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Minor KC, Bianco K, Mayo JA, Abir G, Judy AE, Lee HC, Leonard SA, Ayotte S, Hedli LC, Schaffer K, Sie L, Daniels K. Virtual simulation training for postpartum hemorrhage in low-to-moderate-volume hospitals in the US. AJOG GLOBAL REPORTS 2024; 4:100357. [PMID: 38975047 PMCID: PMC11227018 DOI: 10.1016/j.xagr.2024.100357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background Maternal mortality in the United States is rising and many deaths are preventable. Emergencies, such as postpartum hemorrhage, occur less frequently in non-teaching, rural, and urban low-birth volume hospitals. There is an urgent need for accessible, evidence-based, and sustainable inter-professional education that creates the opportunity for clinical teams to practice their response to rare, but potentially devastating events. Objective To assess the feasibility of virtual simulation training for the management of postpartum hemorrhage in low-to-moderate-volume delivery hospitals. Study design The study occurred between December 2021 and March 2022 within 8 non-academic hospitals in the United States with low-to-moderate-delivery volumes, randomized to one of two models: direct simulation training and train-the-trainer. In the direct simulation training model, simulation faculty conducted a virtual simulation training program with participants. In the train-the-trainer model, simulation faculty conducted virtual lessons with new simulation instructors on how to prepare and conduct a simulation course. Following this training, the instructors led their own simulation training program at their respective hospitals. The direct simulation training participants and students trained by new instructors from the train-the-trainer program were evaluated with a multiple-choice questionnaire on postpartum hemorrhage knowledge and a confidence and attitude survey at 3 timepoints: prior to, immediately after, and at 3 months post-training. Paired t-tests were performed to assess for changes in knowledge and confidence within teaching models across time points. ANOVA was performed to test cross-sectionally for differences in knowledge and confidence between teaching models at each time point. Results Direct simulation training participants (n=22) and students of the train-the-trainer instructors (n=18) included nurses, certified nurse midwives and attending physicians in obstetrics, family practice or anesthesiology. Mean pre-course knowledge and confidence scores were not statistically different between direct simulation participants and the students of the instructors from the train-the-trainer course (79%+/-13 versus 75%+/-14, respectively, P-value=.45). Within the direct simulation group, knowledge and confidence scores significantly improved from pre- to immediately post-training (knowledge score mean difference 9.81 [95% CI 3.23-16.40], P-value<.01; confidence score mean difference 13.64 [95% CI 6.79-20.48], P-value<.01), which were maintained 3-months post-training. Within the train-the-trainer group, knowledge and confidence scores immediate post-intervention were not significantly different compared with pre-course or 3-month post-course scores. Mean knowledge scores were significantly greater for the direct simulation group compared to the train-the-trainer group immediately post-training (89%+/-7 versus 74%+/-8, P-value<.01) and at 3-months (88%+/-7 versus 76%+/-12, P-value<.01). Comparisons between groups showed no difference in confidence and attitude scores at these timepoints. Both direct simulation participants and train-the-trainer instructors preferred virtual education, or a hybrid structure, over in-person education. Conclusion Virtual education for obstetric simulation training is feasible, acceptable, and effective. Utilizing a direct simulation model for postpartum hemorrhage management resulted in enhanced knowledge acquisition and retention compared to a train-the-trainer model.
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Affiliation(s)
- Kathleen C. Minor
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine & Obstetrics, Stanford University School of Medicine, Stanford, CA (Dr Minor, Dr Bianco, Mr Mayo, Dr Judy, and Dr Leonard)
| | - Katherine Bianco
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine & Obstetrics, Stanford University School of Medicine, Stanford, CA (Dr Minor, Dr Bianco, Mr Mayo, Dr Judy, and Dr Leonard)
| | - Jonathan A. Mayo
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine & Obstetrics, Stanford University School of Medicine, Stanford, CA (Dr Minor, Dr Bianco, Mr Mayo, Dr Judy, and Dr Leonard)
| | - Gillian Abir
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Obstetric Anesthesiology, Stanford University School of Medicine, Stanford, CA (Dr Abir)
| | - Amy E. Judy
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine & Obstetrics, Stanford University School of Medicine, Stanford, CA (Dr Minor, Dr Bianco, Mr Mayo, Dr Judy, and Dr Leonard)
| | - Henry C. Lee
- Department of Pediatrics, Division of Neonatology, University of California San Diego, La Jolla, CA (Dr Lee and Ms Schaffer)
| | - Stephanie A. Leonard
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine & Obstetrics, Stanford University School of Medicine, Stanford, CA (Dr Minor, Dr Bianco, Mr Mayo, Dr Judy, and Dr Leonard)
| | - Stephany Ayotte
- Johnson Center for Pregnancy and Newborn Services, Lucile Packard Children's Hospital, Stanford, CA (Ms Ayotte)
| | - Laura C. Hedli
- Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Stanford, CA (Ms Hedli and Ms Sie)
| | - Kristen Schaffer
- Department of Pediatrics, Division of Neonatology, University of California San Diego, La Jolla, CA (Dr Lee and Ms Schaffer)
| | - Lillian Sie
- Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Stanford, CA (Ms Hedli and Ms Sie)
| | - Kay Daniels
- Department of Obstetrics and Gynecology, Stanford School of Medicine, Stanford, CA (Dr Daniels)
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Zhang L, Sun Z, Jia X, Zhao C, Yu J, Lyu X, Lau JTF, Li N, Qian D, Wang Z, Chen X, Liu Z. Confronting health disparities: Lessons from the USA. Aging Med (Milton) 2024; 7:158-161. [PMID: 38725693 PMCID: PMC11077332 DOI: 10.1002/agm2.12303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/24/2024] [Accepted: 03/28/2024] [Indexed: 05/12/2024] Open
Affiliation(s)
- Liming Zhang
- Second Affiliated Hospital, and School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang ProvinceZhejiang University School of MedicineHangzhouZhejiangChina
| | - Zhenyu Sun
- Department of Health Policy and ManagementYale School of Public HealthNew HavenConnecticutUSA
- School of Health Policy and ManagementNanjing Medical UniversityNanjingJiangsuChina
| | - Xueqing Jia
- Second Affiliated Hospital, and School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang ProvinceZhejiang University School of MedicineHangzhouZhejiangChina
| | - Ciyun Zhao
- Second Affiliated Hospital, and School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang ProvinceZhejiang University School of MedicineHangzhouZhejiangChina
| | - Jiening Yu
- Second Affiliated Hospital, and School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang ProvinceZhejiang University School of MedicineHangzhouZhejiangChina
| | - Xinwei Lyu
- Institute of Epidemiology and Health Care, University College LondonLondonUK
| | - Joseph Tak Fai Lau
- Centre for Health Behaviours Research, School of Public Health and Primary CareThe Chinese University of Hong KongHong KongChina
| | - Na Li
- Department of Chronic Disease Prevention and ControlZhejiang Provincial Center for Disease Control and PreventionHangzhouZhejiangChina
| | - Dongfu Qian
- School of Health Policy and ManagementNanjing Medical UniversityNanjingJiangsuChina
| | - Zhihui Wang
- National Center for Chronic and Non‐Communicable Disease Control and Prevention, Chinese Center for Disease Control and PreventionBeijingChina
| | - Xi Chen
- Department of Health Policy and ManagementYale School of Public HealthNew HavenConnecticutUSA
- Department of EconomicsYale UniversityNew HavenConnecticutUSA
| | - Zuyun Liu
- Second Affiliated Hospital, and School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang ProvinceZhejiang University School of MedicineHangzhouZhejiangChina
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Sealy-Jefferson S. Injustices in Black Maternal Health: A Call for Different Research Questions, Orientations, and Methodologies. Front Public Health 2022; 10:860850. [PMID: 35509507 PMCID: PMC9058078 DOI: 10.3389/fpubh.2022.860850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/24/2022] [Indexed: 11/15/2022] Open
Abstract
For decades, Black mothers have been most likely to suffer the worst outcomes of pregnancy, including death. Even though traditional individual level risk factors do not explain racial inequities in maternal morbidity, most studies identify Black race as a predictor, instead of the ways in which our society is structured around racism that makes Black mothers vulnerable to adverse health outcomes. As an example, the U.S is exceptional in incarcerating its residents, and Black men are six times and Black women are three times more likely than their white counterparts to be incarcerated. Relatedly, violent death caused by homicides disproportionately impacts Black communities, such that is the leading cause of death for males and females aged 10–34 years. Estimates suggest that more than 50% of urban residents know more than 10 murder victims, and approximately 200 people are affected by each neighborhood murder. Recent research has begun to shed light on the impacts of stressful neighborhood social conditions on risk of the adverse birth outcomes among Black mothers however, few studies have quantified the impact of macro-social neighborhood factors like violent death exposures and mass incarceration on Black maternal health. Future research that leverages relevant theoretical frameworks, is co-created and co-led with affected communities, and focuses on relevant neighborhood level traumas is warranted if we are to address the longstanding racial inequities in maternal health.
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Kozhimannil KB, Hardeman RR, Henning-Smith C. Maternity care access, quality, and outcomes: A systems-level perspective on research, clinical, and policy needs. Semin Perinatol 2017; 41:367-374. [PMID: 28889958 DOI: 10.1053/j.semperi.2017.07.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The quality of maternity care in the United States is variable, and access to care is tenuous for rural residents, low-income individuals, and people of color. Without accessible, timely, and high-quality care, certain clinical and sociodemographic characteristics of individuals may render them more vulnerable to poor birth outcomes. However, risk factors for poor birth outcomes do not occur in a vaccum; rather, health care financing, delivery, and organization as well as the policy environment shape the context in which patients seek and receive maternity care. This paper describes the relationship between access and quality in maternity care and offers a systems-level perspective on the innovations and strategies needed in research, clinical care, and policy to improve equity in maternal and infant health.
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Affiliation(s)
- Katy B Kozhimannil
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN.
| | - Rachel R Hardeman
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
| | - Carrie Henning-Smith
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
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