Putting It Out There: An Overview of Public Reports of Perinatal and Women's Health Indicators in the United States.

Addressing the Maternal Mental Health Crisis Through a Novel Tech-Enabled Peer-to-Peer Driven Perinatal Collaborative Care Model

Challenges of reducing maternal and neonatal mortality in Indonesia: Ways forward.

Overview of progress in patient safety

After Childbirth: Better Data Can Help Align Postpartum Needs with a New Standard of Care.

Perioperative Medicine: What the Future Can Hold for Anesthesiology.

Since 2008 Brazil is implementing a Project to decrease infant mortality in the Northeast and the Amazon Regions and reduce inequalities in these poorest regions of the country. An analysis...

To assess the impact of an intervention consisting of a computer-assisted clinical decision support system and performance-based incentives, aiming at improving quality of antenatal and childbirth care. Intervention study in rural primary healthcare (PHC) facilities in Burkina Faso, Ghana and Tanzania. In each country, six intervention and six non-intervention PHC facilities, located in one intervention and one non-intervention rural districts, were selected. Quality was assessed in each facility by health facility surveys, direct observation of antenatal and childbirth care, exit interviews, and reviews of patient records and maternal and child health registers. Findings of pre- and post-intervention and of intervention and non-intervention health facility quality assessments were analysed and assessed for significant (P < 0.05) quality of care differences. Post-intervention quality scores do not show a clear difference to pre-intervention scores and scores at non-intervention facilities. Only a few variables had a statistically significant better post-intervention quality score and when this is the case this is mostly observed in only one study-arm, being pre-/post-intervention or intervention/non-intervention. Post-intervention care shows similar deficiencies in quality of antenatal and childbirth care and in detection, prevention, and management of obstetric complications as at baseline and non-intervention study facilities. Our intervention study did not show a significant improvement in quality of care during the study period. However, the use of new technology seems acceptable and feasible in rural PHC facilities in resource-constrained settings, creating the opportunity to use this technology to improve quality of care.

Increasing efforts toward quality improvement (QI) are necessary in low- and middle-income countries (LMICs) to reduce maternal and perinatal mortality and morbidity and to promote respectful care. In Brazil, perinatal health indicators are below targets in several states despite universal access to perinatal services and very high rates of institutional births, indicating poor quality of care (QoC) as a key issue to be addressed. However, research efforts to develop and test QoC improvement interventions are scarce. We assessed the effects of a 1-year comprehensive QI cycle using a World Health Organization (WHO) assessment and quality tool on maternal and newborn care at hospital level and documented QIs obtained after a 1-year comprehensive QI cycle. Uncontrolled, unblinded, pre-post study carried out in six maternity hospitals in Pernambuco, Brazil, accounting for 29 128 live births in 2014. A standards-based and participatory approach based on a WHO quality assessment and improvement tool for maternal and neonatal care at hospital level was used. A national team of assessors supervised by international experts carried out baseline and final assessments. An action plan was developed and implemented to address key quality gaps emerging from the baseline assessment and from two supportive supervision visits. At baseline, hospitals presented a variety of quality gaps, the majority common to all participating centers. Gaps in case management of normal and complicated deliveries and in respectful and holistic care were predominant, in both teaching/tertiary and secondary care hospitals. After one year, several improvements were observed, particularly in respectful care during labor and at delivery, in case management of normal labor and delivery and in neonatal care. A systematic participatory approach based on a WHO tool produced important QIs in a relatively short time and should be considered for use for large-scale QI programs in Brazil and other LMICs. Its comprehensive, peer-to-peer and action-oriented nature and its capability to document QI over time and to build a QI culture represent important comparative advantages over other QI interventions.

Cardiovascular disease accounts for as much as one third of the differential in life expectancy between blacks and whites in the United States.1 A multifactorial process likely leads to these disparate outcomes (see the Figure), including differences in biology, differential awareness, knowledge, beliefs, and preferences for care for cardiovascular disease, and varying distribution of risk factors (including hypertension, obesity, and life stresses that include poverty and discrimination). Furthermore, blacks in the United States have a greater burden of cardiovascular disease2 and face greater challenges accessing health care, with lower rates of health insurance coverage, less access to a regular primary care doctor, and more frequent use of emergency departments for care.3 Then, once they have accessed the healthcare system, blacks often receive a poorer quality of care than do whites.4–6 Thus, it is no surprise that black patients’ outcomes, whether measured by functional status or mortality, are worse,7,8 and the study in this issue of Circulation by Skinner and colleagues9 adds further weight to this body of evidence. Model of possible pathways toward racial disparities in cardiovascular outcomes. Article p 2634 The results from Skinner et al9 support the notion that segregated health care is not equal and that it has a negative impact on the life expectancy of all patients receiving care in facilities with high proportions of black patients. Their results indicate that patients (both white and black) hospitalized for acute myocardial infarction (AMI) between 1997 and 2001 at …

The Ethics of Transparency: Publication of Cardiothoracic Surgical Outcomes in the Lay Press

Maternal fetal and infant mortality and morbidity are among the most significant public health problems in developing and resource-poor nations. In most developing countries important contributing factors to perinatal and maternal mortality are the lack of adequate diagnostic and pathology facilities inadequate or absent postmortem examination poor diagnostic pathology and microbiology capabilities and deficiency in surveillance systems statistical reporting and diagnostic accuracy of adverse maternal and perinatal health events. Most resource-poor nations have no pathologist trained in perinatal pathology who is available to address the clinical diagnostic public health and research aspects of these mortality and morbidity issues which are so prevalent in the developing world. The following article highlights some of the most important global perinatal health problems - including malaria low birth weight HIV/AIDS maternal malnutrition maternal death unsafe abortion and political turmoil - which would benefit by increased contributions from collaborations with physicians trained in perinatal pathology.

Perinatal quality indicators: yardsticks for quality of care, measures of population health

Color lines: Disparities in pharmacy treatment, education, and practice

Health Care Reform and Care at the Behavioral Health--Primary Care Interface

Addressing Maternal Mental Health: Progress, Challenges, and Potential Solutions