Delivery-related knowledge of mothers of NICU infants compared with well-baby-nursery infants.

OBJECTIVE: The objective of this study was to compare the knowledge of mothers of newborns in a neonatal intensive care unit (NICU) and well-baby nursery (WBN) regarding their understanding of term gestation, delivery mode safety, and elective late preterm delivery. METHODS: Mothers of newborns admitted to either an NICU (n=88) or a WBN (n=145) were surveyed (March 2008-September 2010). RESULTS: Of all mothers, regardless of infant location, 7% were unable to define term gestation, 33% were unaware that scheduling delivery at 35-36 weeks is not advisable, and 30% lacked the knowledge that cesareans are not safer than vaginal deliveries. Multivariate regression models show that socioeconomic and demographic factors underlie many knowledge gaps, and surprisingly, models confirmed that the site (NICU versus WBN) of the infant was not a significant factor related to maternal knowledge. CONCLUSION: This study revealed gaps in mothers' understanding of the medical implications of premature delivery even though most mothers knew the correct length of term gestation. Unexpectedly, NICU mothers who had a child with significant illness and who encountered multiple health care providers did not have improved understanding of perinatal risks. We conclude that all women need to be educated on the significance of the mode and the timing of delivery.

Strategic re-design of team-based patient-focused health care services.

PURPOSE: This paper proposes an organizational change process to prepare physicians and other health professionals for their new roles in patient-centered medical homes (PCMHs). It provides physician-centered tools, models, concepts, and the language to implement transformational patient-centered medical care. DESIGN/METHODOLOGY/APPROACH: To improve care delivery, quality, and patient engagement, a systems approach to care is required. This paper examines a systems approach to patient care where all inputs that influence patient interactions and participation are considered in the design of health care delivery and follow-up treatment plans. Applying systems thinking, organizational change models, and team-building, we have examined the continuum of this change process from ideation through the diffusion of new methods and behaviors. FINDINGS: PCMHs make compelling business sense. Studies have shown that the PCMH improves patient satisfaction, clinical outcomes and reduces underuse and overuse of medical services. Patient-centered care necessitates transitioning from an adversarial to a collaborative culture. It is a transformation process predicated on strong leadership able to align an organization toward a vision of patient-centered care, creating a collaborative culture committed to health-goal achievement. ORIGINALITY/VALUE: This paper proposes that the PCMH is a rigorous team-building transformational organizational change, a radical departure from the current hierarchical, silo-oriented, medical practice model. It requires that participants within and across health care organizations learn new skills and behaviors to achieve the anticipated quality and efficiency improvements. It is an innovative health care organization model of the future whose success is premised on teams supplanting the individual as the building block and unit of health care performance.

Preconception health of low socioeconomic status women: assessing knowledge and behaviors.

INTRODUCTION: The stalled U.S. infant mortality rate and persistent disparities in adverse pregnancy outcomes may be addressed by optimizing a woman's health throughout her childbearing years. This study examines women's knowledge and behaviors related to preconception risk factors in two community health centers serving lower income, racially diverse populations. METHODS: A survey was administered among a convenience sample of women ages 18 to 44 years (n = 340). Questions focused on health behaviors and conditions, knowledge of risk factors, and recommendations of health care providers. Outcomes include the prevalence of risk factors and correlations between the presence of a risk factor and either a respondent's knowledge or a health care provider's recommendation. Data were analyzed for total respondents and two subgroups: Black, non-Hispanic and Hispanic. RESULTS: Despite strong knowledge of risk factors in the preconception period, high-risk behaviors and conditions existed: 63% of women overweight or obese, 20% drinking alcohol, and 42% taking a multivitamin. Significant differences in risk factors were noted between Black, non-Hispanic and Hispanic respondents. Overweight/obesity (t = 3.0; p < .05) and alcohol use (χ² = 9.2; p < .05) were higher among Black, non-Hispanics, whereas Hispanic women had lower rates of multivitamin use (χ² = 11.1; p < .05). The majority of respondents recall being spoken to by a health care provider about pregnancy-related risks. Most risk factors were not influenced by provider's recommendations, including multivitamin use, drinking alcohol, and smoking. However, birth control use was correlated with a provider's recommendation (χ² = 7.6; p < .05). Correlations between the presence of risk factors and respondent's knowledge existed for immunizations (χ² = 9.6; p < .05), but not for multivitamin use, drinking alcohol, or smoking. CONCLUSION: Our study identified behaviors amenable to change. Knowledge alone or a doctor's recommendation are not enough to change those behaviors. Innovative programs and support systems are required to encourage women to adopt healthy behaviors throughout the childbearing years.