15 research outputs found
Using Insurance Standards and Policy Levers to Build a High Performance Health System
Analyzes Rhode Island's use of state health insurance regulatory authority to promote healthcare reform, including improved accessibility, quality, and affordability. Outlines the rationale for and process of developing standards and the expected impact
Assessing the Financial Health of Medicaid Managed Care Plans and the Quality of Patient Care They Provide
Examines the administrative and medical expenses, quality of care, and financial stability of publicly traded health plans contracted to manage the care of Medicaid beneficiaries by plan characteristics and compared with non-publicly traded plans
Differences in nulliparous caesarean section rates across models of care: a decomposition analysis
Pay-for-Performance in the Medi-Cal Managed Care and Healthy Families Programs: Findings and Recommendations
Assesses the feasibility and efficacy of pay-for-performance systems in raising care quality in state health insurance programs. Offers guidance on objectives, measures, incentives and rewards, program design, stakeholders' concerns, and sustainability
Perspective: Ominous Signs And Portents: A Purchaser's View Of Health Care Market Trends
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Maternal-Fetal Medicine Units Network Cesarean Registry: impact of shift change on cesarean complications
This study was undertaken to evaluate the effect of change of shift for physicians and nurses on complications associated with cesarean delivery.
17,996 term women undergoing an unscheduled cesarean delivery in 13 centers from 1999-2000 were included. Maternal and neonatal morbidities were evaluated by time of infant delivery vis-à-vis nursing change of shift (6
am-8
am, 2
pm-4
pm, 10
pm-12
am vs all other hours). The sample was then limited to weekdays only and physician shift changes were evaluated (physician shift change 6
am-8
am, 5
pm-7
pm vs all others). A composite of 30 maternal morbidities was also evaluated by logistic regression, controlling for potentially confounding factors.
Physician change of shift had no measurable effect on maternal and neonatal outcomes. Neonatal facial nerve palsies were increased at nursing change of shift (5 vs 0) as were hysterectomies (33 [0.24%] vs 23 [0.53%];
P < .007). Nursing change of shift had no impact on composite maternal morbidity after controlling for age, race, insurance, medical problems, prior incision type, weekend day, and prenatal care (odds ratio = 0.98; 95% confidence interval = 0.89-1.08).
Physician change of shift does not appear to be associated with an increase in morbidities. However, cesarean delivery during nursing change of shift is associated with increased risk of neonatal facial nerve palsy and hysterectomy. Further investigation is needed to understand the cause of this association
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The MFMU Cesarean Registry: Impact of time of day on cesarean complications
Studies suggest that sleep deprivation adversely affects performance. We hypothesized that cesarean delivery complications would be more frequent during the night shift (11
pm-7
am), and evaluated morbidities by delivery shift.
Eighteen thousand nine hundred and thirty-nine term women undergoing an unscheduled cesarean delivery in 13 centers from 1999 to 2000 within a prospective observational study were included. Maternal/neonatal morbidities and time from decision to cesarean delivery were evaluated by time of delivery (7
am-3
pm, 3
pm-11
pm, 11
pm-7
am). A composite of maternal morbidities was evaluated by logistic regression controlling for potentially confounding factors.
Controlling for age, race, insurance, cardiac disease, preeclampsia, diabetes, previous incision type, and prenatal care, shift of delivery had no impact on maternal morbidity (11
pm-7
am OR 0.9 [95% CI 0.81-1.0]). NICU admissions were slightly increased at night but neonatal complications were not.
Maternal and neonatal complications of cesarean delivery do not increase with delivery during the night shift