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MS WordIndian Health Staff in the ACOG Today News
Links Of Interest 
- Healthcare needs grow, money doesn’t
- Haffner Native Women’s Health Award
- Teaching ob/gyn care for American Indians
- Committee provides consultation to AI/AN hospitals
- Two Fellows honored for decades of serving Native American women
- US OB/GYNs helping to create residency program in Kabul
- William Haffner MD receives ACOG award
- ACOG cervical cancer screening recommendations
- Week calls attention to plight of uninsured
- Project focuses on VBAC
- Preparing for emergency cesarean
Week Calls Attention to Plight of Uninsured
Of the nearly 44 million uninsured Americans, almost half are women. These women are less likely to receive preventive care, early intervention, or needed medications.
An uninsured woman is less likely to receive an annual Pap test, mammogram, or clinical breast exam, meaning her cervical cancer or breast cancer may go unnoticed and untreated. She may not seek out a doctor when she has chest pains or abnormal bleeding or cramping. Thirteen percent of all pregnant women are uninsured, and an uninsured pregnant woman may not seek prenatal care early or often enough.
Doctors, patients, and other Americans will call attention to the plight of the uninsured during Cover the Uninsured Week, May 10–16. ACOG is a supporter of the event, and universal health care is a legislative priority for the College.
“The
data very clearly demonstrate that uninsured women are at a greater risk for
adverse outcomes,” said William H. J. Haffner, MD, chair of ACOG’s
Committee on Health Care for Underserved Women, which has been examining the
uninsured issue for some time. “Uninsured women have more limited access
to health care resources, and their care tends to be more fragmented or episodic … as
opposed to integrated health care.”
Cover the Uninsured Week will feature more than 1,000 events across the country, from a health fair in Tacoma, WA, to business seminars in Bridgeport, CT, from a campus outreach with students at the University of Colorado Health Sciences Center in Denver to an interfaith outreach event in Detroit. Seventeen cities have been selected as target communities for activities; visit the event website (see info below) to see what your city is planning.
Fellows can be proactive
Members of the ACOG Committee on Health Care for Underserved Women say ob-gyns can become proactive in the plight for universal health care. Not only can they speak out on the issue and support state and national legislation, but they can also provide charity care in their practices or volunteer to work in community clinics. “If we each address at least a piece of the problem, it will have an impact,” Dr. Haffner says.
info
www.covertheuninsuredweek.org
Uninsured women
- 20.2 million women lack health insurance
- 13% of pregnant women are uninsured
- Uninsured women have a 49% higher adjusted risk of death from breast cancer after diagnosis
- Uninsured women are 31% more likely to experience an adverse health outcome after giving birth
Vermont, New Hampshire Sections
Recognized for Effort
Project Focuses on VBAC
Concerned with the decline in the number of hospitals offering VBACs, the Vermont and New Hampshire sections of ACOG helped develop a project to improve the safety and availability of VBAC in their region.
The Vermont/New Hampshire VBAC Project led to the development of guidelines for the management of VBAC. The guidelines can be used to re-institute VBACs in hospitals that no longer offer them.
The two sections are being recognized for their leadership of the VBAC Project with the 2003 Wyeth Pharmaceuticals Section Award, to be presented at the Annual Industry and Awards Luncheon at the ACM Sunday, May 2, in Philadelphia.
“This
award gives national recognition to the work of many people, showing that you
can start at a grassroots level and have a significant impact on patient care,” says
Peter H. Cherouny, MD, chair of the Vermont Section.
While VBAC availability has declined in Vermont and New Hampshire, many patients who have had previous cesarean sections continue to ask about delivering their babies vaginally and have difficulty finding hospitals that perform VBACs, according to Dr. Cherouny.
“There’s still clearly a demand for VBACs,” he says.
Project stratifies the risk to patients
The project’s risk stratification of VBAC patients showed that VBACs could be offered in a safe environment, Dr. Cherouny says. After identifying the clinical characteristics of patients with low, medium, and high risk for uterine rupture, a regional institutional classification was developed that included specific recommendations for the care of VBAC patients at the different risk levels. Dr. Cherouny points out that the group at low risk showed fetal and maternal risks similar to what all hospitals deal with every day with obstetric patients.
Three documents were developed and disseminated from the project:
- A patient VBAC education form
- A patient consent form for VBAC
- Regional guidelines for hospital management of VBAC
The support for the project data and new documents is leading to the re-institution of VBAC in some hospitals, while others are considering the option, according to Dr. Cherouny.
Collaborative effort continues
More than 200 health care professionals
and 35 of the 37 hospitals in Vermont and New Hampshire were involved in the
project. Input came from ob-gyns, nurse managers, certified nurse midwives, anesthesia
personnel, administrators, and insurers throughout the region.
Based on the successful collaborative project, the hospitals have decided to
create the Northern New England Perinatal Quality Improvement Network, a consortium
that will develop other projects geared toward improving perinatal care in the
region. The network’s first project will be to collect patient outcome
data on VBAC.
Two innovative ACOG programs receive 2005 Wyeth section award
Two projects—and four ACOG sections—are recipients of the 2004 Wyeth Pharmaceuticals Section Award, which was presented at the Annual Industry and Awards Luncheon at the Annual Clinical Meeting on May 8, 2005.
Both the Army and Air Force sections are being recognized for instituting a comprehensive cystic fibrosis screening program in the US Army, and the New Hampshire and Vermont sections are being honored for their collaborative effort in developing emergency cesarean delivery simulation and performance guidelines for hospitals . . .
. . . Preparing for emergency cesareans
After the New Hampshire and Vermont sections developed guidelines for the management of VBAC—a project for which they received the Wyeth award last year—the hospitals involved in the project decided to form the Northern New England Perinatal Quality Improvement Network. The network’s first project was to develop guidelines for hospitals to perform emergency cesarean delivery drills and performance evaluations.
Because emergency cesareans are uncommon for both hospitals and individual obstetric staff members, practice drills ensure optimal team performance when an emergency does occur.
“As physicians, we are primarily trained to work independently or as autonomous leaders,” said Michele R. Lauria, MD, a member of the New Hampshire Section and medical director of NNEPQIN. “To do a timely cesarean delivery, we need to become a team member. Drills allow us to look at workflow and analyze the process. And, they permit us the opportunity to look for defects in the structures around us, without impairing patient care.”
At the beginning of the project, eight of nine hospitals surveyed in the two states had protocols for emergency cesarean delivery, but only four had defined roles for staff. After the network developed and distributed simulation and performance guidelines, 12 of 15 hospitals surveyed had performed emergency cesarean section drills.
This fall, the sections plan to track regional outcomes for emergency cesarean deliveries and VBAC.
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