validated hospital-defined criteria (intensive care unit admission or ≥ 4 units of blood products). Potential SMM events identified via administrative and blood bank data were reviewed to confirm SMM events had occurred. Primary outcome was total actual costs of delivery admission derived from time-based accounting and acquisition costs in the institutional Value Driven Outcomes database. Cost of delivery admissions with SMM events was compared with the cost of uncomplicated delivery using adjusted generalized linear models, with separate models for each of the SMM definitions. Relative cost differences are reported due to data restrictions. Results Of 12,367 eligible individuals, 12,361 had complete cost data. Two hundred and eighty individuals (2.3%) had confirmed SMM events meeting CDC criteria. CDC criteria excluding transfusion alone occurred in 1.0% (n = 121) and hospital-defined SMM in 0.6% (n = 76). In adjusted models, SMM events by CDC criteria were associated with a relative cost increase of 2.45 times (95% confidence interval [CI]: 2.29–2.61) the cost of an uncomplicated delivery. SMM by CDC criteria excluding transfusion alone was associated with a relative increase of 3.26 (95% CI: 2.95–3.60) and hospital-defined SMM with a 4.19-fold (95% CI: 3.64–4.83) increase. Each additional CDC subcategory of SMM diagnoses conferred a relative cost increase of 1.60 (95% CI: 1.43–1.79). Conclusion SMM is associated with between 2.5- and 4-fold higher cost than uncomplicated deliveries. Key Points

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Severe Maternal Morbidity: A Comparison of Definitions and Data Sources

American Journal of Epidemiology ◽

10.1093/aje/kwab077 ◽

2021 ◽

Author(s):

Jonathan M Snowden ◽

Audrey Lyndon ◽

Peiyi Kan ◽

Alison El Ayadi ◽

Elliott Main ◽

...

Keyword(s):

Administrative Data ◽

Maternal Morbidity ◽

Claims Data ◽

Birth Certificate ◽

Population Level ◽

Kappa Statistic ◽

Data Sources ◽

Severe Maternal Morbidity ◽

Fine Grained ◽

Control And Prevention

Abstract Severe maternal morbidity (SMM) is a composite outcome measure that indicates serious, potentially life-threatening maternal health problems. There is great interest in defining SMM using administrative data for surveillance and research. In the US, one common way of defining SMM at the population level is an index developed by the Centers for Disease Control and Prevention. Modifications have been proposed to this index (e.g., excluding maternal transfusion); some research defines SMM using an index introduced by Bateman et al. Birth certificate data are also increasingly being used to define SMM. We compared commonly used US definitions of SMM to each other among all California births, 2007-2012, using the Kappa statistic and other measures. We also evaluated agreement between maternal morbidity fields on the birth certificate compared to claims data. Concordance was generally low between the 7 definitions of SMM analyzed (i.e., κ < 0.4 for 13 of 21 two-way comparisons), Low concordance was particularly driven by presence/absence of transfusion and claims data versus birth certificate definitions. Low agreement between administrative data-based definitions of SMM highlights that results can be expected to differ between them. Further research is needed on validity of SMM definitions, using more fine-grained data sources.

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Hypertensive Disorders of Pregnancy, Cesarean Delivery, and Severe Maternal Morbidity in an Urban Safety-Net Population

American Journal of Epidemiology ◽

10.1093/aje/kwaa135 ◽

2020 ◽

Vol 189 (12) ◽

pp. 1502-1511

Author(s):

Sheree L Boulet ◽

Marissa Platner ◽

Naima T Joseph ◽

Alexa Campbell ◽

Rachel Williams ◽

...

Keyword(s):

Cesarean Delivery ◽

Maternal Morbidity ◽

Linear Models ◽

Safety Net ◽

Severe Maternal Morbidity ◽

Hypertensive Disorders Of Pregnancy ◽

Adjusted Risk ◽

Relative Risks ◽

Hypertensive Disorders ◽

Urban Safety

Abstract Hypertensive disorders of pregnancy (HDP) are a leading cause of severe maternal morbidity (SMM), yet mediation by cesarean delivery is largely unexplored. We investigated the association between HDP and SMM in a cohort of deliveries at a safety-net institution in Atlanta, Georgia, during 2016–2018. Using multivariable generalized linear models, we estimated adjusted risk differences, adjusted risk ratios, and 95% confidence intervals for the association between HDP and SMM. We examined interactions with cesarean delivery and used mediation analysis with 4-way decomposition to estimate excess relative risks. Among 3,723 deliveries, the SMM rate for women with and without HDP was 124.4 per 1,000 and 52.0 per 1,000, respectively. The adjusted risk ratio for the total effect of HDP on SMM was 2.55 (95% confidence interval (CI): 2.15, 3.39). Approximately 55.2% (95% CI: 25.7, 68.5) of excess relative risk was due to neither interaction nor mediation, 24.9% (95% CI: 15.4, 50.0) was due to interaction between HDP and cesarean delivery, 9.6% (95% CI: 3.4, 15.2) was due to mediation, and 10.3% (95% CI: 5.4, 20.3) was due to mediation and interaction. HDP are a potentially modifiable risk factor for SMM; implementing evidence-based interventions for the prevention and treatment of HDP is critical for reducing SMM risk.

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Cost-Effectiveness of Perirectal Surveillance Cultures for Controlling Vancomycin-ResistantEnterococcus

Infection Control and Hospital Epidemiology ◽

10.1086/502080 ◽

2002 ◽

Vol 23 (8) ◽

pp. 429-435 ◽

Cited By ~ 71

Author(s):

Carlene A. Muto ◽

Eve T. Giannetta ◽

Lisa J. Durbin ◽

Barbara M. Simonton ◽

Barry M. Farr

Keyword(s):

Control Program ◽

Effective Control ◽

University Hospitals ◽

Prevention Guideline ◽

Contact Isolation ◽

Surveillance Cultures ◽

Excess Costs ◽

Large Outbreak ◽

Control And Prevention ◽

The Cost

Background:Several hospitals opting not to use active surveillance cultures to identify carriers of vancomycin-resistantEnterococcus(VRE) have reported that adoption of other parts of the Centers for Disease Control and Prevention guideline for controlling VRE has had little to no impact. Because use of surveillance cultures and contact isolation controlled a large outbreak at this hospital, their costs were estimated for comparison with the excess costs of VRE bacteremias occurring at a higher rate at a hospital not employing these measures.Setting:Two university hospitals.Methods:Inpatients deemed high risk for VRE acquisition at this hospital underwent weekly perirectal surveillance cultures. Estimated costs of cultures and resulting isolation during a 2-year period were compared with the estimated excess costs of more frequent VRE bacteremias at another hospital of similar size and complexity not using surveillance cultures to control spread throughout the hospital.Results:Of 54,052 patients admitted, 10,400 had perirectal swabs taken. Cultures and isolation cost an estimated $253,099. VRE culture positivity was limited to 193 (0.38%) and VRE bacteremia to 1 (0.002%) as compared with 29 bacteremias at the comparison hospital. The estimated attributable cost of VRE bacteremia at the comparison hospital of $761,320 exceeded the cost of the control program at this hospital by threefold.Conclusions:The excess costs of VRE bacteremia may justify the costs of preventive measures. The costs of VRE infections at other body sites, of deaths from untreatable infections, and of dissemination of genes for vancomycin resistance also help to justify the costs of implementing an effective control program.

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Quality of Life after an Episode of Severe Maternal Morbidity: Evidence from a Cohort Study in Brazil

BioMed Research International ◽

10.1155/2018/9348647 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 4

Author(s):

Carina R. Angelini ◽

Rodolfo C. Pacagnella ◽

Mary A. Parpinelli ◽

Carla Silveira ◽

Carla B. Andreucci ◽

...

Keyword(s):

Quality Of Life ◽

Cohort Study ◽

General Health ◽

Maternal Morbidity ◽

Linear Models ◽

Severe Maternal Morbidity ◽

Domain Specific ◽

General Health Score ◽

Assess Quality

Objective. To assess quality of life (QOL) in women who experienced a severe maternal morbidity (SMM) event and associated factors, in comparison to those who did not. Study Design. Retrospective cohort study performed at the maternity of the University of Campinas in Brazil, including 801 women with or without SMM, within 6 months to 5 years after delivery. Women were interviewed by phone and data were electronically stored, using the Brazilian version of the SF36 to assess women’s self-perception of quality of life. To analyze a possible relationship between SMM and perceived impairment in quality of life, χ2 and Fisher’s Exact tests were used. Multiple analysis using Generalized Linear Models was applied to identify factors independently associated with the general health score. The main outcome measures were general and domain-specific SF36 scores on quality of life. Results. Maternal morbidity conditions were associated with lower scores of patient perceptions of quality of life in the following domains: physical functioning, role-limiting physical, pain, and general health status. A lower level of school education, not having a partner, caesarean section, and history of previous clinical conditions were associated with a worse perception of general health and quality of life. Conclusion. Health professionals should know the association between life conditions, previous chronic health conditions, and SMM for women during prenatal care to beyond 42 weeks postpartum. Longitudinal and interdisciplinary actions should be put into practice to provide healthcare for these women, with special emphasis on the effective reduction in health inequities.

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Monitoring Maternal Near Miss/Severe Maternal Morbidity: A Systematic Review

SSRN Electronic Journal ◽

10.2139/ssrn.3444404 ◽

2019 ◽

Author(s):

Natalie England ◽

Julia Madill ◽

Amy Metcalfe ◽

Laura Magee ◽

Stephanie Cooper ◽

...

Keyword(s):

Systematic Review ◽

Maternal Morbidity ◽

Near Miss ◽

Severe Maternal Morbidity ◽

Maternal Near Miss

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397 Can obesity explain racial disparities in severe maternal morbidity?

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2020.12.418 ◽

2021 ◽

Vol 224 (2) ◽

pp. S257

Author(s):

Ayesha SIDDIQUI ◽

Catherine Deneux-Tharaux ◽

Elizabeth Howell ◽

Elie Azria

Keyword(s):

Racial Disparities ◽

Maternal Morbidity ◽

Severe Maternal Morbidity

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Sensuator: A Hybrid Sensor–Actuator Approach to Soft Robotic Proprioception Using Recurrent Neural Networks

Actuators ◽

10.3390/act10020030 ◽

2021 ◽

Vol 10 (2) ◽

pp. 30

Author(s):

Pornthep Preechayasomboon ◽

Eric Rombokas

Keyword(s):

Neural Networks ◽

Recurrent Neural Networks ◽

Linear Models ◽

Open Loop ◽

Proof Of Concept ◽

State Estimator ◽

Loop Control ◽

Practical Applications ◽

Soft Actuator ◽

The Cost

Soft robotic actuators are now being used in practical applications; however, they are often limited to open-loop control that relies on the inherent compliance of the actuator. Achieving human-like manipulation and grasping with soft robotic actuators requires at least some form of sensing, which often comes at the cost of complex fabrication and purposefully built sensor structures. In this paper, we utilize the actuating fluid itself as a sensing medium to achieve high-fidelity proprioception in a soft actuator. As our sensors are somewhat unstructured, their readings are difficult to interpret using linear models. We therefore present a proof of concept of a method for deriving the pose of the soft actuator using recurrent neural networks. We present the experimental setup and our learned state estimator to show that our method is viable for achieving proprioception and is also robust to common sensor failures.

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Effects of Increase in the Cost of Building Materials on the Delivery of Affordable Housing in South Africa

Sustainability ◽

10.3390/su13041772 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1772

Author(s):

Bimpe Alabi ◽

Julius Fapohunda

Keyword(s):

South Africa ◽

Affordable Housing ◽

Building Materials ◽

Statistical Technique ◽

Project Managers ◽

Maintenance Cost ◽

Cost Increase ◽

Sequential Mixed Methods ◽

Adequate Provision ◽

The Cost

Adequate provision of affordable human settlements is a huge challenge in South Africa since its independence. This paper investigates the effects of the cost increase of building materials on affordable housing delivery in South Africa. With potential solutions for cost minimisation of building materials, with the aim of achieving affordable housing delivery in South Africa are provided. This study uses a sequential mixed methods approach, wherein surveys were conducted among the construction professionals (project managers, site managers architects, site engineers, quantity surveyors, contractors, building materials suppliers, and government workers) in the construction industry within Cape Town, South Africa, who were considered as the research participants. The qualitative data obtained from the survey exercise were analysed using content analysis, while the quantitative data were analysed using a descriptive statistical technique on SPSS. The findings attained show fluctuation in construction cost and a rise in maintenance cost (caused by poor workmanship) as significant effects in the cost increase of building materials for affordable housing delivery. Adequate application of the recommendations given in this study will minimise the effects of high cost of building materials and enhance affordable housing delivery. Appropriate handling of the findings given in this study will reduce the effects of the high cost of building materials and augment timely delivery of affordable housing and stakeholders’ satisfaction.

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