Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-10 (of 10 Records) |
Query Trace: Brantley MD[original query] |
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Levels of neonatal care among birth facilities in 20 states and other jurisdictions: CDC levels of care assessment tool(SM) (CDC LOCATe(SM))
Wilkers JL , DeSisto CL , Ewing AC , Madni SA , Beauregard JL , Brantley MD , Goodman DA . J Perinatol 2022 43 (4) 484-489 OBJECTIVE: Describe discrepancies between facilities' self-reported level of neonatal care and Centers for Disease Control and Prevention Levels of Care Assessment Tool(SM) (CDC LOCATe(SM))-assessed level. STUDY DESIGN: CDC LOCATe(SM) data from 765 health facilities in the United States, including 17 states, one territory, one large multi-state hospital system, and one perinatal region within a state, was collected between 2016 and 2021 for this cross-sectional analysis. RESULT: Among 721 facilities that self-reported level of neonatal care, 33.1% had discrepancies between their self-reported level and their LOCATe(SM)-assessed level. Among facilities with discrepancies, 75.3% self-reported a higher level of neonatal care than their LOCATe(SM)-assessed level. The most common elements contributing to discrepancies were limited specialty and subspecialty staffing, such as neonatology or neonatal surgery. CONCLUSION: Results highlight opportunities for jurisdictions to engage with facilities, health systems, and partners about levels of neonatal care, and to collaborate to promote standardized systems of risk-appropriate care. |
Examining the ratio of obstetric beds to births, 2000-2019
DeSisto CL , Goodman DA , Brantley MD , Menard MK , Declercq E . J Community Health 2022 47 (5) 828-834 The number of U.S. births has been declining. There is also concern about rural obstetric units closing. To better understand the relationship between births and obstetric beds during 2000-2019, we examined changes over time in births, birth hospital distributions (i.e., hospital birth volume, ownership, and urban-rural designation), and the ratio of births to obstetric beds. We analyzed American Hospital Association Annual Survey data from 2000 to 2019. We included U.S. hospitals with at least 25 reported births during the year and at least 1 reported obstetric bed. We categorized birth volume to identify and describe hospitals with maternity services using seven categories. We calculated ratios of number of births to number of obstetric beds overall, by annual birth volume category, by three categories of hospital ownership, and by six urban-rural categories. The ratio of births to obstetric beds, which may represent need for maternity services, has stayed relatively consistent at 65 over the past two decades, despite the decline in births and changes in birth hospital distributions. The ratios were smallest in hospitals with < 250 annual births and largest in hospitals with ≥ 7000 annual births. The largest ratios of births to obstetric beds were in large metro areas and the smallest ratios were in noncore areas. At a societal level, the reduction in obstetric beds corresponds with the drop in the U.S. birth rate. However, consistency in the overall ratio can mask important differences that we could not discern, such as the impact of closures on distances to closest maternity care. |
County-level associations between pregnancy-related mortality ratios and contextual sociospatial indicators
Barrera CM , Kramer MR , Merkt PT , Petersen EE , Brantley MD , Eckhaus L , Beauregard JL , Goodman DA . Obstet Gynecol 2022 139 (5) 855-865 OBJECTIVE: To characterize county-level differences in pregnancy-related mortality as a function of sociospatial indicators. METHODS: We conducted a cross-sectional multilevel analysis of all pregnancy-related deaths and all live births with available ZIP code or county data in the Pregnancy Mortality Surveillance System during 2011-2016 for non-Hispanic Black, Hispanic (all races), and non-Hispanic White women aged 15-44 years. The exposures included 31 conceptually-grounded, county-specific sociospatial indicators that were collected from publicly available data sources and categorized into domains of demographic; general, reproductive, and behavioral health; social capital and support; and socioeconomic contexts. We calculated the absolute difference of county-level pregnancy-related mortality ratios (deaths per 100,000 live births) per 1-unit increase in the median absolute difference between women living in counties with higher compared with lower levels of each sociospatial indicator overall and stratified by race and ethnicity. RESULTS: Pregnancy-related mortality varied across counties and by race and ethnicity. Many sociospatial indicators were associated with county-specific pregnancy-related mortality ratios independent of maternal age, population size, and Census region. Across domains, the most harmful indicators were percentage of low-birth-weight births (absolute ratio difference [RD] 6.44; 95% CI 5.36-7.51), percentage of unemployed adults (RD 4.98; 95% CI 3.91-6.05), and food insecurity (RD 4.92; 95% CI 4.14-5.70). The most protective indicators were higher median household income (RD -2.76; 95% CI -3.28 to -2.24), percentage of college-educated adults (RD -2.28; 95% CI -2.81 to -1.75), and percentage of owner-occupied households (RD -1.66; 95% CI -2.29 to -1.03). The magnitude of these associations varied by race and ethnicity. CONCLUSION: This analysis identified sociospatial indicators of pregnancy-related mortality and showed an association between pregnancy-related deaths and place of residence overall and stratified by race and ethnicity. Understanding county-level context associated with pregnancy-related mortality may be an important step towards building public health evidence to inform action to reduce pregnancy-related mortality at local levels. |
CDC LOCATe: discrepancies between self-reported level of maternal care and LOCATe-assessed level of maternal care among 463 birth facilities
Madni SA , Ewing AC , Beauregard JL , Brantley MD , Menard MK , Goodman DA . J Perinatol 2021 42 (5) 589-594 OBJECTIVE: Describe sources of discrepancy between self-assessed LoMC (level of maternal care) and CDC LOCATe(®)-assessed (Levels of Care Assessment Tool) LoMC. STUDY DESIGN: CDC LOCATe(®) was implemented at 480 facilities in 13 jurisdictions, including states, territories, perinatal regions, and hospital systems, in the U.S. Cross-sectional analyses were conducted to compare facilities' self-reported LoMC and LOCATe(®)-assessed LoMC. RESULT: Among 418 facilities that self-reported an LoMC, 41.4% self-reported a higher LoMC than their LOCATe(®)-assessed LoMC. Among facilities with discrepancies, the most common elements lacking to meet self-reported LoMC included availability of maternal-fetal medicine (27.7%), obstetric-specializing anesthesiologist (16.2%), and obstetric ultrasound services (12.1%). CONCLUSION: Two in five facilities self-report a LoMC higher than their LOCATe(®)-assessed LoMC, indicating discrepancies between perceived maternal care capabilities and those recommended in current LoMC guidelines. Results highlight an opportunity for states to engage with facilities, health systems, and other stakeholders about LoMC and collaborate to strengthen systems for improving maternal care delivery. |
Urban-Rural Differences in Pregnancy-Related Deaths, United States, 2011-2016
Merkt PT , Kramer MR , Goodman DA , Brantley MD , Barrera CM , Eckhaus L , Petersen EE . Am J Obstet Gynecol 2021 225 (2) 183 e1-183 e16 BACKGROUND: The U.S. pregnancy-related mortality ratio has not improved over the past decade and includes striking disparities by race/ethnicity and by state. Understanding differences in pregnancy-related mortality across and within urban and rural areas can guide the development of interventions for preventing future pregnancy-related deaths. OBJECTIVE: We sought to compare pregnancy-related mortality across and within urban and rural counties by race/ethnicity and age. STUDY DESIGN: We conducted a descriptive analysis of 3,747 pregnancy-related deaths during 2011-2016 (the most recent available) with available ZIP code or county data in the Pregnancy Mortality Surveillance System, among Hispanic and non-Hispanic White, Black, American Indian/Alaska Native, and Asian/Pacific Islander women ages 15-44 years. We aggregated data by U.S. county and grouped counties per the National Center for Health Statistics Urban-Rural Classification Scheme for Counties. We used R statistical software, epitools, to calculate the pregnancy-related mortality ratio (number of pregnancy-related deaths per 100,000 live births) for each urban-rural grouping, obtain 95% confidence intervals, and perform exact tests of ratio comparisons using the Poisson distribution. RESULTS: Of the total 3,747 pregnancy-related deaths analyzed, 52% occurred in large metro counties and 7% occurred in noncore (rural) counties. Large metro counties had the lowest pregnancy-related mortality ratio (14.8, 95% CI: 14.2-15.5) while noncore counties had the highest (24.1, 95% CI: 21.4-27.1), including for most race/ethnicity and age groups. Pregnancy-related mortality ratio age disparities increased with rurality. Women ages 25-34 years and ages 35-44 years living in noncore counties had pregnancy-related mortality ratios 1.5 and 3 times higher, respectively, than women of the same age groups in large metro counties. Within each urban-rural category, pregnancy-related mortality ratios were higher among non-Hispanic Black women compared to non-Hispanic White women. Non-Hispanic American Indian/Alaska Native pregnancy-related mortality ratios in small metro, micropolitan, and noncore counties were 2-3 times that of non-Hispanic White women in the same areas. CONCLUSION: Although more than half of pregnancy-related deaths occurred in large metro counties, the pregnancy-related mortality ratio rose with increasing rurality. Disparities existed among urban-rural categories, including by age group and by race/ethnicity. Geographic location is an important context for initiatives to prevent future deaths and eliminate disparities. Further research is needed to better understand reasons for the observed urban-rural differences and to guide a multifactorial response to reduce pregnancy-related deaths. |
Geographic access to obstetric critical care for women of reproductive age by race and ethnicity
Kroelinger CD , Brantley MD , Fuller TR , Okoroh EM , Monsour MJ , Cox S , Barfield WD . Am J Obstet Gynecol 2020 224 (3) 304 e1-304 e11 BACKGROUND: The goal of risk-appropriate maternal care is for high-risk pregnant women to receive specialized obstetric services in facilities equipped with capabilities and staffing to provide care or transfer to facilities with resources available to provide care. In the United States (US), geographic access to obstetric critical care (OCC) varies. It is unknown if this variation in proximity to OCC differs by race, ethnicity, and region. OBJECTIVES: We examined the geographic access, defined as residence within 50 miles of a facility capable of providing risk-appropriate OCC services for women of reproductive age, by distribution of race and ethnicity. STUDY DESIGN: Descriptive spatial analysis was used to assess geographic distance to OCC for women of reproductive age by race and ethnicity. Data were analyzed geographically: nationally, by Department of Health and Human Services (HHS) regions, and by all 50 states and the District of Columbia. Dot density analysis was used to visualize geographic distributions of women by residence and OCC facilities across the US. Proximity analysis defined the proportion of women living within an approximate 50-mile radius of facilities. Source data included 2015 American Community Survey from the US Census Bureau and the 2015 American Hospital Association Annual Survey. RESULTS: Geographic access to OCC was greatest for Asian/Pacific Islander women of reproductive age (95.8%), followed by black (93.5%), Hispanic (91.4%), and white women of reproductive age (89.1%). American Indian/Alaska Native (AI/AN) women had more limited geographic access at 66% in all regions. Visualization of proximity to OCC indicated facilities were predominantly located in urban areas, which may limit access to women in frontier or rural areas of states including nationally recognized reservations where larger proportions of white and AI/AN women reside, respectively. CONCLUSIONS: Disparities in proximity to OCC exist in rural and frontier areas of the US, which impact white and AI/AN women, primarily. Examining insurance coverage, inter-state hospital referral networks, and transportation barriers may provide further insight into OCC accessibility. Further exploring the role of other equity-based measures of access on disparities beyond geography is warranted. |
Perinatal regionalization: A geospatial view of perinatal critical care, United States, 2010-2013
Brantley MD , Davis NL , Goodman DA , Callaghan WM , Barfield WD . Am J Obstet Gynecol 2016 216 (2) 185 e1-185 e10 BACKGROUND: Perinatal services exist today as a dyad of maternal and neonatal care. When perinatal care is fragmented or unavailable, excess morbidity and mortality may occur in pregnant women and newborns. OBJECTIVE: Describe spatial relationships between women of reproductive age, individual perinatal subspecialists (Maternal Fetal Medicine and Neonatology), and obstetric and neonatal critical care facilities in the United States to identify gaps in health care access. STUDY DESIGN: We used geographic visualization and conducted surface interpolation, nearest neighbor, and proximity analyses. Source data included 2010 United States Census, October 2013 National Provider Index, 2012 American Hospital Association, 2012 National Center for Health Statistics Natality File, and the 2011 American Academy of Pediatrics Directory. RESULTS: In October 2013, there were 2.5 neonatologists for every Maternal Fetal Medicine specialist in the United States. In 2012 there were 1.4 Level III or higher neonatal intensive care units (NICU) for every Level III obstetric unit (hereafter, obstetric critical care unit). Nationally, 87% of women of reproductive age live within 50 miles of both an obstetric critical care unit and NICU. However, 18% of obstetric critical care units had no NICU and 20% of NICUs had no obstetric critical care unit within a 10 mile radius. Additionally, 26% of obstetric critical care units had no Maternal Fetal Medicine specialist practicing within 10 miles of the facility and 4% of NICUs had no neonatologist practicing within 10 miles. CONCLUSION: Gaps in access and discordance between the availability of Level III or higher obstetric and neonatal care may affect delivery of risk appropriate care for high risk maternal fetal dyads. Further study is needed to understand the importance of these gaps and discordance on maternal and neonatal outcomes. |
Evaluation of the 2012 18th Maternal and Child Health (MCH) Epidemiology and 22nd CityMatCH MCH Urban Leadership Conference: six month impact on science, program, and policy
Arellano DE , Goodman DA , Howlette T , Kroelinger CD , Law M , Phillips D , Jones J , Brantley MD , Fitzgerald M . Matern Child Health J 2014 18 (7) 1565-71 The 18th Maternal and Child Health (MCH) Epidemiology and 22nd CityMatCH MCH Urban Leadership Conference took place in December 2012, covering MCH science, program, and policy issues. Assessing the impact of the Conference on attendees' work 6 months post-Conference provides information critical to understanding the impact and the use of new partnerships, knowledge, and skills gained during the Conference. Evaluation assessments, which included collection of quantitative and qualitative data, were administered at two time points: at Conference registration and 6 months post-Conference. The evaluation files were merged using computer IP address, linking responses from each assessment. Percentages of attendees reporting Conference impacts were calculated from quantitative data, and common themes and supporting examples were identified from qualitative data. Online registration was completed by 650 individuals. Of registrants, 30 % responded to the 6 month post-Conference assessment. Between registration and 6 month post-Conference evaluation, the distribution of respondents did not significantly differ by organizational affiliation. In the 6 months following the Conference, 65 % of respondents reported pursuing a networking interaction; 96 % shared knowledge from the Conference with co-workers and others in their agency; and 74 % utilized knowledge from the Conference to translate data into public health action. The Conference produced far-reaching impacts among Conference attendees. The Conference served as a platform for networking, knowledge sharing, and attaining skills that advance the work of attendees, with the potential of impacting organizational and workforce capacity. Increasing capacity could improve MCH programs, policies, and services, ultimately impacting the health of women, infants, and children. |
Mapping US pediatric hospitals and subspecialty critical care for public health preparedness and disaster response, 2008
Brantley MD , Lu H , Barfield WD , Holt JB , Williams A . Disaster Med Public Health Prep 2012 6 (2) 117-25 OBJECTIVE: The objective is to describe by geographic proximity the extent to which the US pediatric population (aged 0-17 years) has access to pediatric and other specialized critical care facilities, and to highlight regional differences in population and critical resource distribution for preparedness planning and utilization during a mass public health disaster. METHODS: The analysis focused on pediatric hospitals and pediatric and general medical/surgical hospitals with specialized pediatric critical care capabilities, including pediatric intensive care units (PICU), pediatric cardiac ICUs (PCICU), level I and II trauma and pediatric trauma centers, and general and pediatric burn centers. The proximity analysis uses a geographic information system overlay function: spatial buffers or zones of a defined radius are superimposed on a dasymetric map of the pediatric population. By comparing the population living within the zones to the total population, the proportion of children with access to each type of specialized unit can be estimated. The project was conducted in three steps: preparation of the geospatial layer of the pediatric population using dasymetric mapping methods; preparation of the geospatial layer for each resource zone including the identification, verification, and location of hospital facilities with the target resources; and proximity analysis of the pediatric population within these zones. RESULTS: Nationally, 63.7% of the pediatric population lives within 50 miles of a pediatric hospital; 81.5% lives within 50 miles of a hospital with a PICU; 76.1% lives within 50 miles of a hospital with a PCICU; 80.2% lives within 50 miles of a level I or II trauma center; and 70.8% lives within 50 miles of a burn center. However, state-specific proportions vary from less than 10% to virtually 100%. Restricting the burn and trauma centers to pediatric units only decreases the national proportion to 26.3% for pediatric burn centers and 53.1% for pediatric trauma centers. CONCLUSIONS: This geospatial analysis describes the current state of pediatric critical care hospital resources and provides a visual and analytic overview of existing gaps in local pediatric hospital coverage. It also highlights the use of dasymetric mapping as a tool for public health preparedness planning. |
Neonatal and pediatric regionalized systems in pediatric emergency mass critical care
Barfield WD , Krug SE , Kanter RK , Gausche-Hill M , Brantley MD , Chung S , Kissoon N . Pediatr Crit Care Med 2011 12 S128-S134 INTRODUCTION: Improved health outcomes are associated with neonatal and pediatric critical care in well-organized, cohesive, regionalized systems that are prepared to support and rehabilitate critically ill victims of a mass casualty event. However, present systems lack adequate surge capacity for neonatal and pediatric mass critical care. In this document, we outline the present reality and suggest alternative approaches. METHODS: In May 2008, the Task Force for Mass Critical Care published guidance on provision of mass critical care to adults. Acknowledging that the critical care needs of children during disasters were unaddressed by this effort, a 17-member Steering Committee, assembled by the Oak Ridge Institute for Science and Education with guidance from members of the American Academy of Pediatrics, convened in April 2009 to determine priority topic areas for pediatric emergency mass critical care recommendations. Steering Committee members established subcommittees by topic area and performed literature reviews of MEDLINE and Ovid databases. The Steering Committee produced draft outlines through consensus-based study of the literature and convened October 6-7, 2009, in New York, NY, to review and revise each outline. Eight draft documents were subsequently developed from the revised outlines as well as through searches of MEDLINE updated through March 2010. The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29-30, 2010. Feedback on each manuscript was compiled and the Steering Committee revised each document to reflect expert input in addition to the most current medical literature. TASK FORCE RECOMMENDATIONS: States and regions (facilitated by federal partners) should review current emergency operations and devise appropriate plans to address the population-based needs of infants and children in large-scale disasters. Action at the state, regional, and federal levels should address legal, operational, and information systems to provide effective pediatric mass critical care through: 1) predisaster/mass casualty planning, management, and assessment with input from child health professionals; 2) close cooperation, agreements, public-private partnerships, and unique delivery systems; and 3) use of existing public health data to assess pediatric populations at risk and to model graded response plans based on increasing patient volume and acuity. (Copyright 2011 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies). |
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