Association Between Mental Health Conditions at the Hospitalization for Birth and Postpartum Hospital Readmission.

The relationship between physical comorbidities and postpartum hospital readmission is well studied, with less research regarding the impact of mental health conditions on postpartum readmission. Using hospital discharge data (2016-2019) from the Hospital Cost and Utilization Project Nationwide Readmissions Database ( = 12,222,654 weighted), we evaluated the impact of mental health conditions (0, 1, 2, and ≥3), as well as five individual conditions (anxiety, depressive, bipolar, schizophrenic, and traumatic/stress-related conditions) on readmission within 42 days, 1-7 days ("early"), and 8-42 days ("late") of hospitalization for birth. In adjusted analyses, the rate of 42-day readmission was 2.

Advancing health equity through partnerships of state Medicaid agencies, Medicaid managed care organizations, and health care delivery organizations.

Background: Reducing health inequities in marginalized populations, including people with Medicaid insurance, requires care transformation to address medical and social needs that is supported and incentivized by tailored payment methods. Collaboration across health care stakeholders is essential to overcome health system fragmentation and implement sustainable reform in the United States (U.S.

Rates Of Preterm Birth And Low Birthweight: An Analysis Of Racial And Ethnic Populations.

Using National Center for Health Statistics data (2016-20), we evaluated variation in low birthweight and prematurity among racial and ethnic subcategories. Disparities as large as 2.3-fold among rates of low birthweight for "multiple race" subcategories underscore the need for granular data stratification and analysis by racial and ethnic subcategories to address the root causes of inequities in infant outcomes.

Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions.

The objective of this technical report is to provide clinicians with evidence-based, actionable information upon which to make assessment and treatment decisions for children and adolescents with obesity. In addition, this report will provide an evidence base to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are clinically based, effective treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori key questions.

Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities.

The objective of this technical report is to provide clinicians with actionable evidence-based information upon which to make treatment decisions. In addition, this report will provide an evidence base on which to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are effective clinically based treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori Key Questions.

Policy Opportunities To Improve Prevention, Diagnosis, And Treatment Of Perinatal Mental Health Conditions.

One in five pregnant or postpartum people has a diagnosed mood or anxiety disorder, which are the most common mental health illnesses that occur during the perinatal period. Untreated perinatal mental health conditions, encompassing pregnancy and the first five years of a child's life, carry a societal burden of $14 billion per year in the US. This overview article describes the prevalence of perinatal mental health conditions; the implications of those conditions; and associated barriers to screening, treatment, and bias associated with mental health conditions.

Mental Health Conditions Increase Severe Maternal Morbidity By 50 Percent And Cost $102 Million Yearly In The United States.

Perinatal mental health disorders are increasingly acknowledged as contributors to adverse maternal outcomes. We analyzed data from the Healthcare Cost and Utilization Project National Inpatient Sample (2016 and 2017) to estimate hospitalization cost, length-of-stay, and severe maternal morbidity associated with perinatal mental health disorders overall, as well as stratified by payer and by specific mental health category. We found that people with mental health disorders had $458 higher costs per delivery hospitalization and 50 percent higher rates of severe maternal morbidity compared with people without mental health disorders.

Race, Medicaid Coverage, and Equity in Maternal Morbidity.

Background: Severe maternal morbidity (SMM) affects 50,000 deliveries in the United States annually, with around 1.5 times the rates among Medicaid-covered relative to privately covered deliveries. Furthermore, large racial inequities exist in SMM for non-Hispanic Black women and Hispanic women with rates being 2.

Geographic Hotspots for Low Birthweight: An Analysis of Counties With Persistently High Rates.

This study evaluated persistency in county-level rates of low birthweight outcomes to identify "hotspot counties" and their associated area-level characteristics. Administrative data from the National Center for Health Statistics Birth Data Files, years 2011 to 2016 were used to calculate annual county-level rates of low birthweight. Counties ranking in the worst quintile (Q5) for ≥3 years with a neighboring county in the worst quintile were identified as hotspot counties.

Associations Between Comorbidities and Severe Maternal Morbidity.

Objective: To evaluate the associations between the number of chronic conditions and maternal race and ethnicity (race) with the risk of severe maternal morbidity.

Methods: Using the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, years 2016-2017, we examined risk of severe maternal morbidity among 1,480,925 delivery hospitalizations among women of different races and with different numbers of comorbid conditions using multivariable logistic regression.

Results: The rate of severe maternal morbidity was 139.

County-level Variation in Low Birthweight and Preterm Birth: An Evaluation of State Medicaid Expansion Under the Affordable Care Act.

Background: Rates of low birthweight and prematurity vary 2-fold across states in the United States, with increased rates among states with higher concentrations of racial minorities. Medicaid expansion may serve as a mechanism to reduce geographic variation within states that expanded, by improving health and access to care for vulnerable populations.

Objective: The objective of this study was to identify the association of Medicaid expansion with changes in county-level geographic variation in rates of low birthweight and preterm births, overall and stratified by race/ethnicity.

Association of State Medicaid Expansion Status With Low Birth Weight and Preterm Birth.

Importance: Low birth weight and preterm birth are associated with adverse consequences including increased risk of infant mortality and chronic health conditions. Black infants are more likely than white infants to be born prematurely, which has been associated with disparities in infant mortality and other chronic conditions.

Objective: To evaluate whether Medicaid expansion was associated with changes in rates of low birth weight and preterm birth outcomes, both overall and by race/ethnicity.

Disparities by Sex Tracked in the 2015 National Healthcare Quality and Disparities Report: Trends across National Quality Strategy Priorities, Health Conditions, and Access Measures.

Introduction: Established by the Affordable Care Act, the National Quality Strategy (NQS) is the national policy goals aimed at improving the quality of health care for all Americans. The NQS established six priorities to provide better, more affordable care for individuals and communities. This is the first analysis of data on the NQS and access measures that focus on sex differences, health conditions, trends, and disparities.

Variation in Coverage for Progesterone to Prevent Preterm Birth: A Survey of Medicaid Managed Care Organizations.

Introduction: Preterm birth is the leading cause of U.S. infant morbidity and mortality; Medicaid enrollees disproportionately experience preterm deliveries.

Women's Voices in Maternity Care: The Triad of Shared Decision Making, Informed Consent, and Evidence-Based Practices.

The United States is the only industrialized nation that has experienced dramatic increases in the use of maternity interventions resulting in poor birth outcomes. It is speculated that the increased rates of maternal mortality and other outcomes are attributed to the current maternity model of care focused on the overuse of interventions, such as induction of labor, in otherwise healthy pregnant women. The overuse of induction of labor to artificially speed up the birth process has been linked to an increase in preterm and cesarean births.

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients.

Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such as sexual orientation and race/ethnicity, are at particular risk for poor SDM.

Transforming Patient-Centered Care: Development of the Evidence Informed Decision Making through Engagement Model.

Background: In response to the passage of the Affordable Care Act in the United States, clinicians and researchers are critically evaluating methods to engage patients in implementing evidence-based care to improve health outcomes. However, most models on implementation only target clinicians or health systems as the adopters of evidence. Patients are largely ignored in these models.

Moving toward patient-centered care: Women's decisions, perceptions, and experiences of the induction of labor process.

Background: Patient preferences and clinician practices are possible causative factors to explain the increase in induction of labor, but scientific studies that demonstrate this link are limited. The purpose of this study is to identify factors that influence inductions from the perspective of women.

Methods: A qualitative investigation using grounded theory methodology was conducted.

Maternity waiting homes and traditional midwives in rural Liberia.

Objective: Maternity waiting homes (MWHs) can reduce maternal morbidity and mortality by increasing access to skilled birth attendants (SBAs). The present analysis was conducted to determine whether MWHs increase the use of SBAs at rural primary health clinics in Liberia; to determine whether traditional midwives (TMs) are able to work with SBAs as a team and to describe the perceptions of TMs as they engage with SBAs; and to determine whether MWHs decrease maternal and child morbidity and mortality.

Methods: The present analysis was conducted halfway through a large cohort study in which 5 Liberian communities received the intervention (establishment of an MWH) and 5 Liberian communities did not (control group).

Lessons learned in Liberia: preliminary examination of the psychometric properties of trust and teamwork among maternal healthcare workers.

Background: Post-conflict Liberia has one of the fastest growing populations on the continent and one of the highest maternal mortality rates among the world. However, in the rural regions, less than half of all births are attended by a skilled birth attendant. There is a need to evaluate the relationship between trained traditional healthcare providers and skilled birth attendants to improve maternal health outcomes.