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

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.

Integrating Care for Mother-Infant Dyads After Preterm Birth: A Qualitative Study of Clinician Perspectives on Feasibility.

Objective: There are gaps in receipt of maternal preventive services in the interconception period. Yet mother-infant dyads have frequent health care visits. Health systems have opportunities to better capitalize on existing visits to address dyad needs, but this possibility has not been fully explored. Methods: In this qualitative study we conducted semistructured interviews with clinical team members involved with birthing parents or infants after preterm birth. We conducted snowball sampling from teams in pediatrics, obstetrics, and family medicine at two geographically adjacent health systems. Interviews explored perspectives on existing barriers and facilitators to integrating dyad care across adult and infant teams. Interviews were audio-recorded, professionally transcribed, and coded using an integrated approach. Results: We interviewed 24 physicians, nurses, midwives, and social workers (March-November 2021). Participants identified barriers to integrated care including infrequent communication between clinical teams, which was generalizable to care of the birthing parent or infant as individuals, and additional barriers related to privacy, credentialing, and visit design that were specific to dyad care. To improve integration of dyad care, clinicians proposed adapting a variety tools and procedures currently used in their practices, including electronic health record tools for communication, dedicated roles to support communication or navigation, centralized information on resources for dyad care, referral protocols, identifying dyads for proactive outreach, and opportunities for clinicians to connect face-to-face about shared patients or families. Conclusions: Clinicians believe existing health care structures and processes can be adapted to address current substantial barriers to integrated dyad care.

A Policy Analysis of Legally Required Supervision of Nurse Practitioners and Other Health Professionals.

The use of legally required supervision occurs across health professionals who provide similar services. Legally required supervision has the potential to disrupt the production of high-quality, cost-efficient, accessible health services across disciplines. This paper examines the effects of nurse practitioner collaborative practice agreements and similar models of health professional regulation, defined as legally required supervision, on the cost and delivery of health services. A policy analysis examines empirical, policy, and law literature between two health professionals providing a similar service. Analysis includes literature on dental hygienists, dentists, certified registered nurse anesthetists, midwives, nurse practitioners, physicians, and pharmacists. A framework for legally required supervision across health professionals is presented. Antecedents of legally required supervision include occupational licensure, reimbursement policy, and institutional policy. Legally required supervision inhibits provider entry to practice and the production of health services by supervised providers. The cost of care increases under legally required supervision. Costs are measured by wages for providers and the price of services for patients. This paper and proposed framework summarize the antecedents and consequences of legally required supervision. Discipline-specific antecedents and provider characteristics must be considered when calculating the full effect of legally required supervision on the delivery and cost of health services.

Developing a blueprint for cultural competence education at Penn.

This article describes the structure, process, and outcomes of developing a blueprint for integration of cultural competence education into the curriculum at the University of Pennsylvania, School of Nursing. The overarching framework of Kotter (1995) on leading change and organizational transformation was used as a guide for evaluation of faculty efforts. Within the setting of a research-intensive university, the process consisted of implementing a series of action steps which included appointment of a Director of Diversity Affairs, selection of a Master Teachers Taskforce on Cultural Diversity as catalysts for change; conduction of intensive faculty development programs, dissemination of information about cultural competence education, and use of innovative teaching approaches and student participation in curriculum activities. In addition, a Blueprint for Integration of Cultural Competence in the Curriculum (BICCC) was developed and used as the instrument for faculty surveys for 2 consecutive academic years. Faculty survey findings showed a substantial increase in the number of courses integrating cultural competence content in the programs of study. Successful outcomes of the Penn initiative were due to administrative and faculty support, utilization of a Director of Diversity Affairs, innovative work of the Master Teachers Taskforce on Cultural Diversity, faculty development initiatives, and development of the BICCC as a guiding framework for identifying areas of needed curricular change.

Hand-to-hand combat: Preventing MRSA infection.

PURPOSE: To provide practitioners with a general overview of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) and hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) and their diagnoses and treatment. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in preventing, diagnosing, and treating MRSA infection. OBJECTIVES: After reading this article and taking the test, the participant should be able to: 1. Discuss the microbiology, demographics, and epidemiology of CA-MRSA and HA-MRSA. 2. Explain the diagnosis, treatment, and preventative care associated with MRSA infections.