Health Policy

Maternal Obesity, Caesarean Delivery and Caesarean Delivery on Maternal Request: A Cohort Analysis from China

Maternal Obesity, Caesarean Delivery and Caesarean Delivery on Maternal Request: A Cohort Analysis from China
Paediatric and Perinatal Epidemiology. 2015, 29, 232–240.

Zhou Y, Blustein J, Hi H, Ye R, Liu J-m
06/03/2015

Abstract Background To quantify the association between maternal obesity and caesarean delivery, particularly caesarean delivery on maternal request (CDMR), a fast-growing component of caesarean delivery in many nations. Methods We followed 1 019 576 nulliparous women registered in the Perinatal Healthcare Surveillance System during 1993–2010. Maternal body mass index (BMI, kg/m2), before pregnancy or during early pregnancy, was classified as underweight (<18.5), normal (18.5 to <23; reference), overweight (23 to <27.5), or obese (≥27.5), consistent with World Health Organization guidelines for Asian people. The association between maternal obesity and overall caesarean and its subtypes was modelled using log-binomial regression. Results During the 18-year period, 404 971 (39.7%) caesareans and 93 927 (9.2%) CDMRs were identified. Maternal obesity was positively associated with overall caesarean and CDMR. Adjusted risk ratios for overall caesarean in the four ascending BMI categories were 0.96 [95% confidence interval (CI) 0.94, 0.97], 1.00 (Reference), 1.16 [95% CI 1.14, 1.18], 1.39 [95% CI 1.43, 1.54], and for CDMR were 0.95 [95% CI 0.94, 0.96], 1.00 (Reference), 1.20 [95% CI 1.18, 1.22], 1.48 [95% CI 1.433, 1.54]. Positive associations were consistently found in women residing in southern and northern provinces and in subgroups stratified by year of delivery, urban or rural residence, maternal age, education, level of delivering hospital, and birthweight. Conclusions In a large Chinese cohort study, maternal obesity was associated with an increased risk of caesarean delivery and its subtypes, including CDMR. Given the rising global prevalence of obesity, and in view of the growth of CDMR, it seems likely that caesarean births will increase, unless there are changes in obstetrical practice.

Health and Health Care in BRIC Cities: Ideas for Collaborative Research.

Health and Health Care in BRIC Cities: Ideas for Collaborative Research.
Working Paper

Rodwin, VG.
05/09/2015

Available on SSRN database here.

The largest cities in the wealthy nations all face an unprecedented challenge: how to meet the needs of a population that lives longer, has a declining birth rate, is generally healthier, but also increasingly beset by the rise of chronic illness. The World Cities Project (WCP) has produced two books and numerous articles based on comparisons among, and within five of the world's most dynamic cities: New York, Paris, London, Tokyo and Hong Kong. These cities are centres of economic growth and finance, culture and media, sophisticated transportation systems and innovations of all kinds. They are renowned for their centres of excellence in medical care, top-ranking medical schools, institutes of bio-medical research, and public health infrastructure. Likewise, they attract some of the wealthiest, as well as the poorest populations of their nations, which forces their health care systems to confront the challenge of confronting glaring inequalities and redesigning their health care systems.

Vital Signs: Core Metrics for Health and Health Care Progress

Vital Signs: Core Metrics for Health and Health Care Progress
Committee on Core Metrics for Better Health at Lower Cost; Institute of Medicine. Washington, DC: The National Academies Press, 2015.

David Blumenthal, Elizabeth Malphrus, and J. Michael McGinnis (Eds.)
04/28/2015

Thousands of measures are in use today to assess health and health care in the United States. Although many of these measures provide useful information, their sheer number, as well as their lack of focus, consistency, and organization, limits their overall effectiveness in improving performance of the health system. To achieve better health at lower cost, all stakeholders—including health profes­sionals, payers, policy makers, and members of the public—must be alert to the measures that matter most. What are the core measures that will yield the clearest understanding and focus on better health and well-being for Americans?

With support from the Blue Shield of California Foundation, the California Healthcare Foundation, and the Robert Wood Johnson Foundation, the Institute of Medicine (IOM) convened a committee to identify core measures for health and health care. In VITAL SIGNS: Core Metrics for Health and Health Care Progress, the committee proposes a streamlined set of 15 standardized mea­sures, with recommendations for their application at every level and across sec­tors. Ultimately, the committee concludes that this streamlined set of measures could provide consistent benchmarks for health progress across the nation and improve system performance in the highest-priority areas.

In Knickman and Kovner (eds.) 2015. Health Care Delivery in the United States,

In Knickman and Kovner (eds.) 2015. Health Care Delivery in the United States,
11th Edition. Springer Publishing LLC

Gusmano, MK. and Rodwin, VG. Comparative Health Systems.
04/14/2015

Windows can sometimes be mirrors. A look at health systems abroad can enable us to develop a better understanding of our health system in the United States. An international perspective suggests that the United States has the most expensive health care system in the world, but unlike other wealthy countries, we fail to provide universal health insurance coverage and experience large inequities in access to primary and specialty care. Health care costs are often a source of financial strain, even bankruptcy, for people with serious illness (Hacker, 2006), and Americans suffer from high rates of mortality that could have been avoided with timely and appropriate access to a range of effective health care services (Nolte & McKee, 2012). There is also evidence that the U.S. health care system squanders resources and fails to address many of its population’s health care needs. Not surprisingly, public opinion polls regularly find that medical professionals and the public are dissatisfied with the system and believe major change is necessary (Blendon, Benson, & Brulé, 2012). 

Power and Priorities: The Growing Pains of Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”

Power and Priorities: The Growing Pains of Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”
Int J Health Policy Manag 2015, 4(x), 1–2

Karen A. Grépin
03/05/2015

Shiffman has argued that some actors have a great deal of power in global health, and that more reflection is needed on whether such forms of power are legitimate. Global health is a new and evolving field that builds upon the historical fields of public and international health, but is more multi-disciplinary and inter-disciplinary in nature. This article argues that the distribution of power in some global health institutions may be limiting the contributions of all researchers in the field

Assessment of a government-subsidized supermarket in a high-need area on household food availability and children's dietary intakes.

Assessment of a government-subsidized supermarket in a high-need area on household food availability and children's dietary intakes.
Public Health Nutrition. 18(15): 2881-2890.

Elbel B, Moran A, Dixon LB, Kiszko K, Cantor J, Abrams C, Mijanovich T.
01/07/2015

Objective: To assess the impact of a new government-subsidized supermarket in a
high-need area on household food availability and dietary habits in children.
Design: A difference-in-difference study design was utilized.
Setting: Two neighbourhoods in the Bronx, New York City. Outcomes were
collected in Morrisania, the target community where the new supermarket was
opened, and Highbridge, the comparison community.
Subjects: Parents/caregivers of a child aged 3–10 years residing in Morrisania
or Highbridge. Participants were recruited via street intercept at baseline (presupermarket
opening) and at two follow-up periods (five weeks and one year
post-supermarket opening).
Results: Analysis is based on 2172 street-intercept surveys and 363 dietary recalls
from a sample of predominantly low-income minorities. While there were small,
inconsistent changes over the time periods, there were no appreciable differences
in availability of healthful or unhealthful foods at home, or in children’s dietary
intake as a result of the supermarket.
Conclusions: The introduction of a government-subsidized supermarket into an
underserved neighbourhood in the Bronx did not result in significant changes in
household food availability or children’s dietary intake. Given the lack of healthful
food options in underserved neighbourhoods and need for programmes that
promote access, further research is needed to determine whether healthy food
retail expansion, alone or with other strategies, can improve food choices of
children and their families.

The Effect of the Diffusion of the Surgical Robot on the Hospital-level Utilization of Partial Nephrectomy

The Effect of the Diffusion of the Surgical Robot on the Hospital-level Utilization of Partial Nephrectomy
Medical Care, Vol. 53, no. 1, pp. 71-78. DOI: 10.1097/MLR.0000000000000259

Sivarajan, G., G.B. Taksler, D. Walter, C.P. Gross, R.E. Sosa,and D.V. Makarov
01/01/2015

Introduction: The rapid diffusion of the surgical robot has been controversial because of the technology’s high costs and its disputed marginal benefit. Some, however, have suggested that adoption of the robot may have improved care for patients with renal malignancy by facilitating partial nephrectomy, an underutilized, technically challenging procedure believed to be less morbid than radical nephrectomy. We sought to determine whether institutional acquisition of the robot was associated with increased utilization of partial nephrectomy.

Methods: We used all payer data from 7 states to identify 21,569 nephrectomies. These patient-level records were aggregated to the hospital-level then merged with the American Hospital Association Annual Survey and publicly available data on timing of robot acquisition. We used a multivariable difference-in-difference model to assess at the hospital-level whether robot acquisition was associated with an increase in the proportion of partial nephrectomy, adjusting for hospital nephrectomy volume, year of surgery, and several additional hospital-level factors.

Results: In the multivariable-adjusted differences-in-differences model, hospitals acquiring a robot between 2001 and 2004 performed a greater proportion of partial nephrectomy in both 2005 (29.9% increase) and 2008 (34.9% increase). Hospitals acquiring a robot between 2005 and 2008 also demonstrated a greater proportion of partial nephrectomy in 2008 (15.5% increase). In addition, hospital nephrectomy volume and urban location were also significantly associated with increased proportion of partial nephrectomy.

Conclusions: Hospital acquisition of the surgical robot is associated with greater proportion of partial nephrectomy, an underutilized, guideline-encouraged procedure. This is one of the few studies to suggest robot acquisition is associated with improvement in quality of patient care.

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