Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.543
Filtrar
1.
Medicine (Baltimore) ; 99(52): e23763, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350760

RESUMO

ABSTRACT: Emergency departments receive an increasing amount of musculoskeletal injuries, with the majority referred to a fracture clinic (FCs). A literature review revealed certain orthopaedic injuries can be safely managed away from the FC pathway by general practitioners (GPs) or allied health professionals (AHPs). The present study aims to review all paediatric presentations to FCs at 2 Queensland hospitals, identifying low risk injuries that could potentially be managed by GPs or AHPs. This study is a continuation from Cleary et al in which a primary care pathway (PCP) was proposed for the management of low risk adult orthopaedic injuries. A PCP has the potential to have significant savings to the health system.A retrospective study was conducted looking at paediatric patients (<16 years) referrals to 2 FCs over 8 weeks. Injuries were categorised into those requiring FC care supervised by an orthopaedic surgeon, and those that can be safely managed by GPs or AHPs via a PCP.Four hundred ninety (57.7%) of the 849 patients referred to FC were assessed as suitable for PCP care. The most common upper limb injury deemed suitable was radius and ulna buckle fractures (18.4%), while the most common lower limb injury is ankle sprains (8%). Total failure to attend rate in the PCP group was 6.7%.Adopting the PCP has the potential to significantly reduce FC referrals. With proven success of similar pathways abroad, the PCP may generate significant time and financial savings for both the health care system and patient.


Assuntos
Instituições de Assistência Ambulatorial/normas , Serviço Hospitalar de Emergência/normas , Fraturas Ósseas/terapia , Atenção Primária à Saúde , Criança , Serviços de Saúde da Criança/normas , Humanos , Melhoria de Qualidade , Queensland , Encaminhamento e Consulta , Estudos Retrospectivos
2.
JAMA Netw Open ; 3(12): e2029411, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315113

RESUMO

Importance: Genotype-guided prescribing in pediatrics could prevent adverse drug reactions and improve therapeutic response. Clinical pharmacogenetic implementation guidelines are available for many medications commonly prescribed to children. Frequencies of medication prescription and actionable genotypes (genotypes where a prescribing change may be indicated) inform the potential value of pharmacogenetic implementation. Objective: To assess potential opportunities for genotype-guided prescribing in pediatric populations among multiple health systems by examining the prevalence of prescriptions for each drug with the highest level of evidence (Clinical Pharmacogenetics Implementation Consortium level A) and estimating the prevalence of potential actionable prescribing decisions. Design, Setting, and Participants: This serial cross-sectional study of prescribing prevalences in 16 health systems included electronic health records data from pediatric inpatient and outpatient encounters from January 1, 2011, to December 31, 2017. The health systems included academic medical centers with free-standing children's hospitals and community hospitals that were part of an adult health care system. Participants included approximately 2.9 million patients younger than 21 years observed per year. Data were analyzed from June 5, 2018, to April 14, 2020. Exposures: Prescription of 38 level A medications based on electronic health records. Main Outcomes and Measures: Annual prevalence of level A medication prescribing and estimated actionable exposures, calculated by combining estimated site-year prevalences across sites with each site weighted equally. Results: Data from approximately 2.9 million pediatric patients (median age, 8 [interquartile range, 2-16] years; 50.7% female, 62.3% White) were analyzed for a typical calendar year. The annual prescribing prevalence of at least 1 level A drug ranged from 7987 to 10 629 per 100 000 patients with increasing trends from 2011 to 2014. The most prescribed level A drug was the antiemetic ondansetron (annual prevalence of exposure, 8107 [95% CI, 8077-8137] per 100 000 children). Among commonly prescribed opioids, annual prevalence per 100 000 patients was 295 (95% CI, 273-317) for tramadol, 571 (95% CI, 557-586) for codeine, and 2116 (95% CI, 2097-2135) for oxycodone. The antidepressants citalopram, escitalopram, and amitriptyline were also commonly prescribed (annual prevalence, approximately 250 per 100 000 patients for each). Estimated prevalences of actionable exposures were highest for oxycodone and ondansetron (>300 per 100 000 patients annually). CYP2D6 and CYP2C19 substrates were more frequently prescribed than medications influenced by other genes. Conclusions and Relevance: These findings suggest that opportunities for pharmacogenetic implementation among pediatric patients in the US are abundant. As expected, the greatest opportunity exists with implementing CYP2D6 and CYP2C19 pharmacogenetic guidance for commonly prescribed antiemetics, analgesics, and antidepressants.


Assuntos
Serviços de Saúde da Criança , Cálculos da Dosagem de Medicamento , Testes Farmacogenômicos , Padrões de Prática Médica , Medicamentos sob Prescrição , Criança , Serviços de Saúde da Criança/normas , Serviços de Saúde da Criança/estatística & dados numéricos , Estudos Transversais , Citocromo P-450 CYP2C19/genética , Citocromo P-450 CYP2D6/genética , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Perfil Genético , Humanos , Masculino , Pediatria/métodos , Pediatria/normas , Testes Farmacogenômicos/métodos , Testes Farmacogenômicos/estatística & dados numéricos , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Medicina de Precisão/métodos , Medicamentos sob Prescrição/classificação , Medicamentos sob Prescrição/uso terapêutico , Estados Unidos
6.
J Glob Health ; 10(1): 010505, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32257159

RESUMO

Background: Postnatal care (PNC) for mothers and newborns is essential to monitor risks of morbidity and adverse conditions following delivery. Current estimates of the coverage of PNC show substantial discordance between mothers and newborns. We investigate the sources of this discordance in Demographic and Health Surveys (DHS). Methods: We used DHS data from 48 countries collected since 2011, spanning phases 6 and 7 of the survey program with 32 and 16 surveys, respectively, analyzed. We assessed the distribution of the reported timing of PNC and conducted a sensitivity analysis that excludes/includes PNC reported within 0-1 hour or PNC in the day 2. Agreement in PNC reporting considered four groups: (1) Concordance, neither mother nor newborn received PNC; (2) Concordance, mother and newborn pair received PNC; (3) Discordance, mother received PNC and newborn did not; of (4) Discordance, mother did not receive PNC but the newborn did. We carried out logistic regressions to understand correlates of PNC discordance. All analyses distinguished phase 6 surveys from phase 7. Results: We found substantial differences in the PNC coverage estimated between phase 6 and phase 7 surveys. The phase 7 PNC questions for newborns were improved to increase the understanding of the questions by respondent which probably led to reducing the large PNC gap between mothers and newborns observed in phase 6 surveys. With phase 6 surveys, PNC coverage for mother was estimated on average at 62% compared to only 31% for newborns. No such gap was observed for phase 7 surveys, where for both mothers and newborns, the PNC coverage estimate was similar, at 56%. For both phases, over half of the reported PNC for mothers and newborns occurred during 0-1 hour following delivery, leading to substantial overestimation of PNC coverage, due to confusion between intrapartum care and PNC. There were 37% discordant cases between mother and newborn, largely in favor of the mother in phase 6 surveys, compared to 16% in phase 7 surveys. In phase 6 surveys, discordant PNC cases were observed largely among facility deliveries vs non-facility deliveries (44% compared to 19%). Conclusions: Current estimates of coverage of PNC from DHS phase 6 surveys appears to include substantial level of measurement noises that could explain substantial part of the mother-newborn discordance in PNC. The PNC estimates appear to capture a substantial number of intrapartum care. Current measurement approaches warrant further validation to ensure accurate monitoring of the PNC programs.


Assuntos
Serviços de Saúde da Criança/normas , Serviços de Saúde Materna/normas , Cuidado Pós-Natal/normas , Adulto , Artefatos , Demografia , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Recém-Nascido , Mães/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal
8.
Arch Dis Child ; 105(8): 731-737, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32144091

RESUMO

PURPOSE: Patient safety failures are recognised as a global threat to public health, yet remain a leading cause of death internationally. Vulnerable children are inversely more in need of high-quality primary health and social-care but little is known about the quality of care received. Using national patient safety data, this study aimed to characterise primary care-related safety incidents among vulnerable children. METHODS: This was a cross-sectional mixed methods study of a national database of patient safety incident reports occurring in primary care settings. Free-text incident reports were coded to describe incident types, contributory factors, harm severity and incident outcomes. Subsequent thematic analyses of a purposive sample of reports was undertaken to understand factors underpinning problem areas. RESULTS: Of 1183 reports identified, 572 (48%) described harm to vulnerable children. Sociodemographic analysis showed that included children had child protection-related (517, 44%); social (353, 30%); psychological (189, 16%) or physical (124, 11%) vulnerabilities. Priority safety issues included: poor recognition of needs and subsequent provision of adequate care; insufficient provider access to accurate information about vulnerable children, and delayed referrals between providers. CONCLUSION: This is the first national study using incident report data to explore unsafe care amongst vulnerable children. Several system failures affecting vulnerable children are highlighted, many of which pose internationally recognised challenges to providers aiming to deliver safe care to this at-risk cohort. We encourage healthcare organisations globally to build on our findings and explore the safety and reliability of their healthcare systems, in order to sustainably mitigate harm to vulnerable children.


Assuntos
Serviços de Saúde da Criança/normas , Bem-Estar da Criança/estatística & dados numéricos , Erros Médicos/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/normas , Serviço Social/normas , Populações Vulneráveis , Adolescente , Criança , Saúde da Criança , Serviços de Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Erros Médicos/prevenção & controle , Segurança do Paciente/normas , Atenção Primária à Saúde/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Medicina Estatal/normas , Medicina Estatal/estatística & dados numéricos , Reino Unido
9.
PLoS One ; 15(3): e0229755, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32182241

RESUMO

BACKGROUND: Malnutrition is a major public health problem in India, especially among urban poor children. The objective of the study was to determine the effectiveness of a culturally appropriate nutrition educational intervention that can be delivered through health services and digitized child undernutrition tracking module for health workers to improve complementary feeding of infants of age six months to 12 months in Chandigarh, North India, to prevent malnutrition in infants. METHODS: A quasi-experimental study was conducted in a non-randomized intervention (Burail) and control area (Maloya) among a vulnerable population in Chandigarh, North India. The mother-infant dyads (MIDs) in the intervention group(n = 202) received culturally appropriate nutrition educational intervention, were supported individually by trained health workers in infant feeding and followed up for six months. Health workers were monitored through a digitized tracking module. The MIDs in the control group (n = 202) received routine care under the national health program. The mean (±S.D.) age of infants in the intervention and control group was 5.4 (±0.8) months and 5.5 (±0.7) months, respectively. The data was collected using a pre-tested semi-structured questionnaire and anthropometry of infants at baseline and end line. The primary outcome was a mean change in weight. The effectiveness of the intervention was measured by conducting the difference in difference (DID) analysis in mean change in weight between intervention and control group. RESULT: At baseline, the mean (±S.D.) weight of infants was 6.6(±0.64) kg and 6.6 (±0.52) kg in the intervention and control group. The mean (±S.D.) length of infants was 64.3 (±2.0) cm in the intervention group and 65.1 (±1.7) cm in the control group. Out of 404, 190 and 191 MIDs in the intervention and control group completed the study, respectively. A significantly higher number of infants in the intervention group were started on complementary feeding at six months of age (72.6% versus45.5%, p<0.01) and received foods having thick consistency (82.1% versus 41.9%, p<-0.01). There was significant weight gain in intervention group infants (DID means = 0.27 kg, p<0.01) and length gain (DID means = 0.9 cm, p<0.01) from the baseline. Also, there was significant decline in the proportion of undernourished (10% versus18.8%, OR = 0.47, p = 0.01) and wasted infants (7.3% versus15.7%, OR = 0.42, p = 0.01) in the intervention group. CONCLUSION: Community-based nutrition educational intervention delivered through the routine health services and digitized tracking of malnourished children can effectively improve the complementary feeding and growth of children six months to one year among vulnerable populations.


Assuntos
Serviços de Saúde da Criança/normas , Educação em Saúde/normas , Fenômenos Fisiológicos da Nutrição do Lactente , Desnutrição/prevenção & controle , Adulto , Tecnologia Culturalmente Apropriada , Feminino , Educação em Saúde/métodos , Humanos , Índia , Lactente , Masculino , Apoio Nutricional
10.
Metas enferm ; 23(2): 23-31, mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-194498

RESUMO

OBJETIVO: analizar los beneficios del método madre canguro (MMC) y el estado actual en que se encuentra implantado en España. MÉTODO: revisión narrativa. Se realizaron búsquedas bibliográficas en Pubmed, Dialnet y Scielo; usando los términos "método madre-canguro" y "prematuro" y sus sinónimos. La búsqueda se limitó a los últimos 10 años, idiomas inglés y español. Se complementó con búsqueda secundaria a partir de la bibliografía de interés de artículos seleccionados previamente y se complementó con algunos libros y documentos especializados en la materia de organismos relevantes como la Organización Mundial de la Salud (OMS), el Ministerio de Sanidad y Política Social, la Asociación Española de Pediatría (AEP) y la web internacional de European Fundation for the Care of Newborn Infants (EFCNI). RESULTADOS: se seleccionaron en total 18 documentos: tres metanálisis, cuatro revisiones sistemáticas, dos estudios cuasiexperimentales, dos estudios de cohortes, un estudio transversal, cinco revisiones narrativas y un artículo especial. Se complementaron con tres libros y dos monografías. En la revisión se destacan los beneficios de la aplicación del método madre canguro sobre el desarrollo de los prematuros y el vínculo con sus padres. No se mencionan eventos adversos. El conocimiento sobre los beneficios a largo plazo en el ámbito del desarrollo cognitivo y emocional es escaso. La implementación del MMC en las unidades neonatales españolas es heterogéno, siendo inexistente en algunos centros. CONCLUSIONES: la utilización del MMC en las unidades neonatales ha demostrado ser eficaz en muchos aspectos relacionados con el correcto desarrollo de los prematuros. Es necesaria más investigación para determinar sus beneficios a largo plazo en relación al desarrollo cognitivo y emocional. Es fundamental desarrollar protocolos para implementar el MMC en España


OBJECTIVE: to analyze the benefits of Kangaroo Mother Care (KMC) and its current status of implementation in Spain. METHOD: a narrative review. A bibliographic search was conducted in Pubmed, Dialnet and Scielo, using the terms Kangaroo Mother Care ("método madre-canguro") and pre-term ("prematuro") and their synonyms. The search was limited to the last 10 years, in English and Spanish. This was complemented with a secondary search based on the bibliography of interest of previously selected articles, as well as with some books and documents specialized in the matter, by relevant agencies such as the World Health Organization (WHO), the Ministry of Health and Social Policy, the Spanish Association of Pediatrics (AEP), and the international website for the European Foundation for the Care of Newborn Infants (EFCNI). RESULTS: in total, 18 (eighteen) documents were selected: three meta-analyses, four systematic reviews, two quasi-experimental studies, two cohort studies, one cross-sectional study, five narrative reviews and two monographs. The review highlights the benefits of the application of Kangaroo Mother Care on the development of pre-term babies and their bond with parents. No adverse events were mentioned. There is limited knowledge about the long-term benefits at the level of cognitive and emotional development. The implementation of KMC in Spanish newborn units is heterogeneous and non-existent in some centers. CONCLUSIONS: the use of KMC in newborn units has demonstrated efficacy in many aspects associated with the adequate development of newborn babies. More research is required in order to determine its long-term benefits in terms of cognitive and emotional development. It is essential to create protocols for the implementation of KMC in Spain


Assuntos
Humanos , Recém-Nascido , Método Canguru/métodos , Recém-Nascido Prematuro , Estudos de Coortes , Cuidado da Criança , Cuidados de Enfermagem , Serviços de Saúde da Criança/normas , Enfermeiras Neonatologistas/normas
11.
Int J Qual Stud Health Well-being ; 15(1): 1725362, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32048917

RESUMO

Purpose: The experiences of parents caring for the complex care needs of children with rare neurodevelopmental disorders are not well understood. Parents struggle to meet their children's medical, behavioural, and social needs within and across health, social, and family systems. The purpose of this study was to explore the parents' experience of caring for medical and social care needs for children with rare neurodevelopmental disorders.Methods: Hermeneutic phenomenology was used for the data analysis. Fifteen parents participated in semi-structured interviews.Results: Interpretive analysis revealed four insights: (a) difference in children's behaviours and disease manifestations led to misunderstanding and vulnerability within social domains, (b) social taboo and stigma were experienced with rarity, (c) fragmented disconnected care from health and social systems impacted families, and (d) incomprehension from friends and family occurs when managing daily care.Conclusion: New interpretations and increased understanding of parents' experiences are required in supporting parents caring for children with complex needs. Understanding parents' experiences could reduce social isolation and exclusion, and mitigate appropriate and supportive practices and services within and across medical, social, and family systems.


Assuntos
Cuidadores/psicologia , Transtornos do Neurodesenvolvimento , Pais/psicologia , Doenças Raras , Isolamento Social/psicologia , Adulto , Canadá/epidemiologia , Criança , Serviços de Saúde da Criança/normas , Assistência à Saúde/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Relações Pais-Filho , Estigma Social , Apoio Social , Estresse Psicológico
12.
Infant Ment Health J ; 41(3): 327-339, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32045009

RESUMO

Young children of color-especially boys-are at disproportionate risk for suspension and expulsion from early care and education settings. Infant and Early Childhood Mental Health Consultation (IECMHC) is an approach associated with lower than expected expulsion rates, but the mechanisms through which it may influence preschool expulsion are unknown. This paper reflects on the parallels between IECMHC and interventions created to reduce implicit bias. Based on interviews with leaders in IECMHC practice, implementation, and evaluation, a theoretical framework was created to articulate how IECMHC is hypothesized to affect expulsion by first reducing the influence of implicit bias on disciplinary decisions. Implications for practice and research are provided.


Assuntos
Comportamento Infantil , Saúde da Criança/normas , Saúde Mental , Encaminhamento e Consulta/organização & administração , Comportamento Infantil/ética , Comportamento Infantil/psicologia , Desenvolvimento Infantil , Serviços de Saúde da Criança/normas , Bem-Estar da Criança , Pré-Escolar , Intervenção Educacional Precoce/ética , Intervenção Educacional Precoce/métodos , Grupos Étnicos , Humanos , Masculino , Homens/psicologia , Saúde Mental/etnologia , Saúde Mental/normas , Pediatria/métodos , Pediatria/normas , Psicologia Educacional , Fatores de Risco
13.
Int J Health Policy Manag ; 9(1): 17-26, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31902191

RESUMO

BACKGROUND: Training courses in integrated management of childhood illness (IMCI) have been conducted for health workers for nearly one and half decades in Afghanistan. The objective of the training courses is to improve quality of care in terms of health workers communication skills and clinical performance when they provide health services for under-5 children in public healthcare facilities. This paper presents our findings on the effects of IMCI training courses on quality of care in public primary healthcare facilities in Afghanistan. METHODS: We used a cross-sectional post-intervention design with regression-adjusted difference-in-differences (DiD) analysis, and included 2 groups of health workers (treatment and control). The treatment group were those who have received training in IMCI recently (in the last 12 months), and the control group were those who have never received training in IMCI. The assessment method was direct observation of health workers during patient-provider interaction. We used data, collected over a period of 3 years (2015-2017) from primary healthcare facilities, and investigated training effects on quality of care. The outcome variables were 4 indices of quality care related to history taking, information sharing, counseling/medical advice, and physical examination. Each index was formed as a composite score, composed of several inter-related tasks of quality of care carried out by health workers during patient-provider interaction for under-5 children. RESULTS: Data were collected from 733 primary healthcare facilities with 5818 patients. Quality of care was assessed at the level of patient-provider interaction. Findings from the regression-adjusted DiD multivariate analysis showed significant effects of IMCI training on 2 indices of quality care in 2016, and on 4 indices of quality care in 2017. In 2016 two indices of quality care showed improvement. There was an increase of 8.1% in counseling/medical advice index, and 8.7% in physical examination index. In 2017, there was an increase of 5.7% in history taking index, 8.0% in information sharing index, 10.9% in counseling/medical advice index, and 17.2% in physical examination index. CONCLUSION: Conducting regular IMCI training courses for health workers can improve quality of care for under-5 children in primary healthcare facilities in Afghanistan. Findings from our study have the potential to influence policy and strategic decisions on IMCI programs in developing countries.


Assuntos
Serviços de Saúde da Criança/normas , Prestação Integrada de Cuidados de Saúde/normas , Pessoal de Saúde/educação , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , Adulto , Afeganistão , Pré-Escolar , Estudos Transversais , Feminino , Mão de Obra em Saúde/normas , Humanos , Masculino
15.
Pediatrics ; 145(1)2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31888959

RESUMO

CONTEXT: Integrated care models may improve health care for children and young people (CYP) with ongoing conditions. OBJECTIVE: To assess the effects of integrated care on child health, health service use, health care quality, school absenteeism, and costs for CYP with ongoing conditions. DATA SOURCES: Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library databases (1996-2018). STUDY SELECTION: Inclusion criteria consisted of (1) randomized controlled trials, (2) evaluating an integrated care intervention, (3) for CYP (0-18 years) with an ongoing health condition, and (4) including at least 1 health-related outcome. DATA EXTRACTION: Descriptive data were synthesized. Data for quality of life (QoL) and emergency department (ED) visits allowed meta-analyses to explore the effects of integrated care compared to usual care. RESULTS: Twenty-three trials were identified, describing 18 interventions. Compared with usual care, integrated care reported greater cost savings (3/4 studies). Meta-analyses found that integrated care improved QoL over usual care (standard mean difference = 0.24; 95% confidence interval = 0.03-0.44; P = .02), but no significant difference was found between groups for ED visits (odds ratio = 0.88; 95% confidence interval = 0.57-1.37; P = .57). LIMITATIONS: Included studies had variable quality of intervention, trial design, and reporting. Randomized controlled trials only were included, but valuable data from other study designs may exist. CONCLUSIONS: Integrated care for CYP with ongoing conditions may deliver improved QoL and cost savings. The effects of integrated care on outcomes including ED visits is unclear.


Assuntos
Serviços de Saúde do Adolescente , Serviços de Saúde da Criança , Prestação Integrada de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde , Qualidade da Assistência à Saúde , Absenteísmo , Adolescente , Serviços de Saúde do Adolescente/economia , Serviços de Saúde do Adolescente/normas , Serviços de Saúde do Adolescente/estatística & dados numéricos , Asma/terapia , Criança , Saúde da Criança , Serviços de Saúde da Criança/economia , Serviços de Saúde da Criança/normas , Serviços de Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Intervalos de Confiança , Redução de Custos , Análise Custo-Benefício , Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/normas , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Custos de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
17.
Health Serv Res ; 55(1): 71-81, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31713854

RESUMO

OBJECTIVES: To examine the effect of high-risk obstetrics (HROB) care management on infant health and Medicaid expenditures. DATA SOURCES/STUDY SETTING: Medicaid administrative data and vital statistics from 2011 to 2013. In New York State, all Medicaid managed care plans provide HROB care management to their members. STUDY DESIGN: We conducted a retrospective cohort study with a nonequivalent control group. Selection bias was addressed by using probit and OLS models with the Heckman correction and inverse probability weight with regression adjustment. PRINCIPAL FINDINGS: While program enrollment was associated with poor infant health outcomes (low birthweight, very low birthweight, preterm delivery, and gestational age), correcting for sample selection substantially improved most of these outcomes. All infant health outcomes significantly improved as the number of weeks in the program increased. We found that a 1-week increase in program duration is associated with a 0.01 percentage point decrease in low birthweight and a 0.03 percentage point decrease in very low birthweight. Further, a 1-week increase in program duration decreases the probability of preterm delivery by 0.01 percentage points and increases gestational age by 0.14 days. Medicaid expenditures for maternity care and newborn delivery were not significantly or materially affected by program enrollment or program duration. CONCLUSIONS: High-risk obstetrics care management appears to successfully identify individuals with high-risk pregnancies and improve health without substantially increasing medical expenses.


Assuntos
Serviços de Saúde da Criança/economia , Serviços de Saúde da Criança/normas , Serviços de Saúde Materna/economia , Serviços de Saúde Materna/normas , Medicaid/normas , Gravidez de Alto Risco , Cuidado Pré-Natal/economia , Adulto , Feminino , Humanos , Recém-Nascido , Serviços de Saúde Materna/estatística & dados numéricos , Medicaid/estatística & dados numéricos , New York , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...