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Okemos, MI, United States

Covington T.M.,Review Centre | Covington T.M.,Michigan Public Health Institute
Injury Prevention

The National Child Death Review Case Reporting System (NCDR-CRS) was developed in the USA to provide child death review teams with a simple method for capturing, analysing, and reporting on the full set of information shared at a child death or serious injury review. The NCDR-CRS is a web based system currently being used by 35 of the 50 US states. This article describes the purpose, features, limitations, and strengths of the system. It describes current and planned efforts for the dissemination of the data to inform and catalyse local, state, and national efforts to keep children safe, healthy, and alive. Source

Torres J.M.C.,Michigan Public Health Institute
Qualitative Health Research

Much attention has been given to the commercialization of care and its relationship to the outsourcing of family life, as well as larger social and cultural processes that can change the nature of caring. I engage with this question of why certain aspects of care are provided by the market, using 72 interviews with lactation consultants, doulas, clients, and clinicians, as well as 150 hours of ethnographic observation in the USA. Examining how participants understood the role of these services in the maternity care system and the reasons why clients turned to these services, I found that, in several ways, these forms of care work reflected outsourcing trends. However, lactation consultants and doulas were also acting as advocates and guides, helping their clients navigate the complex medical maternity system. This reflects a fundamental transformation in the nature of maternity support, attributed to the impact of medicalization, both historically and currently. © The Author(s) 2014. Source

Siegl E.J.,Breast and Cervical Cancer Control Program | Miller J.W.,Centers for Disease Control and Prevention | Khan K.,Centers for Disease Control and Prevention | Harris S.E.,Michigan Public Health Institute

Quality assurance (QA) is the process of providing evidence that the outcome meets the established standards. Quality improvement (QI), by contrast, is the act of methodically developing ways to meet acceptable quality standards and evaluating current processes to improve overall performance. In the case of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), the desired outcome is the delivery of quality health care services to program clients. The NBCCEDP provides professional development to ensure that participating providers have current knowledge of evidence-based clinical standards regarding breast and cervical cancer screening and diagnosis and are monitoring women with abnormal screening results for timely follow-up. To assess the quality of clinical care provided to NBCCEDP clients, performance data are collected by NBCCEDP grantees and compared against predetermined Centers for Disease Control and Prevention (CDC) benchmarks known as Data Quality Indicator Guides. In this article, the authors describe 1) the development and use of indicators for QI in the NBCCEDP and 2) the professional development activities implemented to improve clinical outcomes. QA identifies problems, whereas QI systematically corrects them. The quality of service delivery and improved patient outcomes among NBCCEDP grantees has enhanced significantly because of continuous monitoring of performance and professional development. By using QA, NBCCEDP grantees can maximize the quality of patient screening, diagnostic services, and follow-up. Examples of grantee activities to maintain quality of care are also described in this report. Cancer 2014;120(16 suppl):2584-90. © 2014 American Cancer Society. Source

Shroff M.R.,Michigan Public Health Institute | Holzman C.,Michigan State University | Tian Y.,Michigan State University | Evans R.W.,University of Pittsburgh | Sikorskii A.,Michigan State University
Clinical Endocrinology

Objective: Maternal blood leptin levels are positively associated with adiposity. Recent studies suggest that leptin is also abundantly produced by the placenta and may function as a regulator of foetal growth. Our goal was to examine mid-pregnancy levels of leptin in maternal blood in relation to birthweight for gestational age (BW/GA) and timing of delivery after accounting for maternal prepregnancy body mass index (prepreg-BMI) and pregnancy complications. Patients Data were from 1304 subcohort mother/infant pairs who participated in the Pregnancy Outcomes and Community Health (POUCH) Study (1998-2004). Measurements Leptin levels, measured at 16-27 weeks' gestation, were log-transformed. Geometric mean (GMean) leptin levels were estimated by weighted linear regression with gestational age at blood draw as a covariate. GMean was re-transformed to the original scale for reporting. Results: Using the GMeans leptin in mothers of term appropriate-for-gestational age (AGA) neonates as the referent (25.2 μg/l), we observed lower levels in mothers of preterm-AGA (21.9 μg/l), term small-for-gestational age (SGA) (20.3 μg/l) and preterm-SGA neonates (21.7 μg/l). Results were largely unchanged after adjustment for prepreg-BMI. Leptin levels were higher in mothers who delivered large-for-gestational age (LGA) neonates, both preterm (33.6 μg/l) and term (29.1 μg/l), but the GMeans were markedly attenuated after adjustment for prepreg-BMI. Conclusion The association between BW/GA and maternal leptin levels after adjustment for prepreg-BMI may represent: (i) a residual effect of maternal adiposity that is not fully captured by BMI; and/or (ii) variation in placental leptin levels entering the maternal circulation. In conclusion, mid-pregnancy maternal blood leptin levels may be an early indicator of foetal growth status. © 2012 Blackwell Publishing Ltd. Source

Palusci V.J.,New York University | Wirtz S.J.,Safe and Active Communities Branch | Covington T.M.,Michigan Public Health Institute
Child Abuse and Neglect

Objectives: To (1) test the use of capture-recapture methods to estimate the total number of child maltreatment deaths in a single state using information from death certificates, child welfare reports, child death review teams, and uniform crime reports; and to (2) compare these estimates to the number of maltreatment deaths identified through an in-depth " gold standard" review. Methods: Child maltreatment deaths were identified in four existing administrative data sources: (1) death reports in our state vital statistics (DC); (2) child death review team reports (CDR); (3) homicide reports filed by our state police agency as uniform crime report (UCR) supplements for the FBI; and (4) abstracted reports of a minor's death from our state child protective services (CPS) agency. Capture-recapture pair-wise and pooled comparisons were then applied to estimate the numbers of abuse and total maltreatment deaths and were compared to the number of cases identified by independent case review. Results: There were a total of 194 child maltreatment deaths in Michigan during 2000-2001 with 66 due to physical abuse. Capture-recapture analysis estimated the mean number of total child maltreatment deaths as 101.02 (95%CI. = 92.52, 109.53), with abuse deaths of 64.55 (60.85, 68.25). Most pair-wise and pooled comparisons worked equally well for abuse deaths, but estimates for total child maltreatment deaths were low. Conclusions: Capture-recapture methods applied to existing administrative datasets produced accurate estimates of child abuse deaths but were not useful in producing reliable estimates of total child maltreatment deaths due to undercounting neglect-related deaths in all existing administrative data sets. The underlying assumptions for capture-recapture methods were not met for neglect deaths. Local and/or state teams conducting ongoing intensive case review may yet remain the best way to identify the total number of child maltreatment deaths. Practice implications: Capture-recapture methods allow for more accurate estimation of the true number of child physical abuse deaths than does using single existing sources of child fatality information, but deaths from causes other than abuse are undercounted. Child maltreatment fatality surveillance requires a systematic process and standard criteria for identifying cases of maltreatment, particularly neglect-related child deaths. © 2010 Elsevier Ltd. Source

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