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Kandasamy V, Hirai AH, Kaufman JS, James AR, Kotelchuck M. Regional variation in Black infant mortality: The contribution of contextual factors. PLoS One 2020; 15:e0237314. [PMID: 32780762 PMCID: PMC7418975 DOI: 10.1371/journal.pone.0237314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 07/15/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Compared to other racial/ethnic groups, infant mortality rates (IMR) are persistently highestamong Black infants in the United States, yet there is considerable regional variation. We examined state and county-level contextual factors that may explain regional differences in Black IMR and identified potential strategies for improvement. METHODS AND FINDINGS Black infant mortality data are from the Linked Birth/Infant Death files for 2009-2011. State and county contextual factors within social, economic, environmental, and health domains were compiled from various Census databases, the Food Environment Atlas, and the Area Health Resource File. Region was defined by the nine Census Divisions. We examined contextual associations with Black IMR using aggregated county-level Poisson regression with standard errors adjusted for clustering by state. Overall, Black IMR varied 1.5-fold across regions, ranging from 8.78 per 1,000 in New England to 13.77 per 1,000 in the Midwest. In adjusted models, the following factors were protective for Black IMR: higher state-level Black-White marriage rate (rate ratio (RR) per standard deviation (SD) increase = 0.81, 95% confidence interval (CI):0.70-0.95), higher state maternal and child health budget per capita (RR per SD = 0.96, 95% CI:0.92-0.99), and higher county-level Black index of concentration at the extremes (RR per SD = 0.85, 95% CI:0.81-0.90). Modeled variables accounted for 35% of the regional variation in Black IMR. CONCLUSIONS These findings are broadly supportive of ongoing public policy efforts to enhance social integration across races, support health and social welfare program spending, and improve economic prosperity. Although contextual factors accounted for about a third of regional variation, further research is needed to more fully understand regional variation in Black IMR disparities.
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Affiliation(s)
- Veni Kandasamy
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ashley H. Hirai
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Jay S. Kaufman
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Arthur R. James
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio, United States of America
- The Kirwan Institute for the Study of Race and Ethnicity, Ohio State University, Columbus, Ohio, United States of America
| | - Milton Kotelchuck
- Department of Pediatrics, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Fieber JH, Kuo LE, Wirtalla C, Kelz RR. Variation in the utilization of robotic surgical operations. J Robot Surg 2019; 14:593-599. [PMID: 31560125 DOI: 10.1007/s11701-019-01003-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/15/2019] [Indexed: 12/28/2022]
Abstract
The appropriate use of the robot in surgery continues to evolve. Robotic operations (RO) are particularly advantageous for deep pelvic and retroperitoneal procedures, but the implementation of RO is unknown. We aimed to examine regional variation for the most commonly performed RO in general, gynecologic, and urologic surgery. A three-state inpatient database from 2008 to 2011 was used. Nine common robotic inpatient general, gynecologic and urologic surgery procedures were analyzed. States were divided into hospital service areas (HSAs). The percentage of RO was calculated for each operation. Hospital service areas that had < 50% or > 150% of the RO average were outliers. Hospital service areas were compared based on demographics, patterns of adoption, variation in usage, and association with population, physician and hospital density. Hysterectomies were the procedure that was performed most often robotically. Over 50% of radical prostatectomies were performed robotically. Procedures with the highest rate of RO performance were performed with the least variation. Characteristics that were significantly correlated with RO included provider and hospital density. Variation in the utilization of RO is common and differs by operation. Physician density impacts access to care and is associated with the variation in use of RO depending on procedure type. Further research is needed to understand the causes of variation and adoption of RO.
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Affiliation(s)
- Jennifer H Fieber
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Lindsay E Kuo
- Department of Surgery, Temple University, 3401 North Broad Street, Philadelphia, 19140, PA, USA
| | - Chris Wirtalla
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
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Donohue LT, Hoffman KR, Marcin JP. Use of Telemedicine to Improve Neonatal Resuscitation. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E50. [PMID: 30939758 PMCID: PMC6518228 DOI: 10.3390/children6040050] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 12/14/2022]
Abstract
Most newborn infants do well at birth; however, some require immediate attention by a team with advanced resuscitation skills. Providers at rural or community hospitals do not have as much opportunity for practice of their resuscitation skills as providers at larger centers and are, therefore, often unable to provide the high level of care needed in an emergency. Education through telemedicine can bring additional training opportunities to these rural sites in a low-resource model in order to better prepare them for advanced neonatal resuscitation. Telemedicine also offers the opportunity to immediately bring a more experienced team to newborns to provide support or even lead the resuscitation. Telemedicine can also be used to train and assist in the performance of emergent procedures occasionally required during a neonatal resuscitation including airway management, needle thoracentesis, and umbilical line placement. Telemedicine can provide unique opportunities to significantly increase the quality of neonatal resuscitation and stabilization in rural or community hospitals.
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Affiliation(s)
- Lee T Donohue
- University of California at Davis Children's Hospital, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
| | - Kristin R Hoffman
- University of California at Davis Children's Hospital, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
| | - James P Marcin
- University of California at Davis Children's Hospital, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
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Mapping Geographic Variation in Infant Mortality and Related Black-White Disparities in the US. Epidemiology 2018; 27:690-6. [PMID: 27196804 DOI: 10.1097/ede.0000000000000509] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the US, black infants remain more than twice as likely as white infants to die in the first year of life. Previous studies of geographic variation in infant mortality disparities have been limited to large metropolitan areas where stable estimates of infant mortality rates by race can be determined, leaving much of the US unexplored. METHODS The objective of this analysis was to describe geographic variation in county-level racial disparities in infant mortality rates across the 48 contiguous US states and District of Columbia using national linked birth and infant death period files (2004-2011). We implemented Bayesian shared component models in OpenBUGS, borrowing strength across both spatial units and racial groups. We mapped posterior estimates of mortality rates for black and white infants as well as relative and absolute disparities. RESULTS Black infants had higher infant mortality rates than white infants in all counties, but there was geographic variation in the magnitude of both relative and absolute disparities. The mean difference between black and white rates was 5.9 per 1,000 (median: 5.8, interquartile range: 5.2 to 6.6 per 1,000), while those for black infants were 2.2 times higher than for white infants (median: 2.1, interquartile range: 1.9-2.3). One quarter of the county-level variation in rates for black infants was shared with white infants. CONCLUSIONS Examining county-level variation in infant mortality rates among black and white infants and related racial disparities may inform efforts to redress inequities and reduce the burden of infant mortality in the US.
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Abstract
OBJECTIVE The goal of this study was to examine regional variation in use of minimally invasive surgical (MIS) operations. SUMMARY BACKGROUND DATA Regional variation exists in performance of surgical operations. Variation in the use of MIS has not been studied. METHODS Five operations that are performed open or MIS were selected: cholecystectomy, appendectomy, colectomy, antireflux, and bariatric. A 3-state database from 2008 to 2011 was used; states were divided into hospital service areas (HSAs). For each operation, the percentage of MIS operations was calculated. HSAs with less than 50% or more than 150% of the MIS average were considered outliers. Population demographics, geography, and hospital and physician presence were compared between HSAs. Rates of performance by patient disease and the presence of MIS surgeons were also investigated. RESULTS MIS cholecystectomy was performed with low variation; MIS appendectomy, antireflux, and bariatric operations with medium variation; and MIS colectomy with high variation. With the exception of MIS colectomy, there were no differences in the patient demographics, geography, or disease types treated with an MIS approach between HSAs with low-, non-, or high utilization of MIS. There is no correlation between the number of MIS surgeons and the percentage of procedures performed MIS. CONCLUSIONS Variation in utilization of MIS exists and differs by operation. Patient demographics, patient disease, and the ability to access care are associated only with variation in use of MIS for colectomy. For all other operations studied, these factors do not explain variation in MIS use. Further investigation is warranted to identify and eliminate causes of variation.
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Rodríguez-Balderrama I, Ostia-Garza P, Villarreal-Parra R, Tijerina-Guajardo M. Risk factors and the relation of lactic acid to neonatal mortality in the first week of life. MEDICINA UNIVERSITARIA 2016. [DOI: 10.1016/j.rmu.2015.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ng M, Fullman N, Dieleman JL, Flaxman AD, Murray CJL, Lim SS. Effective coverage: a metric for monitoring Universal Health Coverage. PLoS Med 2014; 11:e1001730. [PMID: 25243780 PMCID: PMC4171091 DOI: 10.1371/journal.pmed.1001730] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A major challenge in monitoring universal health coverage (UHC) is identifying an indicator that can adequately capture the multiple components underlying the UHC initiative. Effective coverage, which unites individual and intervention characteristics into a single metric, offers a direct and flexible means to measure health system performance at different levels. We view effective coverage as a relevant and actionable metric for tracking progress towards achieving UHC. In this paper, we review the concept of effective coverage and delineate the three components of the metric - need, use, and quality - using several examples. Further, we explain how the metric can be used for monitoring interventions at both local and global levels. We also discuss the ways that current health information systems can support generating estimates of effective coverage. We conclude by recognizing some of the challenges associated with producing estimates of effective coverage. Despite these challenges, effective coverage is a powerful metric that can provide a more nuanced understanding of whether, and how well, a health system is delivering services to its populations.
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Affiliation(s)
- Marie Ng
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington, United States of America
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington, United States of America
| | - Joseph L. Dieleman
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington, United States of America
| | - Abraham D. Flaxman
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington, United States of America
| | - Christopher J. L. Murray
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington, United States of America
| | - Stephen S. Lim
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington, United States of America
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Patzer RE, Pastan SO. Kidney transplant access in the Southeast: view from the bottom. Am J Transplant 2014; 14:1499-505. [PMID: 24891223 PMCID: PMC4167710 DOI: 10.1111/ajt.12748] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/08/2014] [Accepted: 01/12/2014] [Indexed: 01/25/2023]
Abstract
The Southeastern region of the United States has the highest burden of end-stage renal disease (ESRD) but the lowest rates of kidney transplantation in the nation. There are many patient-, dialysis facility-, ESRD Network- and health system-level barriers that contribute to this regional disparity. Compared to the rest of the nation, the Southeast has a larger population of African-Americans and higher poverty, as well as more prevalent ESRD risk factors including hypertension, obesity and diabetes. Dialysis facilities--where ESRD patients receive the majority of their healthcare--play an important role in transplant access. Identifying characteristics of individual dialysis units with low rates of kidney transplantation, such as understaffing or for-profit status, can help identify targets for quality improvement initiatives. Geographic differences across the country can identify opportunities to increase funding for healthcare resources in proportion to patient and disease burden. Focusing interventions among dialysis facilities with the lowest transplant rates within the Southeast, such as provider and patient education, has the potential to increase referrals for kidney transplantation, leading to higher rates of kidney transplants in this region. Referral for transplantation should be measured on a national level to monitor disparities in early access to transplantation. Transplant centers have an obligation to assist underserved populations in ensuring equity in access to services. Policies that improve access to care for patients, such as the Affordable Care Act and Medicaid expansion, are particularly important for Southern states and may alleviate geographic disparities.
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Affiliation(s)
- R. E. Patzer
- Emory Transplant Center, Atlanta, GA,Department of Epidemiology, Rollins School of Public Health, Atlanta, GA,Corresponding author: Rachel E. Patzer,
| | - S. O. Pastan
- Emory Transplant Center, Atlanta, GA,Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA
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