First name
Lisa
Middle name
D
Last name
Levine

Title

Acceptability of Dyad Care Management After Preterm Birth: A Qualitative Study.

Year of Publication

2023

Number of Pages

Date Published

11/2023

ISSN Number

1573-6628

Abstract

OBJECTIVES: Care management programs for medically complex infants interact with parents after complicated pregnancies, when gaps in maternal health care are well documented. These care managers may have the relationships and skills to promote postpartum and interconception health and health care access. It is unknown whether expanding these care management models to address maternal needs would be acceptable.

METHODS: We conducted qualitative interviews with women with a history of preterm birth and clinicians. For women with a history of preterm birth, additional inclusion criteria were Medicaid-insured infant in one health system and English proficiency. We purposively oversampled women whose infants received care management. Clinicians worked in two geographically adjacent health systems. Interviews explored priorities after preterm birth and perceived acceptability of mother-infant dyad care management. Interviews were audio recorded, transcribed, and coded following an integrated approach in which we applied a priori codes and captured emergent themes.

RESULTS: We interviewed 33 women (10/2018-7/2021) and 24 clinicians (3/2021-8/2021). Women were predominantly non-Hispanic Black, and 15 had infants receiving care management. Clinicians included physicians, nurses, and social workers from Pediatrics, Obstetrics, and Family Medicine. Subgroups converged thematically, finding care management acceptable. Tailoring programs to address stress and sleep, emphasizing care managers with strong interpersonal skills and shared experiences with care management users, and program flexibility would contribute to acceptability.

CONCLUSIONS FOR PRACTICE: Dyad care management after preterm birth is acceptable to potential program end-users and clinicians. Dyad health promotion may contribute to improved birth outcomes, infant, and parent health.

DOI

10.1007/s10995-023-03848-5

Alternate Title

Matern Child Health J

PMID

37980700
Inner Banner
Publication Image
Featured Publication
No
Inner Banner
Publication Image

Title

Implementation of a calculator to predict cesarean during labor induction: a qualitative evaluation of the patient perspective.

Year of Publication

2023

Number of Pages

100968

Date Published

04/2023

ISSN Number

2589-9333

DOI

10.1016/j.ajogmf.2023.100968

Alternate Title

Am J Obstet Gynecol MFM

PMID

37061041
Inner Banner
Publication Image
Featured Publication
No
Inner Banner
Publication Image

Title

A Qualitative Study of Perspectives of Black Women on Autonomy and Motivational Interviewing.

Year of Publication

2023

Number of Pages

94-102

Date Published

12/2023

ISSN Number

2688-4844

Abstract

PURPOSE: Motivational interviewing (MI) is an evidence-based strategy to modify health behaviors, including some risk factors for adverse birth outcomes. Black women, who have disproportionately high rates of adverse birth outcomes, have reported mixed preferences on MI. This study explored the acceptability of MI among Black women who are at high risk for adverse birth outcomes.

METHODS: We conducted qualitative interviews with women with a history of preterm birth. Participants were English-language proficient and had Medicaid-insured infants. We purposively oversampled women whose infants had medical complexity. Interviews explored experiences with health care and health behaviors after birth. The interview guide was iteratively developed to obtain specific reactions to MI by including videos demonstrating MI-consistent and MI-inconsistent counseling. Interviews were audio recorded, transcribed, and coded following an integrated approach in which we applied codes related to MI and allowed themes to emerge from the data.

RESULTS: We interviewed 30 non-Hispanic Black women from October 2018 to July 2021. Eleven viewed the videos. Participants emphasized the importance of autonomy in decision-making and health behavior. Participants expressed a preference for MI-consistent clinical approaches, including autonomy support and building rapport, considering them respectful, nonjudgmental, and likely to support change.

CONCLUSIONS: In this sample of Black women with a history of preterm birth, participants valued an MI-consistent clinical approach. Incorporating MI into clinical care may improve the experience of health care among Black women, thus serving as one strategy to promote equity in birth outcomes.

DOI

10.1089/whr.2022.0094

Alternate Title

Womens Health Rep (New Rochelle)

PMID

36874236
Inner Banner
Publication Image
Featured Publication
No
Inner Banner
Publication Image

Title

Bringing postpartum care to the NICU-An opportunity to improve health in a high-risk obstetric population.

Year of Publication

2023

Number of Pages

1-2

Date Published

01/2023

ISSN Number

1476-5543

DOI

10.1038/s41372-022-01525-z

Alternate Title

J Perinatol

PMID

36198771
Inner Banner
Publication Image
Inner Banner
Publication Image

Title

Motivational interviewing to promote interconception health: A scoping review of evidence from clinical trials.

Year of Publication

2022

Number of Pages

Date Published

07/2022

ISSN Number

1873-5134

Abstract

BACKGROUND: Promoting interconception health can improve birth outcomes and long-term women's health. Motivational Interviewing (MI) is an evidence-based behavior change strategy that can address interconception health behaviors and health care engagement.

OBJECTIVE: This scoping review assessed the evidence for using MI to promote interconception health and assessed features of successful MI interventions.

METHODS: We searched PubMed, CHINAL, and Cochrane databases for clinical trials that involved an MI intervention and at least one comparison group published by 8/31/2021. Interventions occurred during pregnancy or within three months postpartum and outcomes were measured between birth and one year postpartum. We abstracted data on trial characteristics including outcome, population, interventionist training, MI fidelity monitoring, intervention dose, and comparison condition. We examined whether trials that demonstrated statistically significant improvement in outcomes had common features.

RESULTS: There were 37 included studies. Interventions addressed breastfeeding, teen contraception, tobacco, alcohol, or substance use, vaccine acceptance, nutrition, physical activity, and depression. No trials addressed more than one topic. Nineteen studies demonstrated improved outcomes. Interventions during the perinatal or postnatal periods were more likely to demonstrate improved interconception outcomes than interventions in the prenatal period. No other trial characteristics were consistently associated with demonstrating improved outcomes.

DISCUSSION: MI has been applied to a variety of interconception health behaviors, with some promising results, particularly for interventions in the perinatal or postpartum period. Outcomes were not clearly attributable to any other differences in intervention or study design. Further exploring context or implementation may help maximize the potential of MI in interconception health promotion.

PRACTICAL VALUE: MI may be implemented across a range of clinical settings, patient groups, and time points around pregnancy. Interventions on health topics relevant to the interconception period should incorporate perinatal or postpartum components.

DOI

10.1016/j.pec.2022.07.009

Alternate Title

Patient Educ Couns

PMID

35870992
Inner Banner
Publication Image
Inner Banner
Publication Image

Title

Neighborhood deprivation increases the risk of Post-induction cesarean delivery.

Year of Publication

2021

Number of Pages

Date Published

2021 Dec 17

ISSN Number

1527-974X

Abstract

OBJECTIVE: The purpose of this study was to measure the association between neighborhood deprivation and cesarean delivery following labor induction among people delivering at term (≥37 weeks of gestation).

MATERIALS AND METHODS: We conducted a retrospective cohort study of people ≥37 weeks of gestation, with a live, singleton gestation, who underwent labor induction from 2010 to 2017 at Penn Medicine. We excluded people with a prior cesarean delivery and those with missing geocoding information. Our primary exposure was a nationally validated Area Deprivation Index with scores ranging from 1 to 100 (least to most deprived). We used a generalized linear mixed model to calculate the odds of postinduction cesarean delivery among people in 4 equally-spaced levels of neighborhood deprivation. We also conducted a sensitivity analysis with residential mobility.

RESULTS: Our cohort contained 8672 people receiving an induction at Penn Medicine. After adjustment for confounders, we found that people living in the most deprived neighborhoods were at a 29% increased risk of post-induction cesarean delivery (adjusted odds ratio = 1.29, 95% confidence interval, 1.05-1.57) compared to the least deprived. In a sensitivity analysis, including residential mobility seemed to magnify the effect sizes of the association between neighborhood deprivation and postinduction cesarean delivery, but this information was only available for a subset of people.

CONCLUSIONS: People living in neighborhoods with higher deprivation had higher odds of postinduction cesarean delivery compared to people living in less deprived neighborhoods. This work represents an important first step in understanding the impact of disadvantaged neighborhoods on adverse delivery outcomes.

DOI

10.1093/jamia/ocab258

Alternate Title

J Am Med Inform Assoc

PMID

34921313
Inner Banner
Publication Image
Inner Banner
Publication Image

Title

Interconception Preventive Care and Recurrence of Pregnancy Complications for Medicaid-Insured Women.

Year of Publication

2022

Number of Pages

Date Published

2022 Feb 28

ISSN Number

1931-843X

Abstract

<p>Pregnancy complications may recur and are associated with potentially modifiable risks. The role of interconception preventive care in reducing repeat pregnancy complications is understudied. This retrospective cohort used 2007-2012 Medicaid claims from 12 states. Included women who had an index birth complicated by prematurity, hypertension, or diabetes, a subsequent birth within 36 months, and Medicaid eligibility for ≥11 of 12 months after index birth. Logistic regression assessed for an association between the exposure of preventive visits in the year after index birth and primary outcomes of prematurity, hypertension, or diabetes in the subsequent pregnancy. Regression adjusted for confounders including demographics (age, race and ethnicity, rural residence, state), index pregnancy features (complications, prenatal visits, , maternal and infant length of stay, year), visits to address complications in the index birth, and interpregnancy interval. Of 17,372 women, mean age was 24.3 ± 5.3 years, and race/ethnicity was 50.3% non-Hispanic White, 27.2% non-Hispanic Black, and 11.9% Hispanic. In the index pregnancy 43.3% experienced prematurity, 39.2% experienced hypertension, and 34.2% experienced diabetes. In the year after the index pregnancy, 54.7% had at least one preventive visit. In the second pregnancy, 47.7% experienced prematurity, hypertension, or diabetes. Recurrence rates were 28.1% for preterm birth, 38.0% for hypertension, and 48.3% for diabetes. Preventive visits were associated with reduced hypertension in the subsequent pregnancy (OR 0.88, 95% CI 0.82-0.97) but not reduced preterm birth or diabetes. Preventive visits after an index birth complicated by prematurity, hypertension, or diabetes were associated with 10% lower odds of hypertension in a subsequent pregnancy, but not with reductions in diabetes or prematurity. Some complications may be more amenable to interconception preventive services than others.</p>

DOI

10.1089/jwh.2021.0355

Alternate Title

J Womens Health (Larchmt)

PMID

35231191
Inner Banner
Publication Image
Inner Banner
Publication Image

Title

Neighborhood education status drives racial disparities in clinical outcomes in PPCM.

Year of Publication

2021

Number of Pages

Date Published

2021 Apr 24

ISSN Number

1097-6744

Abstract

<p><strong>IMPORTANCE: </strong>Peripartum cardiomyopathy (PPCM) disproportionately affects women of African ancestry. Additionally, clinical outcomes are worse in this subpopulation compared to White women with PPCM. The extent to which socioeconomic parameters contribute to these racial disparities is not known.</p>

<p><strong>OBJECTIVE: </strong>To quantify the association between area-based proxies of socioeconomic status (SES) and clinical outcomes in PPCM, and to determine the potential contribution of these factors to racial disparities in outcomes.</p>

<p><strong>DESIGN, SETTING, AND PARTICIPANTS: </strong>A retrospective cohort study was performed at the University of Pennsylvania Health System, a tertiary referral center serving a population with a high proportion of Black individuals. The cohort included 220 women with PPCM, 55% of whom were Black or African American. Available data included clinical and demographic characteristics as well as residential address georeferenced to US Census-derived block group measures of SES.</p>

<p><strong>MAIN OUTCOMES AND MEASURES: </strong>Rates of sustained cardiac dysfunction (defined as persistent LVEF &lt;50%, LVAD placement, transplant, or death) were compared by race and block group-level measures of SES, and a composite neighborhood concentrated disadvantage index (NDI). The contributions of area-based socioeconomic parameters to the association between race and sustained cardiac dysfunction were quantified.</p>

<p><strong>RESULTS: </strong>Black race and higher NDI were both independently associated with sustained cardiac dysfunction (relative risk [RR] 1.63, confidence interval [CI] 1.13-2.36; and RR 1.29, CI 1.08-1.53, respectively). Following multivariable adjustment, effect size for NDI remained statistically significant, but effect size for Black race did not. The impact of low neighborhood education on racial disparities in outcomes was stronger than that of low neighborhood income (explaining 45% and 0% of the association with black race, respectively). After multivariate adjustment, only low area-based education persisted as significantly correlating with sustained cardiac dysfunction (RR 1.49; CI 1.02-2.17).</p>

<p><strong>CONCLUSIONS: </strong>Both Black race and NDI independently associate with adverse outcomes in women with PPCM in a single center study. Of the specific components of NDI, neighborhood low education was most strongly associated with clinical outcome and partially explained differences in race. These results suggest interventions targeting social determinants of health in disadvantaged communities may help to mitigate outcome disparities.</p>

DOI

10.1016/j.ahj.2021.03.013

Alternate Title

Am Heart J

PMID

33905751
Inner Banner
Publication Image
Inner Banner
Publication Image

Title

Neighborhood education status drives racial disparities in clinical outcomes in PPCM.

Year of Publication

2021

Number of Pages

27-32

Date Published

2021 08

ISSN Number

1097-6744

Abstract

BACKGROUND: Peripartum cardiomyopathy (PPCM) disproportionately affects women of African ancestry. Additionally, clinical outcomes are worse in this subpopulation compared to White women with PPCM.  The extent to which socioeconomic parameters contribute to these racial disparities is not known.

METHODS: We aimed to quantify the association between area-based proxies of socioeconomic status (SES) and clinical outcomes in PPCM, and to determine the potential contribution of these factors to racial disparities in outcomes. A retrospective cohort study was performed at the University of Pennsylvania Health System, a tertiary referral center serving a population with a high proportion of Black individuals. The cohort included 220 women with PPCM, 55% of whom were Black or African American. Available data included clinical and demographic characteristics as well as residential address georeferenced to US Census-derived block group measures of SES. Rates of sustained cardiac dysfunction (defined as persistent LVEF <50%, LVAD placement, transplant, or death) were compared by race and block group-level measures of SES, and a composite neighborhood concentrated disadvantage index (NDI). The contributions of area-based socioeconomic parameters to the association between race and sustained cardiac dysfunction were quantified.

RESULTS: Black race and higher NDI were both independently associated with sustained cardiac dysfunction (relative risk [RR] 1.63, confidence interval [CI] 1.13-2.36; and RR 1.29, CI 1.08-1.53, respectively). Following multivariable adjustment, effect size for NDI remained statistically significant, but effect size for Black race did not. The impact of low neighborhood education on racial disparities in outcomes was stronger than that of low neighborhood income (explaining 45% and 0% of the association with black race, respectively). After multivariate adjustment, only low area-based education persisted as significantly correlating with sustained cardiac dysfunction (RR 1.49; CI 1.02-2.17).

CONCLUSIONS: Both Black race and NDI independently associate with adverse outcomes in women with PPCM in a single center study. Of the specific components of NDI, neighborhood low education was most strongly associated with clinical outcome and partially explained differences in race. These results suggest interventions targeting social determinants of health in disadvantaged communities may help to mitigate outcome disparities.

DOI

10.1016/j.ahj.2021.03.015

Alternate Title

Am Heart J

PMID

33857409
Inner Banner
Publication Image
Inner Banner
Publication Image

Title

Development and evaluation of MADDIE: Method to Acquire Delivery Date Information from Electronic health records.

Year of Publication

2020

Number of Pages

104339

Date Published

2020 Nov 06

ISSN Number

1872-8243

Abstract

<p><strong>OBJECTIVE: </strong>To develop an algorithm that infers patient delivery dates (PDDs) and delivery-specific details from Electronic Health Records (EHRs) with high accuracy; enabling pregnancy-level outcome studies in women's health.</p>

<p><strong>MATERIALS AND METHODS: </strong>We obtained EHR data from 1,060,100 female patients treated at Penn Medicine hospitals or outpatient clinics between 2010-2017. We developed an algorithm called MADDIE: Method to Acquire Delivery Date Information from Electronic Health Records that infers a PDD for distinct deliveries based on EHR encounter dates assigned a delivery code, the frequency of code usage, and the time differential between code assignments. We validated MADDIE's PDDs against a birth log independently maintained by the Department of Obstetrics and Gynecology.</p>

<p><strong>RESULTS: </strong>MADDIE identified 50,560 patients having 63,334 distinct deliveries. MADDIE was 98.6 % accurate (F-score 92.1 %) when compared to the birth log. The PDD was on average 0.68 days earlier than the true delivery date for patients with only one delivery (± 1.43 days) and 0.52 days earlier for patients with more than one delivery episode (± 1.11 days).</p>

<p><strong>DISCUSSION: </strong>MADDIE is the first algorithm to successfully infer PDD information using only structured delivery codes and identify multiple deliveries per patient. MADDIE is also the first to validate the accuracy of the PDD using an external gold standard of known delivery dates as opposed to manual chart review of a sample.</p>

<p><strong>CONCLUSION: </strong>MADDIE augments the EHR with delivery-specific details extracted with high accuracy and relies only on structured EHR elements while harnessing temporal information and the frequency of code usage to identify accurate PDDs.</p>

DOI

10.1016/j.ijmedinf.2020.104339

Alternate Title

Int J Med Inform

PMID

33232918
Inner Banner
Publication Image
Inner Banner
Publication Image