Cesarean birth and maternal morbidity among Black women and White women after implementation of a blended payment policy

Snowden, Jonathan M.; Osmundson, Sarah S.; Kaufman, Menolly; Peterson, Cori Blauer; Kozhimannil, Katy B.

doi:10.1111/1475-6773.13319

Cited by 11 publications

(10 citation statements)

References 66 publications

(87 reference statements)

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“…Recommended interventions must be culturally adapted as circumstances warrant [ 58 , 59 ]. WHO guidelines must be applied on a scale large-enough to improve population health equity—or at least not to exacerbate ongoing inequity [ 60 , 61 ].…”

Section: Restructuring the Mental Health Treatment System To Reducmentioning

confidence: 99%

Coronavirus Trauma and African Americans’ Mental Health: Seizing Opportunities for Transformational Change

Snowden

2021

IJERPH

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The COVID-19 pandemic is a natural disaster of historic proportions with widespread and profound psychological sequelae. African Americans fall ill and die more than whites from COVID and more survivors and loved ones face psychological risk. African Americans also experience greater personal, social, and financial stress even when not personally touched by COVID illness, and they are again vulnerable as COVID diminishes African American community’s capacity for mutual support. Enactment of the American Rescue Act of 2021 can moderate if not eliminate African Americans’ greater adversity and greater psychological challenge; other provisions can move the mental health treatment system beyond its previous failure to reach African Americans as it constructively responds to the crisis that COVID presents. From outreach through trusted community actors and institutions for meeting African Americans’ needs of varying intensity and duration, and by providing a spectrum of evidence supported interventions—culturally adapted as needed—newfound success can mark a turning point toward new approaches and lasting success.

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Section: Restructuring the Mental Health Treatment System To Reducmentioning

confidence: 99%

Coronavirus Trauma and African Americans’ Mental Health: Seizing Opportunities for Transformational Change

Snowden

2021

IJERPH

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“…Given that CS outcomes may vary due to systemic inequities in healthcare access and quality [ 26 , 27 ], greater care is needed to evaluate not only variation and outcomes related to opioid use, but additional outcomes associated with quality of life, chronic pain, and overall functioning. There was also a lack of information regarding other outcomes, such as return to duty or work, that may be meaningful to explore in future studies.…”

Section: Resultsmentioning

confidence: 99%

Variation by default: cesarean section discharge opioid prescription patterns and outcomes in Military Health System hospitals: a retrospective longitudinal cohort study

et al. 2022

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Background To examine factors associated with post-Cesarean section analgesic prescription variation at hospital discharge in patients who are opioid naïve; and examine relationships between pre-Cesarean section patient and care-level factors and discharge morphine equivalent dose (MED) on outcomes (e.g., probability of opioid refill within 30 days) across a large healthcare system. Methods The Walter Reed Institutional Review Board provided an exempt determination, waiver of consent, and waiver of HIPAA authorization for research use in the present retrospective longitudinal cohort study. Patient records were included in analyses if: sex assigned in the medical record was “female,” age was 18 years of age or older, the Cesarean section occurred between January 2016 to December 2019 in the Military Health System, the listed TRICARE sponsor was an active duty service member, hospitalization began no more than three days prior to the Cesarean section, and the patient was discharged to home < 4 days after the Cesarean section. Results Across 57 facilities, 32,757 adult patients had a single documented Cesarean section procedure in the study period; 24,538 met inclusion criteria and were used in analyses. Post-Cesarean section discharge MED varied by facility, with a median MED of 225 mg and median 5-day supply. Age, active duty status, hospitalization duration, mental health diagnosis, pain diagnosis, substance use disorder, alcohol use disorder, gestational diabetes, discharge opioid type (combined vs. opioid-only medication), concurrent tubal ligation procedure, single (vs. multiple) births, and discharge morphine equivalent dose were associated with the probability of an opioid prescription refill in bivariate analyses, and therefore were included as covariates in a generalized additive mixed model (GAMM). Generalized additive mixed model results indicated that non-active duty beneficiaries, those with mental health and pain conditions, those who received an opioid/non-opioid combination medication, those with multiple births, and older patients were more likely to obtain an opioid refill, relative to their counterparts. Conclusion Significant variation in discharge pain medication prescriptions, as well as the lack of association between discharge opioid MED and probability of refill, indicates that efforts are needed to optimize opioid prescribing and reduce unnecessary healthcare variation.

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“…Meanwhile, economic acumen is already leveraged to maximize individual profit or organizational return on investment by 'cherry picking', in other words focusing on lucrative procedures and affluent clientele with favorable risk profile and resource utilization, thus augmenting the pervasive existing healthcare disparities [83,84]. Health services research can evaluate the impacts of public policies for example how the alignment of institutional incentives improves care and outcomes for minoritized populations or leads to unintended consequences [85].…”

Section: Health Systems Science Health Economics and Strategic Change...mentioning

confidence: 99%

Health equity research in obstetric anesthesia

Toyobo

Guglielminotti

Andreae³

et al. 2022

Current Opinion in Anaesthesiology

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Purpose of reviewHealth equity is an important priority for obstetric anesthesia, but describing disparities in perinatal care process and health outcome is insufficient to achieve this goal. Conceptualizing and framing disparity is a prerequisite to pose meaningful research questions. We emphasize the need to hypothesize and test which mechanisms and drivers are instrumental for disparities in perinatal processes and outcomes, in order to target, test and refine effective countermeasures. Recent findingsWith an emphasis on methodology and measurement, we sketch how health systems and disparity research may advance maternal health equity by narrating, conceptualizing, and investigating social determinants of health as key drivers of perinatal disparity, by identifying the granular mechanism of this disparity, by making the economic case to address them, and by testing specific interventions to advance obstetric health equity.

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Cesarean birth and maternal morbidity among Black women and White women after implementation of a blended payment policy

Cited by 11 publications

References 66 publications

Coronavirus Trauma and African Americans’ Mental Health: Seizing Opportunities for Transformational Change

Coronavirus Trauma and African Americans’ Mental Health: Seizing Opportunities for Transformational Change

Variation by default: cesarean section discharge opioid prescription patterns and outcomes in Military Health System hospitals: a retrospective longitudinal cohort study

Health equity research in obstetric anesthesia

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