Tag: Outcomes

UNC ObGyn, Orange County Department of Health Receive Funding to Reduce Inequities in Maternal Health Care and Outcomes

The joint study between the UNC School of Medicine and the Orange County Health Department has been awarded a $21 million funding award from the Patient-Centered Outcomes Research Institute (PCORI) to make pregnancy and birth safer for North Carolinians with hypertensive disorders of pregnancy. Alison Stuebe, MD, is the UNC-Chapel Hill lead.


A study between the UNC Chapel-Hill and Orange County Health Department, called “Thriving Hearts: Healing-Centered, Integrated, Community Maternity Care,” has been approved for a $21-million funding award from the Patient-Centered Outcomes Research Institute (PCORI), an independent, nonprofit organization based in Washington, D.C. The funding award will be used to reduce the incidence of hypertensive disorders of pregnancy (HDP) and improve maternal outcomes across 10 North Carolina counties over the next six years.

In the United States, rates of maternal mortality and severe maternal morbidity are rising, especially among Black and American Indian/Alaska Native women and women with disabilities, low incomes, or rural residences. Black women with HDP – a group of high blood pressure disorders that includes preeclampsia and gestational hypertension – are 3.7 times more likely to die from complications and are more likely to experience severe morbidity than their white counterparts.

The project, led by Alison Stuebe, MD, professor of obstetrics and gynecology at the UNC School of Medicine, and Quintana Stewart, director of Orange County’s Health Department, will be coordinating with local health departments, families, and community groups to make pregnancy and birth safer. Their project strategy involves a multi-level intervention to provide support and connection at the individual patient level, the healthcare team level, and the community level.

“The overarching goal of ‘Thriving Hearts’ is to cultivate conditions for mothers to not only survive pregnancy, but to thrive,” said Stuebe, who is also a Distinguished Scholar

Health care utilization and outcomes of patients seen by virtual urgent care versus in-person emergency department care

Abstract

Background: Virtual urgent care (VUC) is intended to support diversion of patients with low-acuity complaints and reduce the need for in-person emergency department visits. We aimed to describe subsequent health care utilization and outcomes of patients who used VUC compared with similar patients who had an in-person emergency department visit.

Methods: We used patient-level encounter data that were prospectively collected for patients using VUC services provided by 14 pilot programs in Ontario, Canada. We linked the data to provincial administrative databases to identify subsequent 30-day health care utilization and outcomes. We defined 2 subgroups of VUC users; those with a documented prompt referral to an emergency department by a VUC provider, and those without. We matched patients in each cohort to an equal number of patients presenting to an emergency department in person, based on encounter date, medical concern and the logit of a propensity score. For the subgroup of patients not promptly referred to an emergency department, we matched patients to those who were seen in an emergency department and then discharged home.

Results: Of the 19 595 patient VUC visits linked to administrative data, we matched 2129 patients promptly referred to the emergency department by a VUC provider to patients presenting to the emergency department in person. Index visit hospital admissions (9.4% v. 8.7%), 30-day emergency department visits (17.0% v. 17.5%), and hospital admissions (12.9% v. 11.0%) were similar between the groups. We matched 14 179 patients who were seen by a VUC provider with no documented referral to the emergency department. Patients seen by VUC were more likely to have a subsequent in-person emergency department visit within 72 hours (13.7% v. 7.0%), 7 days (16.5% v. 10.3%) and 30 days (21.9% v. 17.9%), but hospital admissions were similar within 72 hours (1.1% v. 1.3%), and higher

Medical-legal partnerships can help improve maternal and infant health outcomes

Medical-legal partnerships (MLPs), which include a lawyer as part of a patient’s care team, can help health systems address health-harming legal needs and better support pregnant and postpartum patients, according to a new research commentary published today in Obstetrics & Gynecology. The article offers insights and expert advice from Georgetown University Health Justice Alliance’s Perinatal Legal Assistance and Wellbeing (LAW) Project at MedStar Washington Hospital Center, one of the first medical-legal partnerships in the country to focus specifically on the perinatal period and a key component of the D.C. Safe Babies Safe Moms (SBSM) initiative that aims to improve maternal and infant health in the nation’s capital.

MLPs have long been used to improve health and well-being for historically marginalized communities and have been identified as potentially helpful in combating racism in healthcare. In the maternal health space, offering legal support to pregnant and postpartum patients facing unsafe housing, food insecurity, and challenges with navigating public benefits or insurance coverage can be a powerful tool. To date, the Perinatal LAW Project has served over 164 patients/clients, helping to recover more than $200,000 in the form of income support, paid leave, back wages, health insurance coverage, debt relief, rent abatements, and security deposit refunds.

Lawyers know that unmet legal needs in these areas are often at the root of daily life struggles that make achieving optimal health impossible. We are so grateful for the opportunity SBSM has provided to build a robust collaboration with health providers willing to work side-by-side with our academic MLP to treat patients’ health-harming legal needs in this setting.”


Vicki Girard, JD, Co-Founder and Faculty Director of the Georgetown University Health Justice Alliance, professor at Georgetown Law, and one of the publication’s authors

The Perinatal LAW Project helps patients tackle these issues head-on

US Leads World in Health-Care Spending Yet Key Health Outcomes Lag, Study Says

(Bloomberg) — The US spends as much as three times more on health care per person as other high-income countries, yet residents are often less likely to visit doctors, according to a report that highlights poor returns for the nation’s large investment.

The pandemic has widened discordances between medical spending and health results in the US and the rest of the world, findings from the Commonwealth Fund study show. The only high-income country that doesn’t guarantee access to health care, the US spent almost 18% of its gross domestic product on health and related services in 2021. 

The report adds to a litany of indicting data from the US, where half of adults are worried about medical costs that sometimes force them to delay or forgo care, according to a recent study, and life expectancy of 77 years ranks 39th among all nations. One glaring problem is that Americans visit the doctor just four times a year, trailing most other wealthy countries, perhaps because of cost and a lack of practicing physicians, the authors said. 

The American health system “can seem designed to discourage people from using services,” they wrote in the report, US Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes. “High out-of-pocket costs lead nearly half of working-age adults to skip or delay getting needed care.” 

The US spends $10,687 per person each year on health-care programs and insurance, plus another $1,225 for household out-of-pocket costs, the research found. That compares to less than $4,000 for both components in South Korea, the lowest of 13 countries the group tracked, and just over $7,000 in Germany, the second-biggest spender after the US.

Yet Americans are seen by doctors less than half as often as people in the Netherlands, Germany, Japan and Korea, and the US has

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