Fidelity of Enhanced Recovery Protocol Implementation With Assessment of Hospital-Specific Materials.

Introduction: Variability in implementation of enhanced recovery protocols (ERPs) often reduces the effects of an intervention on clinical outcomes. This study aimed to evaluate hospital-level implementation fidelity to a pediatric gastrointestinal surgery ERP by assessing site-specific implementation materials.

Methods: This document analysis study operationalized implementation fidelity as adherence to the creation of specified materials at each study site.

"So that I can trust them with my body:" How people with low incomes who may become pregnant define and prioritize quality reproductive health care.

Objectives: As part of a larger mixed-methods study to better define equity in access to sexual and reproductive health (SRH) care in Georgia, this analysis sought to understand: (1) how individuals define quality care for their SRH services; and (2) how quality of care is salient in their SRH care-seeking.

Study Design: From January 2019 to February 2020, we conducted life history interviews with individuals with the capacity to become pregnant in suburban areas in Georgia. We analyzed interviews using thematic analysis.

"I probably have access, but I can't afford it": expanding definitions of affordability in access to contraceptive services among people with low income in Georgia, USA.

Background: Disparities in rates of contraceptive use are frequently attributed to unequal access to and affordability of care. There is a need to better understand whether common definitions of affordability that solely relate to cost or to insurance status capture the reality of individuals' lived experiences. We sought to better understand how individuals with low incomes and the capacity for pregnancy conceptualized one domain of contraceptive access-affordability --in terms of health system and individual access and how both shaped contraceptive care-seeking in the US South.

Planning for the forgotten fourth trimester of pregnancy: A parallel group randomized control trial to test a postpartum planning intervention vs. standard prenatal care.

Background: Black and brown birthing people experience persistent disparities in adverse maternal health outcomes, partially due to inadequate perinatal care. The goal of this study is to design and evaluate a patient-centered intervention for obstetric patients with one or more cardiometabolic risk factors for severe maternal morbidity [gestational diabetes, diabetes mellitus, hypertensive disorders of pregnancy (chronic hypertension, preeclampsia, eclampsia, or gestational hypertension), or preconception obesity (BMI > 30)] to promote postpartum visit attendance.

Methods: To address identified unmet needs for postpartum support and barriers to postpartum care, we developed 20 thematic postpartum planning modules, each with corresponding patient educational materials, community resources, care coordination protocols, and clinician support tools (decision aids, electronic medical record prompts and fields).

Investigating the Barriers and Facilitators to Using Antiretroviral Therapy among Women Living with HIV in Plateau State, Nigeria.

Background: Women and girls account for more than 50% of the global HIV population. In Nigeria, the proportion of women living with HIV on long-term antiretroviral therapy (ART) has been on the rise. Despite this, little research exists on their experiences regarding antiretroviral therapy use, especially for women living with HIV (WLHIV) in Plateau State, Nigeria.

Person-centered hospital discharge data: Essential existing infrastructure to enhance public health surveillance of maternal substance use disorders in the midst of a national maternal overdose crisis.

Objectives: As crises of drug-related maternal harms escalate, US public health surveillance capacity remains suboptimal for drug-related maternal morbidities. Most state hospital discharge databases (HDDs) are encounter-based, and thus limit ascertainment of morbidities to delivery visits and ignoring those occurring during the 21 months spanning pregnancy and postpartum year. This study analyzes data from a state that curates person-centered HDD to compare patterns of substance use disorder (SUD) diagnoses at delivery vs.

Addressing the Community Resource and Social Service Needs of Families During the COVID-19 Pandemic: Perspectives of Home Visiting Staff and Clients in Georgia.

Introduction: Home visiting programs provide support services to families and their children to promote positive health outcomes. This study sought to describe strategies employed by home visiting programs during the early phase of the COVID-19 pandemic to address the community resource and social service needs of home visiting clients in Georgia.

Methods: We conducted a mixed methods study between December 2020 and April 2021 using online surveys and key informant interviews of home visiting staff and clients from 21 program sites.

Consortium for violence prevention research, leadership training, and implementation for excellence (CONVERGE): a protocol to train science leaders in gender-based-violence and violence-against-children research for impact.

Background: Gender-based violence (GBV) and violence against children (VAC) are two prevalent and highly interconnected global health challenges, yet data and research capacities to study these forms of violence and to generate evidence-based policies and programs remain limited. To address critical shortages in research capacity in Vietnam and to establish a model for other Low- and Middle-Income Countries (LMICs), we are establishing CONVERGE-the Consortium for Violence Prevention Research, Implementation, and Leadership Training for Excellence.

Methods: Based on a needs assessment with partners in Vietnam, CONVERGE will provide a comprehensive research training program supporting 15 long-term, postdoctoral trainees with multi-disciplinary research training in GBV and VAC.

A mixed-method approach to generate and deliver rapid-cycle evaluation feedback: lessons learned from a multicenter implementation trial in pediatric surgery.

Background: Rapid-cycle feedback loops provide timely information and actionable feedback to healthcare organizations to accelerate implementation of interventions. We aimed to (1) describe a mixed-method approach for generating and delivering rapid-cycle feedback and (2) explore key lessons learned while implementing an enhanced recovery protocol (ERP) across 18 pediatric surgery centers.

Methods: All centers are members of the Pediatric Surgery Research Collaborative (PedSRC, www.

Maternal health equity in Georgia: a Delphi consensus approach to definition and research priorities.

Background: Pregnancy-related mortality in the United States is the greatest among all high-income countries, and Georgia has one of the highest maternal mortality rates-almost twice the national rate. Furthermore, inequities exist in rates of pregnancy-related deaths. In Georgia, non-Hispanic Black women are nearly 3 times more likely to die from pregnancy-related complications than non-Hispanic White women.

Factors That Influence Sleep Behaviors of High School Students: Findings From a Semi-Rural Community in Georgia.

Background: Inadequate sleep has been shown to have detrimental effects on academic performance, physical, mental, and emotional health among adolescents. Factors that influence sleep have been identified. However, most literature is currently limited to urban settings.

Adaptations to the Learning Environment for Elementary School Children in Georgia during the COVID-19 Pandemic.

In March 2020, the rapid spread of COVID-19 led to physical school closures across the United States. Schools quickly transitioned to a remote and/or virtual learning environment. This transition had implications for students at all levels of education, especially for those most vulnerable and school-dependent for ancillary resources.

Medication Abortion "Reversal" Laws: How Unsound Science Paved the Way for Dangerous Abortion Policy.

To longitudinally examine the legal landscape of laws requiring abortion patients be informed about the possibility of medication abortion (MAB) "reversal" (in quotes as it does not refer to an evidence-based medical procedure). We collected legal data on enacted state MAB-reversal laws across all 50 US states and Washington, DC, (collectively, states) from 2012 through 2021. We descriptively analyzed these laws to identify legal variation over time and geography, and conducted a content analysis to identify qualitative themes and patterns in MAB-reversal laws.

Implementation of Enhanced Recovery Protocols for Gastrointestinal Surgery in Children: Practical Tools From Key Stakeholders.

Introduction: We explored patient, caregiver, and provider recommendations for development of a tool kit to implement enhanced recovery protocols (ERPs) for pediatric patients undergoing gastrointestinal surgery. ERPs are widely used for adults to decrease hospital length of stay, hospital costs, and complications while hastening patient recovery after surgery. With limited data available for ERPs among pediatric populations informed modification of adult ERPs is needed to facilitate successful implementation for pediatric surgery.

Implementation of Title X Family Planning Services in Primary Care: A Qualitative Study of a Primary Care Network in Georgia.

Context: There is increasing interest and value in integrating family planning services into primary care. Title X services provide an opportunity to expand low-cost access to these services. This study sought to identify and describe implementation factors that influenced the integration of a package of Title X services into a unique primary care setting within a Georgia primary care network whose community health center sites are primarily federally qualified health centers.

A qualitative examination of barriers and facilitators of pediatric enhanced recovery protocol implementation among 18 pediatric surgery services.

Background: Enhanced recovery protocols (ERPs) are an evidence-based intervention to optimize post-surgical recovery. Several studies have demonstrated that the use of an ERP for gastrointestinal surgery results in decreased length of stay, shortened time to a regular diet, and fewer administered opioids, while also trending toward lower complication and 30-day readmission rates. Yet, implementation of ERPs in pediatric surgery is lagging compared to adult surgery.

Effects of Remote Education During the COVID-19 Pandemic on Young Children's Learning and Academic Behavior in Georgia: Perceptions of Parents and School Administrators.

Background: In Spring 2020, Georgia public schools implemented remote learning to manage the spread of COVID-19. This study explores the effects of remote schooling on the learning of young children in Georgia during the early COVID-19 pandemic from the perspectives of school administrators and essential working parents.

Methods: A qualitative exploratory study was conducted with eight school administrators and 26 essential working parents of children in kindergarten through third grades of two rural and two urban schools in Georgia.

Age- and Sex-Specific Needs for Children Undergoing Inflammatory Bowel Disease Surgery: A Qualitative Study.

Introduction: The use of enhanced recovery protocols (ERP) is extending to pediatric surgical populations, such as patients with inflammatory bowel diseases (IBDs). Given the variation in age- and sex-specific characteristics of pediatric IBD patients, it is important to understand the unique needs of subgroups, such as male versus female or preadolescent versus older patients, when implementing ERPs. We gathered clinician, patient, and caregiver perspectives on age- and sex-specific needs for children undergoing IBD surgery.

Stakeholder perspectives on the advantages and challenges of expanded school mental health services for publically-insured youth.

Although partnerships between community-based mental health (MH) organizations and school systems to deliver MH services on school grounds (i.e., expanded school mental health, ESMH services) are growing, qualitative research is needed about stakeholders' perspectives on ESMH services.

Influences on Women's Care Seeking at Planned Parenthood Health Centers in Two Southern States.

Introduction: In the context of a shifting health care landscape, better understanding of the factors that motivate women to seek services from specialized family planning clinics like Planned Parenthood (PP) can provide insights about potential changes in the role of specialized family planning clinics.

Methods: We surveyed 725 women seeking services at two PP health centers in Louisiana and Kentucky from March 2016 to May 2017. We examined differences in care-seeking between women who had varying levels of access including those who did and did not have insurance instability or a regular source of care (RSOC) besides the clinic.

Perspectives on caregiver-focused MHealth Technologies to improve mental health treatment for low-income youth with ADHD.

Objective: To examine stakeholder perspectives regarding: (1) whether mobile health (MHealth) tools can improve the mental health (MH) treatment process for low-income youth with ADHD in safety net settings; and (2) what functions would be helpful to improve the treatment process.

Methods: This study analyzed qualitative data from a larger project that collected information from key stakeholders at four safety-net clinics across Georgia. We conducted five focus groups with caregivers who had a Medicaid-insured child receiving treatment for ADHD, and 17 semi-structured interviews with clinic administrators and providers.

Prior Authorization Policies and Preferred Drug Lists in Medicaid Plans: Stakeholder Perspectives on the Implications for Youth with ADHD.

This qualitative study describes how Medicaid policies create challenges for the delivery and receipt of mental health treatment for low-income youth in Georgia. We conducted focus groups with caregivers of Medicaid-enrolled children with ADHD and semi-structured interviews with providers and administrators at four safety net clinics that provided mental health care to these youth. Stakeholders reported that prior authorization policies for psychosocial services, restrictiveness of preferred drug lists, and changes in preferred drug lists in Medicaid plans created barriers to treatment continuity and quality for youth with ADHD and led to more administrative burden for safety-net clinics serving these youth.

Implementation of Florida Long Term Care Emergency Preparedness Portal Web Site, 2015-2017.

We built an online emergency preparedness Web site for Florida nursing homes after an earlier study revealed gaps in information and a lack of available preparedness resources for long-term care providers. The Long Term Care Emergency Preparedness Portal ( www.ltcprepare.

Georgia's Medicaid Family Planning Waiver: Working Together with Title X to Enhance Access to and Use of Contraceptive and Preventive Health Services.

Purpose: We sought to assess the impact of Georgia's family planning demonstration waiver upon access to and use of contraceptive and preventive health services within Title X and Medicaid.

Procedures: Georgia Title X and Medicaid data for January 2009 through December 2013 (before and after the waiver), restricting Title X data to women targeted by the waiver (18-44 years, incomes from 25% and 50% through 200% of the federal poverty level [FPL]) was assembled by quarter and marginal effects of the changes before and after waiver implementation were derived using multivariate regression models.

Findings: After implementation, there was a significant increase in the probability of Title X clients in the waiver-targeted age and income ranges who had Medicaid versus no insurance and who exited the encounter with higher effectiveness contraceptive methods, including long-acting reversible contraceptives (LARCs), and with cervical cytology and sexually transmitted infection testing.

Influenza vaccination rates and beliefs about vaccination among nursing home employees.

Background: Recent studies have suggested that vaccination of nursing home staff members may reduce the incidence of influenza among nursing home residents. Current national estimates of employee vaccination rates (around 50%) indicate that residents may be at an unnecessarily high risk of contracting influenza. This article reports on the influenza vaccination rates and attitudes toward the vaccine among employees in 37 nursing homes in 3 states.