Biomedical subjects

Deborah Rosenberg

Publications and source records attributed to Deborah Rosenberg.

18 recordsLinked to original sources

PubMed2006

Prenatal care initiation among very low-income women in the aftermath of welfare reform: does pre-pregnancy Medicaid coverage make a difference?

OBJECTIVES: To examine pre-pregnancy Medicaid coverage and initiation of prenatal care among women likely eligible for Medicaid coverage regardless of pregnancy. METHODS: The Pregnancy Risk Assessment Monitoring System (PRAMS) was used to identify very low-income women with Medicaid payment for delivery. We then compared prenatal care initiation among women with (Non-GAP) and without (Medicaid GAP) pre-pregnancy Medicaid coverage. RESULTS: Rates of first trimester prenatal care were 47.3% for women in the Medicaid GAP, 70.0% for women who were not. The adjusted odds ratio for being in the Medicaid GAP and delayed prenatal care was 2.7 (95% CI 1.2, 6.2), although this varied by race/ethnicity and education. The relationship was strongest among White and Hispanic women with less than a high school education: OR=13.8, (95% CI 3.0, 62.7) and OR=19.0 (95% CI 2.4, 149.2), respectively. CONCLUSIONS: Pre-pregnancy Medicaid coverage appears to be associated with early initiation of prenatal care. Almost a decade after welfare reform, it is essential to preserve the Medicaid expansions for pregnant women, foster Medicaid family planning waivers, and promote access to primary care and early prenatal care, particularly for very low-income women.

Adult↗

PubMed2006

Validity of self-reported use of assisted reproductive technology treatment among women participating in the Pregnancy Risk Assessment Monitoring System in five states, 2000.

OBJECTIVES: To assess the validity of a question on assisted reproductive technology (ART) incorporated into the Pregnancy Risk Assessment Monitoring System (PRAMS) in 2000. While the intent of the question is to ascertain whether the index infant was conceived using ART, the phrasing was ambiguous for women who had used ART while trying to conceive the index infant but became pregnant after discontinuing treatment. METHODS: We compared weighted PRAMS estimates from five states that incorporated the ART question in 2000 with data from the U.S. ART Surveillance System (ART-SS) maintained by the Centers for Disease Control and Prevention (CDC). U.S. medical practices are mandated to report data for every ART procedure to CDC annually; thus, the ART-SS is highly specific and complete. RESULTS: ART use was reported for 156 of the PRAMS births in our study population, representing 4,571 (95% Confidence Limit, 3,452-5,690) births from the total birth cohort in the five states of interest in 2000. For the same maternal residency states and year, 1,768 births were reported to the ART-SS. Thus, we calculate that PRAMS overestimated ART use by 2,803 births. PRAMS estimated 2.59 times as many ART births as reported to the ART-SS. While for singletons, a large excess in estimated births from PRAMS was observed (ratio=3.50), there was little difference between the PRAMS estimates and ART-SS for twin and triplet births. CONCLUSION: These findings suggest women responding to PRAMS may be reporting past ART use in addition to current. The findings by plurality support this hypothesis.

Birth Weight↗

PubMed2006

A pilot study to modify the SF-36V physical functioning scale for use with veterans with spinal cord injury.

OBJECTIVE: To develop a valid and reliable spinal cord injury (SCI) specific physical functioning (PF) scale for the Veterans Health Administration (VHA) version of the 36-Item Short-Form Health Survey. DESIGN: A mixed qualitative and quantitative research design was used. In phase 1, a pool of SCI-specific PF items was generated based on focus groups with patients and health care providers. In phase 2, the psychometric properties of the SCI-specific PF scale were established. SETTING: A VHA SCI center. PARTICIPANTS: The sample consisted of valid responses from 359 veterans with traumatic SCI who were seen at a VHA SCI center during the prior year (2002). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Physical functioning in people with SCI. RESULTS: Exploratory factor analysis was conducted separately on respondents with lower neurologic-level injuries (paraplegia, 53% [n=190]) and those with higher neurologic-level injuries (tetraplegia, 45% [n=163]) and identified 9 items loading on 1 factor in both groups. These 9 items were included in separate item response theory (IRT) model analyses for each subgroup. Based on the IRT analysis, 1 item was eliminated, resulting in an 8-item, SCI-specific PF scale. CONCLUSIONS: Although several of the items in the SCI-specific PF scale showed floor effects, particularly in people with tetraplegia, we found excellent reliability and strong support of convergent and divergent validity of the scale.

Adult↗

PubMed2006

Under-reporting of work-related musculoskeletal disorders in the Veterans Administration.

PURPOSE: Work-related musculoskeletal disorders following patient contact represent a major concern for health care workers. Unfortunately, research and prevention have been hampered by difficulties ascertaining true prevalence rates owing to under-reporting of these injuries. The purpose of this study is to determine the predictors for under-reporting work-related musculoskeletal injuries and their reasons. DESIGN/METHODOLOGY/APPROACH: Multivariate analysis using data obtained in a survey of Veterans Administration employees in the USA was used to determine underreporting patterns among registered nurses, licensed practical nurses and nursing assistants. Focus groups among health care workers were conducted at one of the largest Veterans Administration hospitals to determine reasons for under-reporting. FINDINGS: A significant number of workers reported work-related musculoskeletal pain, which was not reported as an injury but required rescheduling work such as changing shifts and taking sick leave to recuperate. The findings indicate that older health care workers and those with longer service were less likely to report as were those working in the evening and night shifts. Hispanic workers and personnel who had repetitive injuries were prone to under-reporting, as were workers in places that lack proper equipment to move and handle patients. Reasons for under-reporting include the time involved, peer pressure not to report and frustration with workers' compensation procedures. ORIGINALITY/VALUE: This study provides insights into under-reporting musculoskeletal injuries in a major US government organization. The research indicates that current reporting procedures appear to be overtly cumbersome in time and effort. More flexible work assignments are needed to cover staff shortfalls owing to injuries. Health education on the detrimental long-term effects of ergonomic injuries and the need for prompt attention to injuries should prove useful in improving rates of reporting.

Data Collection↗

PubMed2006

The pre-pregnancy insurance status of public aid recipients in the aftermath of welfare reform: women in the Medicaid Gap.

The passage of welfare reform in 1996 led to sweeping changes in both welfare and Medicaid policy. This study examines the pre-pregnancy Medicaid coverage of women on public aid who had Medicaid payment for delivery in the time periods before and after welfare reform. Pregnancy Risk Assessment Monitoring System (PRAMS) data were used to examine changes in the prevalence of being in the Medicaid Gap (i.e., having no pre-pregnancy Medicaid coverage despite having Medicaid payment for delivery) in eight states between 1996 (n=302) and 1998-2000 (n=364). Of this population, 16.1% of women were in the Medicaid Gap in 1996, compared with 36.5% in 1998-2000. The overall adjusted relationship between time period and being in the Medicaid Gap was 4.5 (95% CI 2.1-9.6). This analysis suggests that in the period after welfare reform, there was an increase in the prevalence of very low-income women who, despite having their delivery paid for by Medicaid, did not have pre-pregnancy Medicaid coverage. Lack of Medicaid coverage regardless of pregnancy, particularly among women who historically have had such coverage and who are at higher risk of adverse pregnancy outcomes, has important implications for progress toward Healthy People 2010 objectives in prenatal care initiation and utilization, low birth weight, and other pregnancy outcomes.

Adult↗

PubMed2005

Disparities in mortality among high risk pregnant women in Illinois: a population based study.

PURPOSE: Researchers are increasingly studying maternal mortality in the context of maternal morbidity in order to identify risk and protective factors operating at each point along the morbidity-mortality continuum. This study examined factors associated with mortality in pregnant women with severe morbidity. In particular, the Black-White disparity was examined. METHODS: Illinois vital records data were linked to identify maternal deaths and other pregnant women with severe morbidity. Pregnancy-related deaths and high risk survivors were compared and case fatality rates were computed. Condition-specific and multivariable analyses were conducted, and time of death was examined. RESULTS: The overall risk of maternal death was 37.1 per 10,000 high risk pregnant women in Illinois from 1994 to 1998. Women who were older, African American, unmarried, or living in Chicago were at elevated risk of death. The adjusted relative risk for the Black-White disparity was 3.7 among all high risk pregnant women and 8.5 among women with hypertensive disorders. A greater proportion of African American and Hispanic women died within 7 days of delivery compared to White women. CONCLUSIONS: Medical risk status alone cannot explain disparities in maternal mortality. The Black-White disparity for risk of death persisted in both overall and condition-specific analyses.

Adolescent↗

PubMed2005

Pain resource nurses: believing the patients, and believing in themselves.

PURPOSE/OBJECTIVES: To describe the experience of being a pain resource nurse (PRN), discuss the influence of the PRN's role on colleagues and patient care, and explore barriers to the PRN role. DESIGN: Qualitative, exploratory. SETTING: A Veterans Administration hospital in the southeastern United States. SAMPLE: 12 nurses who received advanced training in pain assessment and management attended focus groups approximately one year after assuming the PRN role. METHODS: Two focus group sessions, each with four to eight nurses. Each nurse was asked to describe her experience. Interviews were transcribed verbatim. Data were analyzed using Spradley's domain analysis for discovering processes and themes from the transcribed data. MAIN RESEARCH VARIABLES: The experience of being a PRN, the influence of the PRN on staff and patients, and barriers to the role and pain management. FINDINGS: The key processes that described the PRN experience were Believing the Patients (i.e., an awareness that nurses must have to effectively manage patients' pain) and Believing in Themselves (i.e., the PRNs gained authority as experts in pain management, accepted the responsibility of being champions in pain management, and gave themselves permission to make patients comfortable). CONCLUSIONS: The pain-training course the PRNs received enabled them to practice as confident, credible, and empowered professionals. The awareness that they acquired during the course and the year of practice allowed the PRNs to be patient advocates, role models, and educators. IMPLICATIONS FOR NURSING: The findings of this study indicate a high level of nurse satisfaction with the PRN role. Nurses with an interest and specialized knowledge in pain assessment and management at the unit level may greatly improve patient outcomes.

Adult↗

PubMed2005

The need for care coordination among children with special health care needs in Illinois.

OBJECTIVES: The objectives of this study were: 1) to estimate the need for care coordination among children with special health care needs (CSHCN) in Illinois, 2) to assess the need for care coordination among CSHCN in Illinois by sociodemographic, condition-related, and access to care factors, and 3) to discuss approaches for meeting the need for care coordination. METHODS: The study included 745 Illinois families interviewed as part of the State and Local Area Integrated Telephone Survey (SLAITS) of CSHCN. Classifying families of CSHCN as needing care coordination was based on three survey questions. The prevalence of the need for care coordination among CSHCN in Illinois was examined overall and by sociodemographic characteristics, descriptors of the child's health condition, and measures of access to services. Multivariable modeling was carried out to jointly assess these factors and the need for care coordination. RESULTS: In Illinois, 25.2% of CSHCN families reported a need for care coordination. Condition severity, need for supplementary/ancillary services, lack of insurance coverage and inadequate communication among providers were significantly associated with the need for care coordination (OR = 1.14, OR = 1.72, OR = 2.45, and OR = 3.08, respectively). Having a primary care provider/medical home was not associated with the need for care coordination in multivariable analysis. CONCLUSION: Coordination of health services is important for all children and all adults, but it is particularly important for children with special health care needs. The variation in the need for care coordination both within and across states underscores the need for flexibility in program and policy development for CSHCN.

Adolescent↗

PubMed2005

Factors associated with health care access for Mississippi children with special health care needs.

OBJECTIVES: This purpose of the study was to examine the factors associated with access to routine care and to specialty care for Mississippi children with special health care needs (CSHCN). METHODS: We analyzed data for Mississippi CSHCN from the 2001 National Survey of Children with Special Health Care Needs. Using a modified version of Andersen and Aday's Behavioral Model of Health Services Use, we explored the relationship of independent variables (e.g., demographics, insurance, severity of illness) to dependent variables (did not obtain routine care, did not obtain specialty care). We conducted bivariate and logistic regression analyses using SAS and SUDAAN. RESULTS: Based on self-reported data, with a 61% response rate, 66% of Mississippi CSHCN needed routine health care, and 52.8% needed specialty care. Of these children, 6.5% did not receive routine care and 9.3% did not receive specialty care. In a fully adjusted model, discontinuous insurance coverage was an important factor associated with not having obtained routine care (OR = 7.8; CI = 1.7-35.9) and specialty care (OR = 8.6; CI = 2.0-36.8). Children with a high illness severity rank were more likely to have not obtained routine care than children with a low rank (OR 1.4; CI = 1.1-1.9). CONCLUSIONS: It may be important to establish a health insurance safety net for families who lack insurance continuity since it appears that a lapse in insurance coverage impedes health care access. Further research is needed to understand the relationship between illness severity and lack of health care access, especially for children with special health care needs.

Adolescent↗

PubMed2004

International Classification of Diseases-9th revision coding for preeclampsia: how accurate is it?

OBJECTIVE: The purpose of this study was to evaluate the accuracy of the International Classification of Diseases-9th revision codes for preeclampsia and eclampsia. STUDY DESIGN: The University of Illinois Medical Center at Chicago discharge database was used to identify 135 women from 1999 through 2001 whose disease was coded as having preeclampsia or eclampsia. With American College of Obstetrics and Gynecology criteria as the gold standard, the diagnosis that was determined through chart review was compared with the International Classification of Diseases-9th revision code that was present in the discharge database. Patients were classified as true cases if the International Classification of Diseases-9th revision code matched the American College of Obstetricians and Gynecologists diagnosis; the positive predictive value of the code was then calculated. RESULTS: The overall positive predictive value for the complete sample was only 54%, but the positive predictive value for severe preeclampsia was 84.8%, which was high compared with mild preeclampsia (45.3%) and eclampsia (41.7%). Diagnostic (clinician) error was the most common reason for miscoding error. CONCLUSION: The findings suggest that International Classification of Diseases-9th revision codes for preeclampsia/eclampsia vary greatly in their accuracy of diagnosis. Therefore, a review of medical records is required when data are being gathered on the incidence of preeclampsia and eclampsia.

Adolescent↗

PubMed2004

The continuum of maternal morbidity and mortality: factors associated with severity.

OBJECTIVE: The goal of this study was to examine whether sociodemographic, clinical, and other service-related factors, as well as preventability issues affect a woman's progression along the continuum of morbidity and mortality. STUDY DESIGN: This was a case-control study of pregnancy-related deaths, women with near-miss morbidity, and those with other severe, but not life threatening, morbidity. Factors associated with maternal outcome were examined. RESULTS: Provider factors (related to preventability) and clinical diagnosis were significantly associated with progression along the continuum after controlling for sociodemographic characteristics (P < .01 for both associations). CONCLUSION: In order to improve mortality rates, we must understand maternal morbidity and how it may lead to death. This study shows that important initiatives include addressing preventability, in particular, provider factors, which may play a role in moving women along the continuum of morbidity and mortality.

Case-Control Studies↗

PubMed2004

A scoring system identified near-miss maternal morbidity during pregnancy.

OBJECTIVE: The objective of this study was to develop a scoring system for identifying women with near-miss maternal morbidity, and differentiating these women from those with severe but not life-threatening conditions. STUDY DESIGN AND SETTING: The study was conducted at the University of Illinois Medical Center at Chicago (UIMC), which is a tertiary care hospital with approximately 2,220 births per year. UIMC is in a major urban area serving a predominantly African-American and Latina population. This article focuses on five clinical factors: organ failure (>/=1 system), extended intubation (>12 hr), ICU admission, surgical intervention, and transfusion (>3 units), grouped into several scoring system alternatives. The total score on each scoring system was calculated as the weighted sum of the clinical factors present for each woman. RESULTS: The five-factor scoring system had the highest specificity (93.9%), but the four-factor scoring system, which eliminated organ system failure for simplification of data collection, still had a specificity of 78.1%. CONCLUSION: Near-miss morbidities identified using the scoring systems presented can be incorporated into clinical case review and epidemiologic studies to enhance the monitoring of obstetric care and to improve estimates of the incidence of life-threatening complications in pregnancy.

Female↗

PubMed2004

A new method for classifying patterns of prenatal care utilization using cluster analysis.

OBJECTIVES: The objectives of this study were: to 1) define patterns of prenatal care utilization using cluster analysis, 2) describe two alternative cluster solutions and compare these groupings to the Adequacy of Prenatal Care Utilization Index (APNCU), 3) compare the cluster solutions and the APNCU with respect to maternal age and prematurity, and 4) discuss advantages and disadvantages of using cluster analysis to study prenatal care. METHODS: The study sample included 3544 women in the 1988 National Maternal and Infant Health Survey for whom complete prenatal care visit data were available. Clustering was carried out in two stages, first employing nearest centroid sorting (the k means method), a nonhierarchical approach, and then using Ward's Minimum Variance Method, a hierarchical clustering technique. RESULTS: Patterns of prenatal care defined by cluster analysis varied by timing of the first visit, total number of visits, and the rate of accumulation of visits, but this variation was different compared to that seen for the APNCU. While the cluster solutions and the APNCU identified a similar normative pattern of care, other patterns identified were quite different. In particular, the six-cluster solution differentiated among women who entered care at similar times, but accumulated visits at differing rates and experienced differing rates of preterm delivery. CONCLUSION: Cluster analysis is a new tool for studying prenatal care. Further studies are needed to refine the method and test whether the alternative perspective it provides will lead to new findings concerning the relationship of prenatal care and birth outcomes.

Birth Certificates↗

PubMed2003

Satisfaction and use of prenatal care: their relationship among African-American women in a large managed care organization.

BACKGROUND: Although many more mothers of almost all ethnic groups began prenatal care in the first trimester during the last decade, a significant number of low-income and minority women still fail to obtain adequate care in the United States-a failure that may be related to their dissatisfaction with the prenatal care experience. This study sought to examine the relationship between satisfaction with care and subsequent prenatal care utilization among African-American women using prospective methods. METHODS: A sample of 125 Medicaid and 275 non-Medicaid African-American adult women seeking care through a large Midwest managed care organization were interviewed before or at 28 weeks' gestation at one of two prenatal care sites. Women were interviewed about personal characteristics, prenatal care experience, and ratings of care (satisfaction). Information about subsequent use of prenatal care was obtained through retrospective medical record review after delivery. Univariate and multivariable analyses examining the relationship between women's satisfaction and prenatal care use were conducted using a dichotomous measure of satisfaction and a continuous measure of utilization. RESULTS: Women were highly satisfied with prenatal care, with an overall mean satisfaction score of 80.3. Non-Medicaid women were significantly (p < 0.05) less satisfied with their prenatal care (mean score, 79.1) than Medicaid women (mean score, 82.8), and the latter had significantly fewer visits on average than the former subsequent to the interview. Analyses showed no significant difference in subsequent utilization according to whether a woman had a high versus low level of satisfaction at the prenatal care interview. CONCLUSIONS: This study challenges the assumption that improving a woman's satisfaction with care will lead to an increase in the adequacy of her prenatal care utilization. Since this study was limited to African-American women and is the first prospective study of women's satisfaction with care and prenatal care utilization, the negative findings do not yet settle this area of inquiry. Monitoring women's satisfaction with prenatal care in both managed care and fee-for-service settings and working to improve those aspects of care associated with decreased satisfaction is warranted.

Adolescent↗

PubMed2003

Patient dignity in persons with spinal cord injury.

Technology is changing the way nurses provide patient care in spinal cord injury. A key nursing concern is the impact of technology-assisted caregiving tasks (TACT) on the patients' sense of dignity. Despite frequent use of the term dignity in discussing treatment of persons with disabilities, there is a dearth of empirical research related to this topic. In particular, there have been few attempts to define the construct for the purposes of valid measurement. The purpose of this article is, therefore, to critically review the relevant literature on patient dignity with an aim toward eventual development and validation of a Dignity Assessment Tool.

Attitude of Health Personnel↗

PubMed2002

The likelihood of placenta previa with greater number of cesarean deliveries and higher parity.

OBJECTIVE: To examine the relationship between prior cesarean delivery and placenta previa. METHODS: A hospital-based, case-control study was conducted in which 316 multiparous women with placenta previa were identified. Controls consisted of 2051 multiparous women with spontaneous vaginal deliveries. Information on prior cesarean delivery was examined in three forms: as a dichotomous variable, as an ordinal variable, and as a set of three indicator variables for one, two, and three or more cesarean deliveries. Multivariable logistic regression modeling was used to obtain an adjusted estimate of this association. RESULTS: Women with a prior cesarean delivery were more likely to have a placenta previa than those without (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.21, 2.08). The likelihood of placenta previa increased as both parity and number of cesarean deliveries increased. Thus, the adjusted OR for a primiparous woman with one cesarean delivery was 1.28 (95% CI 0.82, 1.99). For a woman who has four or more deliveries with only a single cesarean delivery, the OR increases to 1.72 (95% CI 1.12, 2.64). This trend continues with greater parity and a greater number of cesarean deliveries such that the likelihood of placenta previa for a woman with parity greater than four and greater than four cesarean deliveries was OR 8.76 (95% CI 1.58, 48.53). CONCLUSION: This study supports the association between prior cesarean delivery and placenta previa and demonstrates that the joint effect of parity and prior cesarean delivery is greater than that of either variable alone.

Adult↗

PubMed2002

Defining a conceptual framework for near-miss maternal morbidity.

Maternal mortality is the major indicator used to monitor maternal health in the United States. For every woman who dies, however, many suffer serious life-threatening complications of pregnancy. Yet relatively little attention has been given to identifying a general category of morbidities that could be called near misses. Characterizing near-miss morbidity is valuable for monitoring the quality of hospital-based obstetric care and for assessing the incidence of life-threatening complications. Cases of near-miss morbidity also provide an appropriate comparison group both for dinical case review and for epidemiologic analysis. This paper presents an initial framework and a process for the definition and identification of near-miss morbidity that minimizes loss of information yet has practical utility. A clinical review team classified 22 of 186 women as near misses and 164 as other severe morbidity. A quantitative score classified 28 women as near misses and 156 as other severe morbidity. Precise classification of near-miss morbidity is the first step in analyzing factors that may differentiate survival from death on the continuum from morbidity to mortality. Ultimately, a methodology for the identification and analysis of near-miss morbidity will allow for integrated morbidity and mortality reviews that can then be institutionalized. The results will serve as important models for other researchers, state health agencies, and regionalized perinatal systems that are engaged in morbidity and mortality surveillance.

Chicago↗

PubMedDate not supplied

Prenatal care characteristics and African-American women's satisfaction with care in a managed care organization.

This study examined the characteristics of prenatal care affecting women's satisfaction for two groups of African-American women, those with Medicaid insurance and those with commercial insurance, who sought care through a large managed care organization in the Midwest. African-American pregnant managed care patients (n = 400), regardless of payer status, were more satisfied when their providers spent more time with them and when their providers engaged them by explaining procedures, asking them questions, and answering their questions. Satisfaction was also higher for both Medicaid (n = 125) and commercially insured women (n = 275) when the waiting room was clean and comfortable. The care characteristics most important to an African-American woman's satisfaction with prenatal care do not appear to be dependent on her payer status, nor do they seem to be particularly dependent on the financial arrangements of her care provider. While improvements in health care delivery tend to focus on increasing technical proficiency to improve pregnant women's satisfaction with care, prenatal care providers should focus on improvements in patient-provider communication, as well as features of the prenatal care setting (e.g., cleanliness, waiting times, availability of ancillary services).

Adult↗