2022: A year in review

The article offers a look at the advances in obstetrics and gynecology in 2022 along with some impactful articles that were important to women's health care providers. It includes an article on addressing physician burnout published in the January 2021 issue, another on a study on the treatment for mild chronic hypertension in pregnancy, and another study which evaluated whether the addition of lenvatinib and pembrolizumab improved outcome in women with recurrent advanced endometrial cancer.

Risk management in gynaecology

Healthcare providers are obliged to reduce the risk of harm to patients using their services. Robust risk management embraces a blame-free reporting culture and learning from clinical errors whilst adopting a proactive approach to the measurement of patient safety indicators. A good safety culture within an organisation provides assurance to service users, staff, and the public, that there is commitment to provision of high quality safe and effective care. Risk management is everybody's responsibility. Therefore, all clinicians must possess an understanding of risk management processes. This review outlines the key elements of risk management within gynaecology and explains how risks are identified, assessed, quantified and managed. Examples from within the gynaecological setting and the challenges and the emergent risks posed by the COVID19 pandemic, are also discussed. © 2022

2022: A year in review

The article offers a look at the advances in obstetrics and gynecology in 2022 along with some impactful articles that were important to women's health care providers. It includes an article on addressing physician burnout published in the January 2021 issue, another on a study on the treatment for mild chronic hypertension in pregnancy, and another study which evaluated whether the addition of lenvatinib and pembrolizumab improved outcome in women with recurrent advanced endometrial cancer.

Pilot Implementation of a Health Equity Checklist to Improve the Identification of Equity-Related Adverse Events

In assessing the occurrence of an unexpected medical adverse event following pharmaceutical,medical, or surgical treatment, the causal or contributory roles played by bias, systemic racism, and social determinants of health should be investigated. Up to 80% of clinical outcomes are estimated to be driven by social determinants including the environments in which patients live, work, learn, worship, and play. Among women, there are racial health disparities in sterilization procedures, method of hysterectomy, cesarean birth rates, preterm birth rates, and, most recently, the rates of COVID-19 death and hospitalizations. At the same time, there is little specific guidance of how to investigate social determinants of health that affect patient outcomes. Differences in health equity-related factors affect the quality of gynecologic care. There is immeasurable potential for bias in patient characteristics: race;ethnicity;persons with obesity;LGBTQ+ (lesbian, gay, bisexual, transgender, queer+) persons;socioeconomic factors;and young and old age. Within existing models for patient safety, inclusion of equity-related aspects of care may improve the current understanding of the causes of medical adverse events. It is critical to consider social determinants of health, structural racism, and both overt and implicit bias. The aim of this studywas to establish a sustainable and trackable process to determine the role of social determinants of health, bias, and racism in adverse gynecologic events. Each adverse event case is assessed for preventability, harm, and standards of care. Cases are identified for review utilizing existing hospital event-reporting systems (RLDatix) and enhanced by resident and attending physician self-reporting. The following equity-focused process was used: (1) creating a standardized health equity checklist;(2) applying the checklist to each gynecologic adverse event beginning on September 1, 2020;(3) collecting event review data in a secure central digital repository;(4) reviewing each adverse case to understand apparent causes of the event;(5) exploring areas for improvement using standard fields;and (6) identifying specific ideas for improvement. Within 15 months (between September 1, 2020, and November 30, 2021), 46 safety cases were identified using standard criteria. Twenty-four of these were deemed preventable.Of the 24 cases, 12 cases were identified inwhich social determinants of health, bias, or both had a role. Delays in diagnosis and care were attributed to social determinants of health and implicit bias. This process has mapped areas of infrastructure as well as the need for culture improvement and restorative work to address implicit bias and improve approaches to shared decision-making. These findings show that with use of a health equity checklist, it is feasible to create a systematic and trackable process to begin delineating the role of social determinants of health, bias, and racism in adverse gynecologic events. Copyright © 2023 Lippincott Williams and Wilkins. All rights reserved.

Impact of the COVID-19 Pandemic on Women's Health Care Access: A Cross-Sectional Study.

Background: There has been limited study of how the COVID-19 pandemic has affected women's health care access. Our study aims to examine the prevalence and correlates of COVID-19-related disruptions to (1) primary care; (2) gynecologic care; and (3) preventive health care among women. Materials and Methods: We recruited 4,000 participants from a probability-based online panel. We conducted four multinomial logistic regression models, one for each of the study outcomes: (1) primary care access; (2) gynecologic care access; (3) patient-initiated disruptions to preventive visits; and (4) provider-initiated disruptions to preventive visits. Results: The sample included 1,285 women. One in four women (28.5%) reported that the pandemic affected their primary care access. Sexual minority women (SMW) (odds ratios [OR]: 1.67; 95% confidence intervals [CI]: 1.19-2.33) had higher odds of reporting pandemic-related effects on primary care access compared to women identifying as heterosexual. Cancer survivors (OR: 2.07; 95% CI: 1.25-3.42) had higher odds of reporting pandemic-related effects on primary care access compared to women without a cancer history. About 16% of women reported that the pandemic affected their gynecologic care access. Women with a cancer history (OR: 2.34; 95% CI: 1.35-4.08) had higher odds of reporting pandemic-related effects on gynecologic care compared to women without a cancer history. SMW were more likely to report patient- and provider-initiated delays in preventive health care. Other factors that affected health care access included income, insurance status, and having a usual source of care. Conclusions: The COVID-19 pandemic disrupted women's health care access and disproportionately affected access among SMW and women with a cancer history, suggesting that targeted interventions may be needed to ensure adequate health care access during the COVID-19 pandemic.

The Promise of Telemedicine: Are We Reaching the Underserved?

INTRODUCTION: The use of telemedicine has dramatically increased during the COVID-19 pandemic. We evaluated characteristics and experiences of underserved women utilizing telemedicine for gynecologic visits at an urban teaching hospital. METHODS: We conducted a prospective study of patients using telemedicine for gynecologic care from January 2021-September 2021. Patients completed a demographic survey and a modified Telemedicine Usability Questionnaire (TUQ) using a 1-5 Likert scale. Statistical analyses used Fisher's exact test. RESULTS: One hundred ninety two patients consented to participate, and 157 completed surveys. The majority of patients were non-White (Hispanic 32%, Black 28%, and Asian 10%), with a median age of 40 years (range 18-69 years). A total of 61% had children and some level of education (24% GED or below, 28% vocational/associate degree, and 47% college or above), and 41% were employed, with 63% reporting an income of less than $40,000, and 85% being government insured (Medicaid/Medicare). Without telemedicine visits, 47% would have traveled 1-2 hours to appointments, with 46% spending more than $35 on travel, and 27% missing at least 1 work day for an in-person visit. The most common visit indications were lab/imaging results review (37%), postoperative follow-up (21%), and abnormal uter- ine bleeding (14%). The mean score overall for the entire TUQ was 4.3/5. Participants preferred telemedicine for follow-up visits rather than for initial visits (81% vs. 33%;P<.01). CONCLUSION: Underserved women utilizing telemedicine for gynecologic care reported largely positive experiences with improved access to health care, cost, and time savings over inperson visits. However, a higher preference for utilization was found for follow-up visits, providing an opportunity to further improve quality and access.

Underserved Patients' Experiences Using Telemedicine for Gynecologic Care During COVID- 19

INTRODUCTION: The use of telemedicine has dramatically increased during the COVID-19 pandemic. We evaluated the experience of underserved women using telemedicine for gynecologic visits at an urban teaching hospital. METHODS: We conducted a prospective study of patient experiences using telemedicine for outpatient gynecologic visits from January 2021-September 2021. Demographic/clinical data were obtained. Participants completed a modified, previously validated Telemedicine Usability Questionnaire (TUQ), with responses on a 1-5 Likert scale. Statistical analyses used the Wilcoxon signed-rank test or t test. RESULTS: One hundred ninety two patients agreed to participate, of which 157 completed the surveys. A total of 87% had video visits, whereas 13% had telephone visits. The majority of patients were ethnic minorities (non-Hispanic White 16%, Hispanic 32%, Black 28%, and Asian 10%), median age 40 years (range 18-69 years), with 63% having income (44 vs.<39, P=.02). Race/ethnicity, income, education level, and prior experience with telemedicine had no effect on responses for this subscale. CONCLUSION: Underserved women utilizing telemedicine for outpatient gynecologic visits report largely positive experiences overall. Although telemedicine holds promise in increasing access to healthcare services, attention needs to be paid to ensure reliability among telehealth visits, particularly for older populations.