Elevated care at home: An alternative to traditional levels of care.

Background: Elevated care at home (ECH) is a novel in-home care model supporting early hospital discharge and providing an alternative to institutional postacute care.

Objectives: This study compares patient characteristics, mortality, and readmission outcomes of hospitalized patients who transitioned to ECH to patients who transitioned to skilled nursing facilities (SNF) and skilled home health services (SHH).

Methods: A retrospective study of patients between May 2020 and January 2022 transitioned from the hospital to ECH, SNF, or SHH.

Reach and effectiveness of a non-university cardio-obstetrics program.

Background: Current guidelines recommend multidisciplinary cardiovascular obstetric programs (CVOB) to manage complex pregnant patients with cardiovascular disease. Minimal evaluation of these programs exists, with most of these programs offered at university-based centers.

Methods: A cohort of 113 patients managed by a CVOB team at a non-university health system (2018-2019) were compared to 338 patients seen by cardiology prior to the program (2016-2017).

Patient Experience and Decision-Making Process for Laser Photocoagulation for Monochorionic Twin Pregnancy: A Qualitative Exploration.

Introduction: The aim of the study was to explore patients' perspectives on diagnosis and treatment options for complicated monochorionic multiple gestations, and experiences with fetoscopic laser photocoagulation.

Methods: This is a prospective cohort study of patients undergoing laser photocoagulation. Participants were interviewed during pregnancy and the postpartum period.

Prenatal and postpartum depression diagnosis in a large health system: prevalence and disparities.

Background/objectives/introduction: Depression during pregnancy or postpartum carries the same risks as general depression as well as additional risks specific to pregnancy, infant health and maternal well-being. The purpose of this study is to document the prevalence of depression symptoms and diagnosis during pregnancy and in the first 3 months postpartum among a cohort of women receiving prenatal care in a large health system. Secondarily, we examine variability in screening results and diagnosis by race, ethnicity, language, economic status and other maternal characteristics during pregnancy and postpartum.

The Use of Saliva Samples to Test for Congenital Cytomegalovirus Infection in Newborns: Examination of False-Positive Samples Associated with Donor Milk Use.

A universal screening research study was conducted in six hospitals to identify the clinical sensitivity of polymerase chain reaction (PCR) testing on newborn dried blood spots (DBSs) versus saliva specimens for the diagnosis of congenital cytomegalovirus (cCMV). CMV DNA positive results from DBSs or saliva were confirmed with urine testing. Findings of several false-positive (FP) saliva PCR results prompted an examination of a possible association with donor milk.

Implementation and Outcomes of a Model of Care for Placenta Accreta Spectrum in a Community-Based Private Practice.

Objective: The aim of the study is to describe a model of care and outcomes for placenta accreta spectrum (PAS) implemented in the context of a community based non-academic health system.

Study Design: The program for management of PAS includes a multidisciplinary team approach with protocols for ultrasound assessment, diagnosis, and surgery. The program was implemented in the two largest private hospitals in the Twin Cities, Minnesota, United States.

The impact of a population-based prevention program on cardiovascular events: Findings from the heart of new Ulm project.

Background: Cardiovascular disease (CVD) and its associated risk factors are the principal drivers of mortality and healthcare costs in the United States with rural residents experiencing higher CVD death rates than their urban counterparts.

Methods: The purpose of this study was to examine incidence of major CVD events over 9 years of implementation of the Heart of New Ulm (HONU) Project, a rural population-based CVD prevention initiative. HONU interventions were delivered at individual, organizational, and community levels addressing clinical risk factors, lifestyle behaviors and environmental changes.

Universal childhood obesity prevention in a rural community: Study design, methods and baseline participant characteristics of the NU-HOME randomized controlled trial.

Childhood obesity is a major health concern in the United States (US) and those living in rural communities are at higher risk than their urban counterparts. Few prevention trials have engaged whole families of school-age children in community settings, and none to date have promoted family meals, family activity and healthful home environments in rural settings through a rigorous, randomized controlled trial (RCT). The New Ulm at HOME (NU-HOME) study recruited 114 parent/child dyads in a two-arm (intervention versus wait-list control) RCT to test the efficacy of a family meals-focused program aimed to prevent excess weight gain among 7-10 year-old children in rural Minnesota.

Maternal and Neonatal Outcomes in Hospital-Based Deliveries With Water Immersion.

Objective: To compare neonatal intensive care unit (NICU) or special care nursery admission for deliveries with water immersion compared with deliveries in the matched control group without water immersion. Secondary outcomes included adverse neonatal diagnoses, maternal infections, and perineal lacerations.

Methods: We conducted a retrospective study using electronic health record data (2014-2018) from two health systems (eight hospitals), with similar clinical eligibility, associated with low risks of intrapartum complications, and implementation policies for waterbirth.

Trends in prevalence of guideline-based use of lipid-lowering therapy in a large health system.

Background: The 2013 ACC/AHA (American College of Cardiology/American Heart Association) cholesterol guidelines provided an evidence-based rationale for the allocation of lipid-lowering therapy based on risk for atherosclerotic cardiovascular disease (ASCVD). Adoption of these guidelines was initially suboptimal but whether this has improved over time remains unclear.

Hypothesis: Prevalence of guideline-based statin therapy will increase over time.

Population-Level Reach of Cardiovascular Disease Prevention Interventions in a Rural Community: Findings from the Heart of New Ulm Project.

This study examines participation by residents of a rural community in programs implemented as part of The Heart of New Ulm (HONU) Project, a population-based cardiovascular disease (CVD) prevention initiative. The study compares participation rates for the various interventions to assess which were the most engaging in the priority community and identifies factors that differentiate participants vs. nonparticipants.

Who Gives Birth in the Water? A Retrospective Cohort Study of Intended versus Completed Waterbirths.

Introduction: Most waterbirth studies have been conducted outside the United States with a primary focus on birth outcomes. Studies to date provide limited information about how often women choosing waterbirth end water immersion before the birth and about the reasons for tub exit. This study examines a cohort of women intending a hospital-based waterbirth and documents the timing and reasons for tub exit.

Population-level changes in lifestyle risk factors for cardiovascular disease in the Heart of New Ulm Project.

Lifestyle significantly influences development of cardiovascular disease (CVD), but limited data exists demonstrating lifestyle improvements in community-based interventions. This study aims to document how lifestyle risk factors changed at the population level in the context of Heart of New Ulm (HONU), a community-based CVD prevention initiative in Minnesota. HONU intervened across worksites, healthcare and the community/environment to reduce CVD risk factors.

Assessing the impact of the heart of New Ulm Project on cardiovascular disease risk factors: A population-based program to reduce cardiovascular disease.

The Heart of New Ulm Project (HONU), is a population-based project designed to reduce modifiable cardiovascular disease (CVD) risk factors in the rural community of New Ulm, MN. HONU interventions address multiple levels of the social-ecological model. The community is served by one health system, enabling the use of electronic health record (EHR) data for surveillance.

Changing the restaurant food environment to improve cardiovascular health in a rural community: implementation and evaluation of the Heart of New Ulm restaurant programme.

Objective: The goals of the present study were to: (i) describe the implementation of a programme to improve the restaurant food environment in a rural community; and (ii) describe how practices changed in community restaurants.

Design: The intervention included a baseline assessment of all community restaurants (n 32) and a report on how they could increase the availability and promotion of healthful options. The assessment focused on sixteen healthy practices (HP) derived from the Nutrition Environment Measures Survey for Restaurants.

Examination of Routine Use of Prenatal Weight Gain Charts as a Communication Tool for Providers.

Objectives In 2009 the IOM revised prenatal weight gain guidelines. The primary purpose of this pilot study was to assess if provider education and use of prenatal weight gain charts to track weight gain and counsel patients was associated with better patient and provider knowledge and communication about the guidelines. Methods A prospective non-randomized study conducted in four OB practices (two control, two intervention).

Clinical implications of the American College of Cardiology/American Heart Association guidelines for the treatment of blood cholesterol for a rural community: Data from the Heart of New Ulm Project.

Background: The 2013 American College of Cardiology (ACC)/AHA cholesterol guidelines represented a significant paradigm shift in the approach to the treatment of cholesterol in the United States.

Objective: To assess prevalence of indications for statin therapy according to the ACC/AHA cholesterol guidelines in a rural community.

Methods: A cross-sectional analysis was performed using data from the Heart of New Ulm Project, a population-based intervention aimed at reducing modifiable Adult Treatment Panel (ATP) III guidelines for the treatment of cholesterol for cardiovascular disease (ASCVD) risk factors in New Ulm, MN.

Lifestyle changes and prevention of metabolic syndrome in the Heart of New Ulm Project.

Prior research has shown that unhealthy lifestyles increase the risk for developing a number of chronic diseases, but there are few studies examining how lifestyle changes impact metabolic syndrome. This study analyzed the association between two-year changes in key lifestyle risk metrics and incident metabolic syndrome in adults. A retrospective cohort study was conducted using data from metabolic syndrome free adults in the Heart of New Ulm Project (New Ulm, MN).

Changes in cardiovascular risk factors after 5 years of implementation of a population-based program to reduce cardiovascular disease: The Heart of New Ulm Project.

Background: Population-based interventions aimed at reducing cardiovascular disease (CVD) hold significant potential and will be increasingly relied upon as the model for health care changes in the United States.

Methods: The Heart of New Ulm Project is a population-based project with health care, community, and workplace interventions addressing multiple levels of the social-ecological model designed to reduce modifiable CVD risk factors in rural New Ulm, MN. The community is served by one health system, enabling the use of electronic health record data for surveillance.

A Description of Inpatient Palliative Care Actions for Patients With Acute Heart Failure.

In a recent randomized trial, inpatient palliative care (PC) visits were associated with improved quality of life and symptom burden for patients with heart failure. To better understand what actions by PC providers may have led to those outcomes, we conducted chart reviews of 101 patients in the intervention group (who received PC). Palliative care actions are described for all patients and for those with higher symptoms.

Two-year impact of lifestyle changes on workplace productivity loss in the Heart of New Ulm Project.

Objective: Unhealthy lifestyles have been associated with lower workplace productivity and are the main targets of worksite wellness programmes. The degree to which workplace productivity increases over time in response to changes in lifestyle habits, however, remains unclear. The purpose of this study was to examine the association between 2-year changes in key lifestyle risk factors and workplace productivity loss.

Inpatient palliative care for patients with acute heart failure: outcomes from a randomized trial.

Background: Heart failure (HF) is associated with a high symptom burden and reduced quality of life (QOL). Models integrating palliative care (PC) into HF care have been proposed, but limited research is available on the outcomes of such models.

Objective: Our aim was to assess if inpatient PC for HF patients is associated with improvements in symptom burden, depressive symptoms, QOL, or differential use of services.

Exploring electronic health records as a population health surveillance tool of cardiovascular disease risk factors.

The objective of this study was to examine the utility of using electronic health record (EHR) data for periodic community health surveillance of cardiovascular disease (CVD) risk factors through 2 research questions. First, how many years of EHR data are needed to produce reliable estimates of key population-level CVD health indicators for a community? Second, how comparable are the EHR estimates relative to those from community screenings? The study takes place in the context of the Heart of New Ulm Project, a 10-year population health initiative designed to reduce myocardial infarctions and CVD risk factor burden in a rural community. The community is served by 1 medical center that includes a clinic and hospital.