Linda A. Detman

Oral-Systemic Health During Pregnancy: Exploring Prenatal and Oral Health Providers’ Information, Motivation and Behavioral Skills

Pregnancy is identified as a sensitive period of increased risk for poor oral health among mothers and offspring. Subsequently, both medical and dental associations have re-endorsed consolidated, inter-professional guidelines promoting oral health during pregnancy. The objective was to explore prenatal and oral health providers’ information, motivation and practice behaviors related to oral health during pregnancy. Twenty-two in-depth interviews were conducted with prenatal and oral health providers based on the Information-Motivation-Behavioral Skills Model. Data were analyzed using the constant comparative method in NVivo 10. Providers held variable knowledge with regards to identified oral-systemic connections and implications. Most providers were unaware of the guidelines; however, some oral health providers reported avoiding specific treatment behaviors during this period. Motivation to address oral-systemic health during pregnancy included: prevention; healthy pregnancy/birth outcomes; patient’s complaint/question as cue to action; comprehensive, patient-centered, and family-centered care; ethical duty; and professional governing body. Oral health providers reported assessing, educating, and communicating with patients about oral health issues; whereas prenatal providers rarely addressed oral health but reported signing approval forms to receive such care. A few oral health providers highlighted lifecourse implications and the need for family-centered care when addressing poor oral health among pregnant patients. Findings suggest gaps in oral health prevention information and behaviors among prenatal and oral health providers. Future efforts should examine effective dissemination and implementation strategies that translate evidence-based guidelines into clinical practice, with the ultimate goal of improve oral-systemic health among women and their offspring across the lifecourse.

Hospital Variations in Unexpected Complications Among Term Newborns.

We examined contributing factors and reasons for the large variation in hospital rates of unexpected complications among low-risk term newborns in Florida. OBJECTIVES: To examine contributing factors and potential reasons for hospital differences in unexpected newborn complication rates in Florida. METHODS: We conducted a population-based retrospective cohort study of linked birth certificate and hospital discharge records from 2004 to 2013. The study population included 1 604 774 term, singleton live births in 124 hospitals. Severe and moderate complications were identified via a published algorithm. Logistic mixed-effects models were used to examine risk factors for complications and to estimate the percentage of hospital variation explained by factors. Descriptive analyses were performed to explore reasons for the differences. RESULTS: Hospital total complication rates varied from 6.7 to 98.6 per 1000 births. No correlation between severe and moderate complication rates by hospital was identified. Leading risk factors for complications included medically indicated early-term delivery, no prenatal care, nulliparity, prepregnancy obesity, tobacco use, and delivery in southern Florida hospitals. Hospital factors such as geographic location, level of care or birth volume, and Medicaid births percentage explained 35% and 27.8% of variation in severe and moderate complication rates, respectively. Individual factors explained an additional 6% of variation in severe complication rates. Different complication subcategories (eg, infections, hospital transfers) drove the hospital factors that contributed to severe and moderate complications. CONCLUSIONS: Variation in unexpected complication rates is more likely to be related to hospital rather than patient characteristics in Florida. The high proportion of variation explained by hospital factors suggests potential opportunities for improvement, and identifying specific complication categories may provide focus areas. Some of the opportunities may be related to differences in hospital coding practice.

Contextual factors influencing the implementation of the obstetrics hemorrhage initiative in Florida

Objective:The purpose of this study was to explore the multilevel contextual factors that influenced the implementation of the Obstetric Hemorrhage Initiative (OHI) among hospitals in Florida.Study Design:A qualitative evaluation was conducted via in-depth interviews with multidisciplinary hospital staff (n=50) across 12 hospitals. Interviews were guided by the Consolidated Framework for Implementation Research and analyzed in Atlas.ti using rigorous qualitative analysis procedures.Result:Factors influencing OHI implementation were present across process (leadership engagement; engaging people; planning; reflecting), inner setting (for example, knowledge/beliefs; resources; communication; culture) and outer setting (for example, cosmopolitanism) levels. Moreover, factors interacted across levels and were not mutually exclusive. Leadership and staff buy-in emerged as important components influencing OHI implementation across disciplines.Conclusion:Key contextual factors found to influence OHI implementation experiences can be useful in informing future quality improvement interventions given the institutional and provider-level behavioral changes needed to account for evolving the best practices in perinatology.

Promoting teamwork may improve infant care processes during delivery room management: Florida perinatal quality collaborative’s approach

Background:LOCAL PROBLEM: Inadequate understanding of compliance with standardized evidence-based DR management. INTERVENTIONS: Promote inter-professional teamwork and a bundle of interventions focusing on resuscitation team roles, equipment check, and debriefing using QI methodology. Optimize delivery room (DR) management to achieve 10-min SPO2 targets, delayed-cord clamping (DCC), team role assignment and debriefings in >50% of deliveries, and achieve normothermia in >75% of infants.Methods:Over 15 months (Epoch 1 to 5), nine Florida hospitals implemented a DR management plan for infants <31 weeks gestational age or <1500 g (N=814) using quality improvement methodology.Results:There was increased compliance of DCC (36 to 66%), role assignment (53 to 98%), debriefing rates (33 to 76%) and having all seven pre-delivery preparedness components fulfilled (34 to 75%). There were no significant improvements in admission temperatures or SPO2 targeting. When 7 vs 0 items of pre-delivery preparedness were completed, we saw improvements in thermoregulation (57% vs 72%), SPO2 targeting (60% vs 78%) and DCC compliance (43 to 67%).Conclusion:Promoting teamwork by increasing pre-delivery preparedness is associated with improvement of thermoregulation, SPO2 targeting and DCC compliance.

Strategic partnerships for outreach and enrollment: Filling in insurance gaps for Florida's military children and families

Summary:Military-provided health insurance does not adequately cover children with special needs and children of veterans. Medicaid and the Childrens Health Insurance Program (CHIP) can help eliminate insurance gaps, if promoted within the military community. This manuscript describes a Military Outreach Program to educate and reach Florida military families about insurance.

Developing a Framework to Promote Children’s Health Insurance Enrollment in Florida

Florida Covering Kids & Families (FL-CKF) at the University of South Florida’s Chiles Center for Healthy Mothers and Babies advocates for uninsured children and promotes outreach and enrollment in the state’s children’s health insurance program, Florida KidCare. FL-CKF facilitates the development of local coalitions to reach children and families throughout the state. Coalitions are provided with one-on-one training and a wide array of tools to increase effectiveness such as coalition-building resources, membership guides, and assistance in building strong local partnerships. FL-CKF places emphasis on creating formalized membership structures so each member knows his or her responsibilities and is accountable for them, partnering with other organizations in the community, and training on how to create and maintain partnerships in the community at large. These approaches help create lasting coalitions and offer an easily replicable approach for others to enhance children’s health insurance outreach and enrollment.