Spring 03a: Readmissions and Maternal Health Flashcards
T/F: Transitions of care are times of high risk for lapses in care.
True
(X) method is a way to assess patient understanding. This method (increases/decreases) chance of readmission.
X = “teach back”
Decreases
To decrease chance of readmission, it’s a good idea to send discharge summary to (X) of patient.
X = PCP
T/F: Depression increases chance of readmission.
True
(Males/females) are more likely to be readmitted after discharge.
Males
(Weekend/weekday) discharge increases chance of readmission.
Weekend
It’s important to (restart/eliminate) home meds after discharge if they were stopped at time of admission. This will reduce chance of readmission.
Restart
T/F: Substance abuse increases chance of readmission.
True
A (local/state/federal) program, (X), penalizes hospitals with higher than expected (Y) day readmission rates.
Federal;
X = Hospital Readmission Reduction Program
Y = 30
In (X) payment method, hospitals have incentive to fill beds.
X = fee for service
RED, aka (X), is a program aimed to reduce hospital readmissions. Their checklist consists of (Y) number of components to reducing readmission.
X = Re-Engineered Discharge; Y = 11
Define maternal mortality ratio.
Number of maternal deaths per 100,000 live births
Maternal mortality ratio is measured based on woman who die in which stage(s) of pregnancy/birth?
Either during pregnancy or within 42 days after end of pregnancy, from cause related to it
Maternal mortality ratio globally is (X). and in the US is (Y).
X = 216/100,000 Y = 14/100,000
List some of the most common causes of maternal mortality (from most to least common).
- Hemorrhage
- Infection
- BP-related
- Labor complications
- Unsafe abortions/lack of access
Define Neonatal mortality.
Number of newborn deaths (within 28 days of birth) per 1000 live births
Neonatal mortality in 2015, globally, is (X). This is (Y)% of all under-5 y.o. deaths.
X = 2.7 million Y = 45
2015 Global neonatal mortality WITHIN first week was (X). And (Y) were on the day of birth.
X = 2 million Y = 1 million
Define Infant mortality.
Number of infant deaths (within first year of life) per 1000 live births
Infant mortality in 2015, globally, is (X). This is (Y)% of all under-5 y.o. deaths.
X = 4.5 million Y = 75
Infant mortality ratio globally is (X). and in the US is (Y).
X = 32/1000 Y = 6/1000
List factors that would “pull” people to emigrate to US.
- Education
- Economics
- Reuniting with parents
List factors that would “push” people to emigrate to US.
- Violence (political turmoil, high child homicide rate, etc.)
- Poverty
T/F: Earlier abortions are both more common and safer.
True
Your patient wants to get pregnant. List some options you’d offer for (preconception/contraception) care.
Preconception;
- Prenatal vitamins
- Management of existing risk factors or health conditions
Your patient doesn’t want to get pregnant. You’d offer options for (preconception/contraception) care.
Contraception
Abortions are relatively (common/rare). Restrictions on abortions are (X)-specific.
Very common (in US, 30% women had one by age 45); X = State
Reproductive Health Life Plan refers to:
Thinking about when and if a patient/couple wants to have children
List some barriers to Reproductive Health Life Plan.
- Health
- Finances
- Timing (career, education, etc.)
What’s the base of the “trauma” pyramid? This represents the (earliest/latest) event.
Adverse childhood experience
Earliest
List the levels of the “trauma” pyramid, from bottom to top.
- Adverse childhood experience
- Social/emotional/cognitive impairment
- Adopts health-risk behavior
- Disease, disability, and social problems
- Early death
T/F: For minors, reproductive health laws vary based on state.
True
In MA, parental consent of (one/both) parent(s) is required for abortion care for minor, unless:
One;
- Medical emergency
- Judicial bypass obtaines
T/F: In MA, minors can consent for services such as contraception.
True
T/F: In MA, minors can consent for services such as STD testing.
True
In MA, minors generally need parent/guardian permission for care with these exceptions:
- Married/parent
- In armed forces
- Living independently
- Determined to be a “mature” minor (understands nature/consequences of treatment)
T/F: Today, 1st trimester abortions is an inpatient procedure, requiring a surgical team.
False - 2016 case made it outpatient procedure (no surgical team required)
Preconception care is any intervention offered to (X), (before/during/after) pregnancy. Their aim is to improve (Y).
X = women/couples of childbearing age
Before;
Y = health outcomes (maternity/newborn/infant)
T/F: Preconception care is provided, regardless of pregnancy status or desire.
True
Pregnant women, who are unaware or not monitored, can be at risk for adverse outcomes. List some examples of this.
- Chronic diseases
- Not taking folic acid
- Teratogenic exposure (meds)
- Overweight/obese
T/F: Current interventions to prevent adverse outcomes in pregnancy are often too late. Aka crucial development period has already occurred.
True
(X)% of pregnant women smoke.
X = 10
(X)% of women smokers quit during pregnancy.
X = 55
Of women who stop smoking during pregnancy, (X)% go back to smoking afterwards.
X = 40
(X) glasses per week of alcohol is the safe limit of consumption during pregnancy.
X = ZERO (no amount is safe)
List some examples of chronic diseases that would be important to manage in preconception phase to allow for healthier pregnancy.
- Diabetes
- HT
- CVD
- Asthma
In perconception phase, if patient has history of depression, it’s important to assess the risks/benefits of (X) action.
X = decreasing their meds during pregnancy
(X) has highest risk of fatal injury deaths during pregnancy/postpartum period.
X = intimate partner (current or former) homicide
List some medications that can serve as teratogens.
Certain statins, antidepressants, anticoagulants
Your patient (BMI of 32) comes in for a check-up and discovers she’s 5 weeks pregnant. Do you recommend she wait until after pregnancy to lose weight?
No - during pregnancy
T/F: Providing HIV treatment to pregnant woman doesn’t prevent transmission to child.
False
T/F: It’s important to provide live vaccines (i.e. Rubella) during first trimester.
False - before pregnancy! Live vaccines cannot be given during pregnancy
List some examples of Family Planning you should implement in preconception care.
- Genetic counseling/testing
2. Spacing out pregnancies
(X) months between pregnancies is the safest range, to lower risk of (Y) outcomes.
X = 18-59 (1.5-5 y) Y = preterm birth/low birth weight
T/F: Those most in need of preconception services are least likely to receive them
True
T/F: Data shows that intervention for all conditions prior to conception is better than intervention early in pregnancy.
False - only certain conditions
T/F: Effective health promotion messages requires motivated people on the receiving end.
True
T/F: Clinical training often emphasizes risk assessment, but not health promotion skills.
False - emphasizes neither (a barrier to care)
T/F: There is not enough reimbursement (thus, provider incentive) for risk assessment and health promotion activities.
True
Weathering hypothesis first described by (X) in (Y). What’s the hypothesis?
X = Geronimus Y = 1992
Life stressors can impact health
(X) refers to wear and tear on the body due to exposure to stress.
X = allostatic load
Early life events plus the cumulative (X) over the course of life contributes to disparities in health outcomes. This phenomenon is called:
X = allostatic load
Life-course perspective
T/F: Poor pregnancy outcomes continue to be higher than acceptable.
True - hence importance of preconception care
T/F: Only pregnant women with previous adverse pregnancies are “at risk” for adverse pregnancy outcomes.
False! All women entering pregnancy are at risk
Women “mean entry” into prenatal care is just prior to critical period of development of which structure(s)/system(s)?
After all critical periods have passed! Around week 12 from gestation
Your patient has recently noticed she missed her period and thinks she may be pregnant. If true, which critical periods of development have already begun?
CNS and heart (week 5 of gestation)
T/F: Maternal tobacco smoking puts baby at increased risk of cleft lip/palate.
True
Maternal smoking cessation primarily reduces infant (X).
X = LBW and mortality
T/F: Maternal diabetes, especially if poorly controlled, puts child at increased risk of developing diabetes.
True
T/F: Poor glycemic control during pregnancy puts the infant/child at risk, but not so much the mother.
False - maternal health at risk also (retinopathy, nephropathy, hypertension)
