scholarly journals Impact of a Population-based Systems Approach on Evidence-based Care for Medicaid-insured Pregnant and Postpartum Women: A Quasi-Experimental Study

2021 ◽  
Author(s):  
Lee Anne Roman ◽  
Jennifer E. Raffo ◽  
Kelly L. Strutz ◽  
Zhehui Luo ◽  
Melinda Johnson ◽  
...  
Keyword(s):  
Black Women ◽  
Systems Approach ◽  
First Trimester ◽  
Population Based ◽  
Postpartum Care ◽  
Care Utilization ◽  
Evidence Based ◽  
Experimental Population ◽  
Positive Effects ◽  
Quasi Experimental

AbstractIntroductionEvidence-based enhanced prenatal/postnatal care (EPC) programs for Medicaid-insured women have significant positive effects on care and health outcomes. However, EPC enrollment rates are typically low, enrolling less than 30% of eligible women. This study investigated the effects of a population-based systems approach on timely EPC participation and other health care utilization.MethodsThis quasi-experimental, population-based, difference-in-difference study used linked birth certificates, Medicaid claims, and EPC data from complete statewide Medicaid birth cohorts retrieved from 2009-2017 and analyzed in 2019-20. System strategies included cross-agency leadership, clinical-community linked practices, Community Health Worker care, mental health coordination, and patient empowerment. Outcomes included EPC participation and early enrollment, prenatal care adequacy, emergency department contact, and postpartum care.ResultsPrenatal EPC (7.4 absolute percentage points; 95% CI: 6.3—8.5) and first trimester EPC, (12.4; 95% CI: 10.2—14.5) increased among women served by practices that co-located EPC resources, relative to the comparator group. First trimester EPC improved in the county (17.9; 95% CI: 15.7—20.0); ED decreased in the practices (−11.1; 95% CI: -12.3— -9.9) and postpartum care improved (7.1; 95% CI: 6— 8.2) in the county. EPC participation for Black women served by the practices improved (4.4; 95% CI: 2.2—6.6), as well as early EPC (12.3; 95% CI: 9.0—15.6) and postpartum visits (10.4; 95% CI: 8.3—12.4).ConclusionsA population systems approach improved EPC participation and service utilization for Medicaid-insured women in a county population, for those in practices that co-located EPC resources, and for Black women.

Epidemiology for Monitoring and Evaluation

2021 ◽  
pp. 199-212
Author(s):  
J Patrick Vaughan ◽  
Cesar Victora ◽  
A Mushtaque R Chowdhury
Keyword(s):  
Systems Approach ◽  
Health Planning ◽  
Monitoring And Evaluation ◽  
Health Status Indicators ◽  
Population Based ◽  
Experimental Population ◽  
Quasi Experimental ◽  
Efficacy Measures ◽  
Study Designs ◽  
The Impact

Monitoring involves continuous observation to see if plans are on track and evaluation determines the effectiveness of planned health interventions delivered by the health services and programmes. The systems approach uses indicators to measure delivery, access, quality, and coverage of services and programmes and their impact on health status indicators. Efficacy measures the impact of interventions in individual people. Measuring effectiveness in whole communities utilizes quasi-experimental population-based study designs with community controls. The importance of ethical principles and monitoring equity in health planning is presented and emphasised.

scholarly journals Middle-age dementia risk scores and old-age cognition: a quasi-experimental population-based twin study with over 20-year follow-up

2020 ◽  
pp. jnnp-2020-324009
Author(s):  
Paula Iso-Markku ◽  
Jaakko Kaprio ◽  
Noora Lindgren ◽  
Juha O Rinne ◽  
Eero Vuoksimaa
Keyword(s):  
Old Age ◽  
Middle Age ◽  
Twin Pair ◽  
Population Based ◽  
Self Report ◽  
Risk Scores ◽  
Experimental Population ◽  
Dementia Risk ◽  
Quasi Experimental ◽  
Intervention Trials

BackgroundMiddle-age risk scores predict cognitive impairment, but it is not known if these associations are evident when controlling for shared genetic and environmental factors. Using two risk scores, self-report educational-occupational score and Cardiovascular Risk Factors, Aging and Dementia (CAIDE), we investigated if twins with higher middle-age dementia risk have poorer old-age cognition compared with their co-twins with lower risk.MethodsWe used a population-based older Finnish Twin Cohort study with middle-age questionnaire data (n=15 169, mean age=52.0 years, SD=11.8) and old-age cognition measured via telephone interview (mean age=74.1, SD=4.1, n=4302). Between-family and within-family linear regression analyses were performed.ResultsIn between-family analyses (N=2359), higher educational-occupational score was related to better cognition (B=0.76, 95% CI 0.69 to 0.83) and higher CAIDE score was associated with poorer cognition (B=−0.73, 95% CI −0.82 to -0.65). Within twin-pair differences in educational-occupational score were significantly related to within twin-pair differences in cognition in dizygotic (DZ) pairs (B=0.78, 95% CI 0.25 to 1.31; N=338) but not in monozygotic (MZ) pairs (B=0.12, 95% CI −0.44 to 0.68; N=221). Within twin-pair differences in CAIDE score were not related to within twin-pair differences in cognition: DZ B=−0.38 (95% CI −0.90 to 0.14, N=343) and MZ B=−0.05 (95% CI −0.59 to 0.49; N=226).ConclusionMiddle-age dementia risk scores predicted old-age cognition, but within twin-pair analyses gave little support for associations independent of shared environmental and genetic factors. Understanding genetic underpinnings of risk score−cognition associations is important for early detection of dementia and designing intervention trials.

Ethnic Differences in Self-Poisoning Across South London

Crisis ◽  
2014 ◽  
Vol 35 (4) ◽  
pp. 268-272
Author(s):  
Sean Cross ◽  
Dinesh Bhugra ◽  
Paul I. Dargan ◽  
David M. Wood ◽  
Shaun L. Greene ◽  
...  
Keyword(s):  
Black Women ◽  
Data Collection ◽  
White Women ◽  
Population Based ◽  
Care Services ◽  
Self Harm ◽  
Managing Risk ◽  
The Uk ◽  
Incident Cases ◽  
Minority Ethnic

Background: Self-poisoning (overdose) is the commonest form of self-harm cases presenting to acute secondary care services in the UK, where there has been limited investigation of self-harm in black and minority ethnic communities. London has the UK’s most ethnically diverse areas but presents challenges in resident-based data collection due to the large number of hospitals. Aims: To investigate the rates and characteristics of self-poisoning presentations in two central London boroughs. Method: All incident cases of self-poisoning presentations of residents of Lambeth and Southwark were identified over a 12-month period through comprehensive acute and mental health trust data collection systems at multiple hospitals. Analysis was done using STATA 12.1. Results: A rate of 121.4/100,000 was recorded across a population of more than half a million residents. Women exceeded men in all measured ethnic groups. Black women presented 1.5 times more than white women. Gender ratios within ethnicities were marked. Among those aged younger than 24 years, black women were almost 7 times more likely to present than black men were. Conclusion: Self-poisoning is the commonest form of self-harm presentation to UK hospitals but population-based rates are rare. These results have implications for formulating and managing risk in clinical services for both minority ethnic women and men.

The Evolution of Physical Activity on Prescription (FaR) in Sweden

2014 ◽  
Vol 62 (2) ◽  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Healthcare Professionals ◽  
Systems Approach ◽  
Ecological Model ◽  
Controlled Trial ◽  
Professional Associations ◽  
Successful Implementation ◽  
Surgeon General ◽  
Positive Effects

In 1996, the first Report of the US Surgeon General on Physical Activity and Health provided an extensive knowledge overview about the positive effects of physical activity (PA) on several health outcomes and PA recommendations. This contributed to an enhanced interest for PA in Sweden. The Swedish Professional Associations for Physical Activity (YFA) were appointed to form a Scientific Expert Group in the project “Sweden on the Move” and YFA created the idea of Physical Activity on Prescription (FaR) and the production of a handbook (FYSS) for healthcare professionals. In Swedish primary care, licensed healthcare professionals, i.e. physicians, physiotherapists and nurses, can prescribe PA if they have sufficient knowledge about the patient’s current state of health, how PA can be used for promotion, prevention and treatment and are trained in patient-centred counselling and the FaR method. The prescription is followed individually or by visiting local FaR providers. These include sport associations, patient organisations, municipal facilities, commercial providers such as gyms, sports clubs and walking clubs or other organisations with FaR educated staff such as health promoters or personal trainers. In clinical practice, the FaR method increases the level of PA in primary care patients, at 6 and at 12 months. Self-reported adherence to the prescription was 65% at 6 months, similar to the known compliance for medications. In a randomised controlled trial, FaR significantly improved body composition and reduced metabolic risk factors. It is suggested that a successful implementation of PA in healthcare depends on a combination of a systems approach (socio-ecological model) and the strengthening of individual motivation and capability. General support from policymakers, healthcare leadership and professional associations is important. To lower barriers, tools for implementation and structures for delivery must be readily available. Examples include handbooks such as FYSS, the FaR system and the use of pedometers.

Effects of Short-Term Mission Trips on Recipients’ Self-Esteem and Readiness for Self-Directed Learning

2021 ◽  
pp. 009164712110115
Author(s):  
Charissa H. W. Wong ◽  
Li Neng Lee ◽  
Alberto Pérez Pereiro
Keyword(s):  
Self Esteem ◽  
Control Group ◽  
Short Term ◽  
Self Directed Learning ◽  
Positive Effects ◽  
Post Test ◽  
Quasi Experimental ◽  
Directed Learning ◽  
Group Post ◽  
Mission Trips

Short-term Christian overseas volunteer trips, also known as short-term mission trips (STMs), have become increasingly prevalent (Howell & Dorr, 2007). However, research on these programs has been limited. This quasi-experimental study adds to the literature by quantitatively measuring the effects of an STM from Singapore to Thailand. STM recipients’ ( n = 44) self-esteem and readiness for self-directed learning (RSDL) were compared across timepoints – pre-test, post-test, follow-up – and with a control group ( n = 50). It was hypothesized that recipients would experience an increase in self-esteem and RSDL such that their scores would be higher than the control group post-STM. Results provide partial support for the hypotheses; while improvements among recipients were either not significant (for self-esteem) or not long-lasting (for RSDL), recipients had higher scores than the control group post-STM. This suggests that STMs have some, albeit limited, positive effects. Recommendations for promoting greater and longer-lasting effects are offered.

scholarly journals Effect of collaborative quality improvement on stillbirths, neonatal mortality and newborn care practices in hospitals of Telangana and Andhra Pradesh, India: evidence from a quasi-experimental mixed-methods study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Karen Zamboni ◽  
Samiksha Singh ◽  
Mukta Tyagi ◽  
Zelee Hill ◽  
Claudia Hanson ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Neonatal Mortality ◽  
Process Evaluation ◽  
Andhra Pradesh ◽  
Newborn Care ◽  
Mechanisms Of Change ◽  
Evidence Based ◽  
Programme Implementation ◽  
Quasi Experimental ◽  
Care Practices

Abstract Background Improving quality of care is a key priority to reduce neonatal mortality and stillbirths. The Safe Care, Saving Lives programme aimed to improve care in newborn care units and labour wards of 60 public and private hospitals in Telangana and Andhra Pradesh, India, using a collaborative quality improvement approach. Our external evaluation of this programme aimed to evaluate programme effects on implementation of maternal and newborn care practices, and impact on stillbirths, 7- and 28-day neonatal mortality rate in labour wards and neonatal care units. We also aimed to evaluate programme implementation and mechanisms of change. Methods We used a quasi-experimental plausibility design with a nested process evaluation. We evaluated effects on stillbirths, mortality and secondary outcomes relating to adherence to 20 evidence-based intrapartum and newborn care practices, comparing survey data from 29 hospitals receiving the intervention to 31 hospitals expected to receive the intervention later, using a difference-in-difference analysis. We analysed programme implementation data and conducted 42 semi-structured interviews in four case studies to describe implementation and address four theory-driven questions to explain the quantitative results. Results Only 7 of the 29 intervention hospitals were engaged in the intervention for its entire duration. There was no evidence of an effect of the intervention on stillbirths [DiD − 1.3 percentage points, 95% CI − 2.6–0.1], on neonatal mortality at age 7 days [DiD − 1.6, 95% CI − 9–6.2] or 28 days [DiD − 3.0, 95% CI − 12.9—6.9] or on adherence to target evidence-based intrapartum and newborn care practices. The process evaluation identified challenges in engaging leaders; challenges in developing capacity for quality improvement; and challenges in activating mechanisms of change at the unit level, rather than for a few individuals, and in sustaining these through the creation of new social norms. Conclusion Despite careful planning and substantial resources, the intervention was not feasible for implementation on a large scale. Greater focus is required on strategies to engage leadership. Quality improvement may need to be accompanied by clinical training. Further research is also needed on quality improvement using a health systems perspective.

scholarly journals Maternal bisphenol urine concentrations, fetal growth and adverse birth outcomes: A population-based prospective cohort

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Chalana M. Sol ◽  
Charissa van Zwol - Janssens ◽  
Elise M. Philips ◽  
Alexandros G. Asimakopoulos ◽  
Maria-Pilar Martinez-Moral ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Fetal Growth ◽  
Head Circumference ◽  
Lower Risk ◽  
First Trimester ◽  
Population Based ◽  
Third Trimester ◽  
Bisphenol S ◽  
Fetal Head ◽  
Urine Concentrations

Abstract Background Exposure to bisphenols may affect fetal growth and development. The trimester-specific effects of bisphenols on repeated measures of fetal growth remain unknown. Our objective was to assess the associations of maternal bisphenol urine concentrations with fetal growth measures and birth outcomes and identify potential critical exposure periods. Methods In a population-based prospective cohort study among 1379 pregnant women, we measured maternal bisphenol A, S and F urine concentrations in the first, second and third trimester. Fetal head circumference, length and weight were measured in the second and third trimester by ultrasound and at birth. Results An interquartile range increase in maternal pregnancy-averaged bisphenol S concentrations was associated with larger fetal head circumference (difference 0.18 (95% confidence interval (CI) 0.01 to 0.34) standard deviation scores (SDS), p-value< 0.05) across pregnancy. When focusing on specific critical exposure periods, any detection of first trimester bisphenol S was associated with larger second and third trimester fetal head circumference (difference 0.15 (95% CI 0.05 to 0.26) and 0.12 (95% CI 0.02 to 0.23) SDS, respectively) and fetal weight (difference 0.12 (95% CI 0.02 to 0.22) and 0.16 (95% CI 0.06 to 0.26) SDS, respectively). The other bisphenols were not consistently associated with fetal growth outcomes. Any detection of bisphenol S and bisphenol F in first trimester was also associated with a lower risk of being born small size for gestational age (Odds Ratio 0.56 (95% CI 0.38 to 0.74) and 0.55 (95% CI 0.36 to 0.85), respectively). Bisphenols were not associated with risk of preterm birth. Conclusions Higher maternal bisphenol S urine concentrations, especially in the first trimester, seem to be related with larger fetal head circumference, higher weight and a lower risk of being small size for gestational age at birth.

Sign in / Sign up

Export Citation Format

Share Document