The Association of Childbirth with Medical Debt in the USA, 2019-2020.

BACKGROUND: Medical debt affects one in five adults in the USA and may disproportionately burden postpartum women due to pregnancy-related medical costs. OBJECTIVE: To evaluate the association between childbirth and medical debt, and the correlates of medical debt among postpartum women, in the USA. DESIGN: Cross-sectional. PARTICIPANTS: We analyzed female "sample adults" 18-49 years old in the 2019-2020 National Health Interview Survey, a nationally representative household survey. MAIN MEASURES: Our primary exposure was whether the subject gave birth in the past year. We had two family-level debt outcomes: problems paying medical bills and inability to pay medical bills. We examined the association between live birth and medical debt outcomes, unadjusted and adjusted for potential confounders in multivariable logistic regressions. Among postpartum women, we also examined the association between medical debt with maternal asthma, hypertension, and gestational diabetes and several sociodemographic factors. KEY RESULTS: Our sample included n = 12,163 women, n = 645 with a live birth in the past year. Postpartum women were younger, more likely to have Medicaid, and lived in larger families than those not postpartum. 19.8% of postpartum women faced difficulty with medical bills versus 15.1% who were not; in multivariable regression, postpartum women had 48% higher adjusted odds of medical debt problems (95% CI 1.13, 1.92). Results were similar when examining inability to pay medical bills, and similar differences were seen for privately insured women. Among postpartum women, those with lower incomes and with asthma or gestational diabetes, but not hypertension, had significantly higher adjusted odds of medical debt problems. CONCLUSIONS: Postpartum women experience higher levels of medical debt than other women; poorer women and those with common chronic diseases may have an even higher burden. Policies to expand and improve health coverage for this population are needed to improve maternal health and the welfare of young families.

Virtual Community Health Workers: Approaches to Patient Outreach During the COVID-19 Pandemic.

BACKGROUND: Prior to the COVID-19 pandemic, community health workers (CHWs) in our health system screened patients in-person for social determinants of health and connected them to community resources. However, when our CHWs were required to work remotely from home due to the pandemic, the best platform to optimize contacting these patients was unknown. This study sought to evaluate the effectiveness of three outgoing phone call approaches (*67, Google Voice®, and Doximity Dialer®) in successfully contacting patients. METHODS: We performed a retrospective analysis comparing reach rates across the three outgoing call approaches. RESULTS: Reach rates were highest when Doximity Dialer was used (64.0%, 95% CI: 58.8-69.0) compared with *67 (40.8%, 95% CI: 30.8-51.6) or Google Voice (53.2%, 95% CI: 48.4-57.8) in this analysis of 1,144 outreach calls. CONCLUSION: Due to higher reach rates, we recommend Doximity Dialer for phone-based outreach to patients. Additional research to improve the efficacy of remote outreach is warranted.

Cultural Competence in Pediatrics: Health Care Provider Knowledge, Awareness, and Skills.

The purpose of this study was to assess the effects of a cultural competence training (CCT) program on pediatric health care providers' self-reported ability to provide culturally competent care to a diverse pediatric patient population. This quantitative, nested ecologic level study design used a repeated measure in the form of pre-test and post-test data to assess percent change in providers' cultural awareness, experience working or learning about different cultures, and preparedness and skills in working with different cultures before and after CCT. The study was conducted between 2011 and 2012 in a pediatric hospital and associated outpatient offices. The sample consisted of pediatric health care providers from various departments, mainly physicians and nurses (n = 69). Participants completed a pre-intervention cultural competence assessment and then were subjected to a cultural competence-training program, after which they completed the assessment a second time. The baseline and post-intervention data were collected in the form of Likert scales and transformed into a quintile or quartile scale as appropriate. Data were assessed using paired t-tests or Wilcoxon's signed-rank tests. Providers indicated a 13% increase in knowledge (53.9% vs. 66.7%, t = 3.4, p = 0.001), 8.7% increase in awareness (46.7% vs. 55.4%, t = 3.0, p = 0.002), and 8% statistically marginal increase in skills (66.4% vs. 74.5%, z = 1.8, p = 0.06). Culturally competent training in a pediatric environment significantly enhances knowledge, awareness and to some extent skills in providing care to culturally diverse patient population.