Biomedical subjects

Andrea Linton

Publications and source records attributed to Andrea Linton.

6 recordsLinked to original sources

PubMed2005

Clinical case mix adjustment of cesarean delivery rates in U.S. military hospitals, 2002.

OBJECTIVE: To assess whether significant variations in observed cesarean rates in U.S. military hospitals may be attributed to differences in clinical case mix. METHODS: Hospital discharge records for births in U.S. military hospitals in 2002 were grouped into mutually exclusive clinical strata to calculate predicted cesarean rates for subgroups defined by maternal race, health plan, hospital location, delivery volume, teaching status, and neonatal intensive care unit (NICU) status. The 95% confidence interval (CI) around each standardized ratio (SR) of the observed-to-predicted cesarean rate was used to assess statistical significance. RESULTS: Observed cesarean rates were significantly higher than predicted rates for small hospitals (23.1% and 20.4%, respectively, SR 1.13, 95% CI 1.08-1.19), teaching hospitals (23.7% and 22.5%, respectively, SR 1.05, 95% CI 1.02-1.08), black women (25.1% and 22.8%, respectively, SR 1.10, 95% CI 1.05-1.14), and other minorities (22.7%, and 21.6%, respectively, SR 1.05, 95% CI 1.01-1.09). No significant differences between observed and predicted cesarean rates were found across hospital locations or NICU status. Significant differences found for non-managed care beneficiaries were attributed to teaching status of the hospitals in which they delivered. CONCLUSION: Clinical case mix does not adequately account for the relatively high rates of cesarean delivery observed for small hospitals and teaching hospitals and among black women in the study population. Further study is recommended to identify additional clinical and nonclinical factors that should be considered when comparing performance across institutions, health plans, or individual providers.

Adult↗

PubMed2005

Developing and implementing an assessment method to evaluate a virtual canine anatomy program.

A computer-based anatomy program, Virtual Canine Anatomy: The Head, was incorporated into a first-year veterinary dissection laboratory two years ago to address challenges inherent in the traditional pedagogical approach. The program uses specimen photographs, QuickTime Virtual Reality, and interactive features to help students study the dissection, osteology, and radiology of the canine head. Photographs of each phase of dissection are displayed in the program, along with dissection instructions. Students can click on anatomical structures in each photograph to highlight the selected structure and display a complete description of it. Related structures and views are accessible through hyperlinks. This study was designed to measure student and faculty attitudes toward the instructional software, to gauge its effect on student achievement, and to propose evaluation methodology and instrumentation for similar projects. Observations, interviews, focus groups, surveys, and test results were used for this assessment. Results suggest positive student and faculty attitudes toward the program. Students felt the program met their needs, increased their confidence and efficiency, and was easy to use. Both students and instructors felt the program was beneficial during dissection. There was no significant change in student achievement on course tests. Future research will measure the program's effect on student-instructor interactions.

Anatomy↗

PubMed2004

Effect of preexisting chronic disease on primary cesarean delivery rates by race for births in U.S. military hospitals, 1999-2002.

BACKGROUND: A previous study of the United States Department of Defense healthcare beneficiaries reported elevated cesarean delivery rates for black and Asian women relative to white women that were independent of maternal socioeconomic status. This finding suggests that other maternal factors may explain the elevated rates. The purpose of this study was to examine the prevalence of specific chronic diseases identified as risk factors for complications during pregnancy, labor, and delivery, and to explore the strength of each disease to predict a cesarean outcome. METHODS: United States military hospital discharge records from 1999 to 2002 for singleton births to women without a previous cesarean were used to calculate primary cesarean and chronic disease rates for diabetes, hypertension, cardiovascular disease, renal disease, anemia, asthma, sexually transmitted diseases, and substance abuse. Stepwise logistic regression was used to calculate adjusted odds ratios for dichotomized race and chronic disease indicators for five maternal age groups using the chi2 difference (p < 0.05) to identify significant variables for inclusion in the model. Primary cesarean delivery rates were then adjusted for the presence of chronic diseases that were significantly associated with a cesarean outcome. RESULTS: Diabetes, genital herpes, and hypertension were significant predictors of cesarean use among all maternal age groups. Cardiovascular disease, renal disease, asthma, and anemia were predictors in some age groups. The remaining disease conditions were not significant predictors for cesarean delivery. Adjustment of cesarean rates for these chronic diseases did not significantly alter the differences in primary cesarean rates for black and Asian mothers relative to white mothers. CONCLUSIONS: The presence of certain chronic conditions before pregnancy may increase the likelihood that a woman will deliver by cesarean section. Adjustment of cesarean rates for the presence of these chronic diseases, however, does not account for the difference in cesarean rates observed for white and minority mothers in the study population. The potential for underreporting of chronic diseases complicates a true assessment of the impact of chronic disease on cesarean delivery rate variations between white and minority women.

Adult↗

PubMed2004

Effect of managed care enrollment on primary and repeat cesarean rates among U.S. Department of Defense health care beneficiaries in military and civilian hospitals worldwide, 1999-2002.

BACKGROUND: In response to rising cesarean rates, it is reasonable for health care organizations to look to a managed care model as a means of controlling further rate increases. However, little conclusive evidence exists to support this solution. We undertook a study of the Department of Defense health care beneficiary population to assess the impact of enrollment in TRICARE Prime, the Department's managed care health plan, on cesarean delivery rates. METHODS: Pooled hospital discharge records from 1999-2002 for live, singleton births were analyzed to calculate primary and repeat cesarean rates for TRICARE Prime and non-Prime beneficiaries in the military and civilian hospitals that comprise the Department of Defense health care network. Stepwise logistic regression was used to calculate adjusted odds ratios for clinical indicators for each combination of health plan and hospital setting using the chi2 difference(p <0.05)to eliminate nonsignificant variables from the model. Total primary and repeat cesarean rates were compared with primary and repeat cesarean rates for women with no reported clinical complications to account for differences in case mix across subgroups. Statistical significance of the differences calculated for subgroups was assessed using chi2. RESULTS: Primary cesarean rates were significantly lower for TRICARE Prime enrollees relative to non-Prime beneficiaries for all race subgroups and three of five age subgroups in military hospitals and four of five age subgroups in civilian hospitals. No significant differences in repeat cesarean rates were observed between Prime and non-Prime beneficiaries within any race or age subgroup. Breech presentation followed by dystocia, fetal distress, and other complications were significant predictors for primary cesarean. Previous cesarean delivery was the leading predictor for repeat cesarean delivery. Primary and repeat cesarean rates observed for military hospitals were consistently lower than rates observed for civilian hospitals within each health plan type and age group. CONCLUSIONS: Enrollment in the managed care health plan was significantly associated with lower risk of primary cesarean delivery relative to membership in other health plans offered to Department of Defense health care beneficiaries. Repeat cesarean rates in this population varied independently of health plan type. Primary cesarean delivery was generally associated with clinical complications, whereas previous cesarean delivery was the strongest indicator for a repeat cesarean delivery. A clear explanation of reduced cesarean rates for Prime enrollees remains elusive, but it is likely that factors beyond individual practitioner decision-making were at work.

Adult↗

PubMed2004

Effects of maternal characteristics on cesarean delivery rates among U.S. Department of Defense healthcare beneficiaries, 1996-2002.

BACKGROUND: National rates of cesarean birth continue a three decade-long escalation, despite widespread recognition that a reduction in the use of the procedure is a continuing appropriate public health goal, as evidenced by the Healthy People 2010 reduction targets. Nonclinical factors associated with cesarean delivery include maternal age, race, socioeconomic status, and insurance coverage. This study compared cesarean delivery rates and trends for the U.S. Department of Defense healthcare beneficiary population from 1996 to 2002 with those observed nationally, and assessed the association of these nonclinical factors with cesarean rate variation in the U.S. Department of Defense healthcare beneficiary population. METHODS: Hospital discharge and claims records for babies born in the military and civilian hospitals that comprise the Department of Defense healthcare network were used to calculate total and primary cesarean delivery rates and vaginal birth after cesarean (VBAC) rates from 1996 to 2002. Annual cesarean rates for subgroups defined by maternal age, race, and socioeconomic status were calculated to examine rate variations and rate trends within the study population. Pooled data from 1999 to 2002 were used to compare rates across socioeconomic status, stratified by age and race. Statistical significance of the differences calculated for subgroups was assessed using chi-square. RESULTS: Total and primary cesarean delivery rates among the U.S. Department of Defense population were lower than those reported nationally for every year examined. Cesarean delivery and VBAC rate trends in the national and Department of Defense populations were similar. Within the Department of Defense population, total cesarean delivery increased with increasing maternal age and was more highly associated with racial minorities relative to white women. The higher socioeconomic subgroup (defined as active duty, retired, and warrant officers and their families in this study) was generally associated with reduced cesarean delivery rates. CONCLUSIONS: Cesarean deliveries are performed less frequently for the U.S. Department of Defense healthcare beneficiary population relative to the national population. Associations between socioeconomic factors and cesarean rates reported for the national population were not apparent in the study population. The consistent pattern of rate variation across racial subgroups in the Department of Defense population suggests that factors beyond those examined in this study are needed to explain the elevated cesarean rates for racial minorities.

Adult↗

PubMed2004

Effect of September 11th terrorist attacks on the self-reported health status of Department of Defense health care beneficiaries.

This study examined the changes in the self-reported health status of Department of Defense health care beneficiaries associated with the September 11th terrorist attacks. Responses to a single-item, general health measure from pre- and post-September 11 quarterly survey events for the calendar year 2001 were analyzed to compare the unfavorable health response rates before and after the attacks. Increases in rates of unfavorable health status following the terrorist attacks were reported by the total population and 39 of 44 subgroups examined. Statistically significant increases in unfavorable health were reported by active duty personnel and dependents of active duty personnel; beneficiaries under the age of 44 years; beneficiaries affiliated with the Army and Marines; and beneficiaries in the Mid-Atlantic, Mid-West/Central, and Pacific Rim regions. These findings suggest that stress associated with the likelihood of being deployed or having a family member deployed following the terrorist attacks significantly contributed to the increase in unfavorable health response reported on the post-September 11 survey.

Adult↗