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OBJECTIVE: Postpartum hemorrhage (PPH) protocols improve patient safety and reduce utilization of blood products; however, few data exist on sustainability of PPH checklist use, how use affects care delivery, and variation of use among patient subgroups. This study aimed to (1) examine compliance with PPH checklist use during vaginal deliveries, (2) evaluate whether checklist use varied by patient and/or care team characteristics, and (3) evaluate whether checklist use was associated with increased use of recommended medications/interventions. STUDY DESIGN: This was a quality improvement study performed from April 2021 through June 2023. A multidisciplinary team developed a revised PPH checklist and used quality improvement methodology to increase checklist use following vaginal birth. Data were collected from medical records and clinician survey. Control charts were generated to track checklist use and evaluate special cause variation. Chi-square tests and logistic regression were used to evaluate variation in medications/interventions and across subgroups. RESULTS: During the study period, there were 342 cases of PPH at the time of vaginal birth. The checklist was used in 67% of PPH cases during the 20-month period after implementation in a setting where no checklist was previously being used. We found no statistically significant differences in checklist use by patient or health care team characteristics. Use of tranexamic acid, carboprost, and misoprostol were significantly associated with checklist use. CONCLUSION: This study demonstrated successful implementation of a checklist protocol where no checklist was previously being used, with sustained use in an average of 67% of PPH cases over 20 months. Checklist use was consistent across subgroups and was associated with higher use of interventions shown to lower blood loss. KEY POINTS: · Our study showed sustainability of PPH checklist use over a 20-month period.. · PPH checklist use was associated with increased use of interventions known to reduce blood loss.. · Checklist was used consistently across patient subgroups; may help address inequities in obstetric outcomes..
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Effective menopausal care constitutes a continuum of symptom management and optimization of medical health, including cardiovascular, bone, and mental health. Menopausal knowledge and prescribing patterns changed significantly after the publication of the Women's Health Initiative. A systematic review was conducted to address three key questions about disparities in menopausal care: 1) What differences in menopausal care are experienced by specific populations? 2) What disparities are there in access to preventive care and symptomatic treatment? 3) What interventions reduce disparities in menopause management? PubMed, PsychInfo, SCOPUS, and EMBASE were queried to identify relevant articles published in the United States between 2002 and 2023. Twenty-eight articles met the review criteria; these included quantitative and qualitative analyses. Symptomatic menopausal patients utilize a range of therapies. Racial and ethnic minorities, veterans, women living with HIV, incarcerated individuals, patients with surgical menopause, and nursing home residents represent specifically studied populations that demonstrate differences in menopausal care. Healthcare professionals may impact access to certain therapeutics, possibly driven by lack of content knowledge or implicit bias. Insurance status and geographic location may also affect menopause management or access to care. Few interventions exist to address disparities in menopausal care. There is an urgent need to understand how patients and providers make menopausal treatment decisions and intervene to mitigate health disparities in menopausal care.