Author Interviews, OBGYNE, Race/Ethnic Diversity / 16.01.2020
Within-Hospital Racial Disparities in Maternal Complications Persist
MedicalResearch.com Interview with:
[caption id="attachment_52827" align="alignleft" width="130"] Dr. Howell[/caption]
Elizabeth A. Howell, MD, MPP
Director of The Blavatnik Family Women’s Health Research Institute
Mount Sinai Health System Vice Chair for Research
Professor in the Department of Obstetrics, Gynecology, and Reproductive Science
Associate Dean for Academic Development
Professor Department of Population Health Science and Policy
Icahn Mount Sinai, New York
MedicalResearch.com: What is the background for this study?
Response: Previous research has demonstrated racial and ethnic disparities in severe maternal morbidity rates in hospitals and that between-hospital differences -- i.e., Black and Latina mothers receiving care at hospitals with worse outcomes -- explain a sizable portion of these disparities. However, less attention has been paid to within-hospital disparities -- whether Black and Latina mothers have worse outcomes than White mothers who deliver in the SAME hospital.
In this paper, we set out to measure within-hospital racial and ethnic disparities and to evaluate the potential contribution of insurance type to these disparities.
Our study question was based on the observation that women with Medicaid can follow different care pathways than women with private insurance. Pregnant women insured by Medicaid are often seen by resident physicians with attending coverage that may differ from attending physicians caring for commercially insured women. In addition, Medicaid reimbursement for delivery hospitalization is far less than that for commercially insured.
Dr. Howell[/caption]
Elizabeth A. Howell, MD, MPP
Director of The Blavatnik Family Women’s Health Research Institute
Mount Sinai Health System Vice Chair for Research
Professor in the Department of Obstetrics, Gynecology, and Reproductive Science
Associate Dean for Academic Development
Professor Department of Population Health Science and Policy
Icahn Mount Sinai, New York
MedicalResearch.com: What is the background for this study?
Response: Previous research has demonstrated racial and ethnic disparities in severe maternal morbidity rates in hospitals and that between-hospital differences -- i.e., Black and Latina mothers receiving care at hospitals with worse outcomes -- explain a sizable portion of these disparities. However, less attention has been paid to within-hospital disparities -- whether Black and Latina mothers have worse outcomes than White mothers who deliver in the SAME hospital.
In this paper, we set out to measure within-hospital racial and ethnic disparities and to evaluate the potential contribution of insurance type to these disparities.
Our study question was based on the observation that women with Medicaid can follow different care pathways than women with private insurance. Pregnant women insured by Medicaid are often seen by resident physicians with attending coverage that may differ from attending physicians caring for commercially insured women. In addition, Medicaid reimbursement for delivery hospitalization is far less than that for commercially insured. 
Dr. Diaz[/caption]
Lucia Diaz, M.D., is chief of pediatric dermatology, dermatology residency associate program director and assistant professor of medicine and pediatrics at Dell Medical School. She is also co-director of the dermatology-rheumatology combined clinic at Dell Children’s Medical Center.
[caption id="attachment_52796" align="alignleft" width="150"]
Dr. Jaquez[/caption]
Sasha Jaquez, Ph.D. is a pediatric psychologist at Dell Children's Medical School/Dell Children's Medical Center and specializes in seeing children with chronic medical illness, including skin disorders.
[caption id="attachment_52791" align="alignleft" width="294"]
Dr. Breyer[/caption]
Benjamin N. Breyer MD, MAS, FACS
Associate Professor
Departments of Urology and Epidemiology and Biostatistics
University of California, San Francisco
Vice-Chair of Urology
Chief of Urology, Zuckerberg San Francisco General Hospital and Trauma Center
Director, UCSF Male Genitourinary Reconstruction and Trauma Surgery Fellowship
MedicalResearch.com: What is the background for this study?
Response: There has been a large increase in upright scooter usage among adults as a mode of transportation. It's convenient for commuters and may encourage greater use of public transit leading to less car traffic in cities.
Dr. Marra[/caption]
Alexandre R. Marra, MD PhD
Iowa Infection Prevention Research Group
University of Iowa Carver College of Medicine
Division of Medical Practice, Hospital Israelita Albert Einstein
São Paulo, Brazil
MedicalResearch.com: What is the background for this study?
Response: This is a comprehensive systematic literature review evaluating the burden of C. difficile infections in the U.S healthcare system. The literature has diverse studies with variable outcomes. Thus, we only included incidence estimates derived from multicenter studies. In our meta-analysis to calculate incidence, data were pooled only with denominators using the same unit (patient-days) to avoid comparisons with different denominators. For length of stay (LOS), we only included studies that used advanced statistical methods (e.g., propensity score matching).
