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Specialty-Based Ambulatory Quality Improvement Program: A Specialty-Specific Ambulatory Metric Project

Nagler, Arielle R; Testa, Paul A; Cho, Ilseung; Ogedegbe, Gbenga; Kalkut, Gary; Gossett, Dana R
BACKGROUND AND OBJECTIVES/OBJECTIVE:Healthcare is increasingly being delivered in the outpatient setting, but robust quality improvement programs and performance metrics are lacking in ambulatory care, particularly specialty-based ambulatory care. METHODS:To promote quality improvement in ambulatory care, we developed an infrastructure to create specialty-specific quality measures and dashboards that could be used to display providers' performance across relevant measures to individual providers and institutional leaders. RESULTS:The products of this program include a governance and infrastructure for specialty-specific ambulatory quality metrics as well as two distinct dashboards for data display. One dashboard is provider-facing, displaying provider's performance on specialty-specific measures as compared to institutional standards. The second dashboard is a leadership dashboard that provides overall and provider-level information on performance across measures. CONCLUSIONS:The Specialty-based Ambulatory Quality program reflects a systematic, institutionally-supported quality improvement framework that can be applied across diverse ambulatory specialties. As next steps, we plan to evaluate the program's impact on provider performance across measures and expand this program to other specialties practicing in the outpatient setting.
PMID: 39466606
ISSN: 1550-5154
CID: 5746782

Time from insertion to expulsion of cervical ripening balloon in preterm versus term inductions of labor

Roth, Lindsey A; Kreiger-Benson, Elana; Friedman, Steven; Gossett, Dana R; Shanahan, Lisa
OBJECTIVE:Preterm induction of labor can be necessary for maternal and fetal wellbeing. Duration of cervical ripening balloon (CRB) use has been studied in only term inductions. Our study investigated duration of time in hours for CRB expulsion and vaginal delivery in preterm inductions of labor. METHODS:This was a single-institution retrospective cohort study of preterm (< 37 weeks) and term (≥ 37 weeks) inductions with CRB between 2010 and 2021. Cesarean deliveries were excluded. Primary outcome was insertion to expulsion time of CRB. Secondary outcomes included induction to delivery time, cervical dilation after expulsion, misoprostol, and Pitocin use. Institutional review board (IRB) approval was obtained prior to the study. RESULTS:Ninety-eight patients with vaginal delivery after preterm CRB use were identified and matched 1:1 on baseline characteristics (p > 0.05) to term patients with vaginal delivery after CRB use. Mean insertion to expulsion time was significantly shorter for term than preterm inductions (mean 7.2 ± 3.09 h versus 8.5 ± 3.38 h; p < 0.01). Mean induction to delivery time was significantly shorter for term than preterm inductions (18.4 ± 7.6 h versus 22.5 ± 9.01 h; p < 0.01). Increased use of misoprostol, Pitocin, and second CRB were noted among the preterm cohort. Among term patients, more CRB placement at start of induction and greater cervical dilation post-balloon were found in comparison to preterm patients. CONCLUSION/CONCLUSIONS:Among patients undergoing preterm induction, longer insertion to expulsion time of CRB, longer induction to delivery time, and increased interventions should be expected. Different standards for labor management should be considered for achieving vaginal delivery in preterm inductions.
PMID: 36806766
ISSN: 1432-0711
CID: 5427442

Patient Experience with Telehealth Medicine During the Ongoing COVID-19 Pandemic in New York City

Aquino, Jennifer; Cyr, Micaela E; Hoskins, Iffath A; Conroy, Erin M; Gossett, Dana R
PMID: 36607815
ISSN: 1556-3669
CID: 5433522

Repetitive catamenial myocardial infarction due to coronary artery spasm: a case report [Case Report]

Talmor, Nina; Gurin, Michael; Smilowitz, Nathaniel; Gossett, Dana; Eisner, Bruria; Pleasure, Mitchell; Reynolds, Harmony R
BACKGROUND/UNASSIGNED:Coronary artery spasm is an established mechanism of myocardial infarction with non-obstructive coronary arteries (MINOCA). Various mechanisms have been proposed, ranging from vascular smooth muscle hyperreactivity to endothelial dysfunction, to autonomic nervous system dysregulation. CASE SUMMARY/UNASSIGNED:We report a case of a 37-year-old woman who presented with recurrent non-ST elevation myocardial infarction (NSTEMI), coinciding with her menstrual periods. Intracoronary acetylcholine provocation testing resulted in coronary spasm in the left anterior descending artery (LAD) that was relieved with nitroglycerine. Initiating calcium channel blockade and suppressing cyclical variation in sex hormones resulted in improvement of her symptoms and cessation of monthly NSTEMI events due to coronary spasm. DISCUSSION/UNASSIGNED:Initiating calcium channel blockade and suppressing cyclical variation in sex hormones resulted in improvement of her symptoms and cessation of monthly NSTEMI events due to coronary spasm. Catamenial coronary artery spasm is a rare, but clinically important, presentation of myocardial infarction with non-obstructive coronary arteries (MINOCA).
PMCID:9924495
PMID: 36793935
ISSN: 2514-2119
CID: 5439902

Time From Insertion to Expulsion of Cervical Ripening Balloon in Preterm Versus Term Inductions of Labor [Meeting Abstract]

Roth, L A; Kreiger-Benson, E; Friedman, S; Gossett, D R; Shanahan, L
INTRODUCTION: Preterm induction of labor can be necessary for maternal and fetal wellbeing. Duration of cervical ripening balloon (CRB) use has been studied only in term inductions. Our study investigated duration of time for CRB expulsion and vaginal delivery in preterm inductions of labor.
METHOD(S): This was a single-institution retrospective cohort study of preterm (<37 weeks) and term (>=37 weeks) inductions with CRB between 2010 and 2021. Cesarean deliveries were excluded. Primary outcome was insertion to expulsion time (IET) of CRB. Secondary outcomes included induction to delivery time (IDT), cervical dilation after expulsion, and misoprostol and Pitocin use. Institutional review board approval was obtained prior to the study.
RESULT(S): A total of 98 patients with vaginal delivery after preterm CRB use were identified and matched 1:1 on baseline characteristics to patients with vaginal delivery after term CRB use. Mean IET was significantly shorter for term CRB than for preterm induction (mean 7.2+/-3.09 hours versus 8.5+/-3.38 hours; P=.004). Mean IDT was significantly shorter for term CRB than preterm CRB induction (18.4+/-7.6 hours versus 22.5+/-9.01 hours; P<.001). Increased use of misoprostol, Pitocin, and second CRB were noted among the preterm cohort compared to the term cohort. Among term patients, more CRB placement at start of induction and greater cervical dilation postballoon were found in comparison to preterm patients.
CONCLUSION(S): Among patients undergoing preterm induction, longer IET, longer IDT, and increased interventions should be expected. Different standards for labor management should be considered for achieving vaginal delivery in preterm inductions
EMBASE:638410712
ISSN: 1873-233x
CID: 5291322

Use of Powder in the Genital Area and Ovarian Cancer Risk: Examining the Evidence [Comment]

Gossett, Dana R; Del Carmen, Marcela G
PMID: 31910265
ISSN: 1538-3598
CID: 4419092

Screening and Treatment After Implementation of a Universal Perinatal Depression Screening Program

Miller, Emily S; Wisner, Katherine L; Gollan, Jacqueline; Hamade, Sara; Gossett, Dana R; Grobman, William A
OBJECTIVE:To evaluate whether initiation of an institutional policy of universal perinatal depression screening was associated with sustained increases in frequency in screening and of depression treatment subsequent to a positive screen. METHODS:This retrospective cohort study included women receiving prenatal care in outpatient offices at a single academic medical center from 2008 to 2015. In 2009, an institutional policy of universal perinatal depression screening was disseminated in which screening twice antenatally and again postpartum were recommended. The frequency of screen completion at each recommended time point was compared between the prepolicy and postpolicy cohorts. A test of trend that assessed the frequency of screening each year after policy initiation was used to assess changes over time. The frequency with which care plans were created for women who screened positive for perinatal depression were compared before and after implementation. RESULTS:Of the 5,127 women who met inclusion criteria, 4,005 (78%) were in the postpolicy cohort. The frequency of completion of depression screening at the first prenatal visit (0.1% vs 65.5%), in the third trimester (0.0% vs 42.7%), and at the postpartum visit (69.5% vs 90.0%) increased after initiation of the policy (P<.001 for all). The improvement in postpartum depression screening completion persisted after controlling for potential confounders (adjusted odds ratio 5.3, 95% CI 4.4-6.5). After the initial increase in uptake of screening, the frequency of screening at the first and third trimester prenatal visits continued to increase over time (P<.001 for each), although this frequency remained stable for the postpartum visit (P=.29). Women with a positive postpartum depression screen were more likely to have depression treatment recommended or provided by their obstetrician postpolicy (64.7% vs 30.1%, P<.001). CONCLUSION:Implementation of an institutional policy of universal perinatal depression screening was associated with improvements in perinatal depression screening with concomitant improvements in depression treatment recommendations for women with a positive postpartum depression screen.
PMID: 31306329
ISSN: 1873-233x
CID: 4419082

Gender Differences in Academic Rank and NIH Funding among Academic Maternal-Fetal Medicine Physicians in the United States

Sperling, Jeffrey D; Shulman, Rachel; Blat, Cinthia; Miller, Edward E; Kokroko, Jolene; Zlatnik, Marya G; Gonzalez-Velez, Juan; Norton, Mary E; Gossett, Dana R
OBJECTIVE:This article evaluates gender differences in academic rank and National Institutes of Health (NIH) funding among academic maternal-fetal medicine (MFM) physicians. STUDY DESIGN:This was a cross-sectional study of board-certified academic MFM physicians. Physicians were identified in July 2017 from the MFM fellowship Web sites. Academic rank and receipt of any NIH funding were compared by gender. Data on potential confounders were collected, including years since board certification, region of practice, additional degrees, number of publications, and h-index. RESULTS: = 0.36). CONCLUSION:Compared with female academic MFM physicians, male academic MFM physicians were twice as likely to hold a higher academic rank but were no more likely to receive NIH funding.
PMID: 30414602
ISSN: 1098-8785
CID: 4419062

Ugandan Health Care Professionals' Response to Sexual Violence Survivors: Exploring Local Strategy and International Guidelines

Fay, Kathryn E; Beyeza-Kashesya, Jolly; Gossett, Dana R
This survey-based study gathered information on health professionals' attitudes and behaviors regarding victims of sexual assault, focusing on the applicability and utility of best practices put forth by the World Health Organization and the United Nations. This cross-sectional study involved a self-administered, 84-question survey to health care professionals affiliated with Mulago National Referral and Kayunga Hospitals in Uganda. The survey included demographic questions as well as questions about participants' attitudes toward sexual violence and the role of HPs in addressing sexual violence. The remainder of the survey transformed two sets of international guidelines into a series of statements with which participants could agree or disagree using a Likert-type scale. In total, 75 partially or fully completed surveys were collected, 45 from Mulago, and 30 from Kayunga. A minority of participants indicated that the guidelines were unrealistic (4.1%) or culturally inappropriate (14.1%). Most HPs agreed (91.8%) with the key components of recommended care. However, many respondents highlighted the need for additional training (68%). Nearly half of participants were uncertain or disagreed that there was a clear protocol for care of survivors of sexual violence (48%). Targets for improvement identified by participants included enhanced support of staff, access to resources, and relationships with community partners. Ugandan HPs have been receptive to the World Health Organization and United Nations guidelines. The majority of participants felt that the guidelines were realistic and culturally appropriate. Furthermore, many of these guidelines have been implemented. However, additional steps identified by Ugandan health workers could be undertaken to further improve the care received by survivors of sexual violence.
PMID: 30569805
ISSN: 1552-6518
CID: 4419072

Labor Curves in Multiparous Women Related to Interbirth Intervals

Mason, Brittney E; Matulich, Melissa C; Swanson, Kate; Irwin, Erin A; Rademaker, Alfred W; Peaceman, Alan M; Gossett, Dana R
OBJECTIVE:Previous studies have shown that risk of cesarean section increases among multiparous women as interbirth interval increases. One possibility is that progress of labor may vary with interbirth interval, such that with longer intervals, labor curves of multiparas more closely resemble those of nulliparas. We sought to define labor curves among a cohort of multiparas with varying interbirth intervals. STUDY DESIGN:-tests for individual effects. Length of second stage was compared using a Wilcoxon's rank-sum test. RESULTS: = 0.003). CONCLUSION:Prolonged interbirth interval is not associated with slower active phase of labor.
PMID: 29920639
ISSN: 1098-8785
CID: 4419042