Spring 03a: Readmissions and Maternal Health

Question 1

T/F: Transitions of care are times of high risk for lapses in care.

Answer 1

True

Question 2

(X) method is a way to assess patient understanding. This method (increases/decreases) chance of readmission.

Answer 2

X = “teach back”

Decreases

Question 3

To decrease chance of readmission, it’s a good idea to send discharge summary to (X) of patient.

Answer 3

X = PCP

Question 4

T/F: Depression increases chance of readmission.

Answer 4

True

Question 5

(Males/females) are more likely to be readmitted after discharge.

Answer 5

Males

Question 6

(Weekend/weekday) discharge increases chance of readmission.

Answer 6

Weekend

Question 7

It’s important to (restart/eliminate) home meds after discharge if they were stopped at time of admission. This will reduce chance of readmission.

Answer 7

Restart

Question 8

T/F: Substance abuse increases chance of readmission.

Answer 8

True

Question 9

A (local/state/federal) program, (X), penalizes hospitals with higher than expected (Y) day readmission rates.

Answer 9

Federal;
X = Hospital Readmission Reduction Program
Y = 30

Question 10

In (X) payment method, hospitals have incentive to fill beds.

Answer 10

X = fee for service

Question 11

RED, aka (X), is a program aimed to reduce hospital readmissions. Their checklist consists of (Y) number of components to reducing readmission.

Answer 11

X = Re-Engineered Discharge;
Y = 11

Question 12

Define maternal mortality ratio.

Answer 12

Number of maternal deaths per 100,000 live births

Question 13

Maternal mortality ratio is measured based on woman who die in which stage(s) of pregnancy/birth?

Answer 13

Either during pregnancy or within 42 days after end of pregnancy, from cause related to it

Question 14

Maternal mortality ratio globally is (X). and in the US is (Y).

Answer 14

X = 216/100,000
Y = 14/100,000

Question 15

List some of the most common causes of maternal mortality (from most to least common).

Answer 15

1. Hemorrhage
2. Infection
3. BP-related
4. Labor complications
5. Unsafe abortions/lack of access

Question 16

Define Neonatal mortality.

Answer 16

Number of newborn deaths (within 28 days of birth) per 1000 live births

Question 17

Neonatal mortality in 2015, globally, is (X). This is (Y)% of all under-5 y.o. deaths.

Answer 17

X = 2.7 million 
Y = 45

Question 18

2015 Global neonatal mortality WITHIN first week was (X). And (Y) were on the day of birth.

Answer 18

X = 2 million
Y = 1 million

Question 19

Define Infant mortality.

Answer 19

Number of infant deaths (within first year of life) per 1000 live births

Question 20

Infant mortality in 2015, globally, is (X). This is (Y)% of all under-5 y.o. deaths.

Answer 20

X = 4.5 million
Y = 75

Question 21

Infant mortality ratio globally is (X). and in the US is (Y).

Answer 21

X = 32/1000
Y = 6/1000

Question 22

List factors that would “pull” people to emigrate to US.

Answer 22

1. Education
2. Economics
3. Reuniting with parents

Question 23

List factors that would “push” people to emigrate to US.

Answer 23

1. Violence (political turmoil, high child homicide rate, etc.)
2. Poverty

Question 24

T/F: Earlier abortions are both more common and safer.

Answer 24

True

Question 25

Your patient wants to get pregnant. List some options you'd offer for (preconception/contraception) care.

Answer 25

Preconception; 1. Prenatal vitamins 2. Management of existing risk factors or health conditions

Question 26

Your patient doesn't want to get pregnant. You'd offer options for (preconception/contraception) care.

Answer 26

Contraception

Question 27

Abortions are relatively (common/rare). Restrictions on abortions are (X)-specific.

Answer 27

``` Very common (in US, 30% women had one by age 45); X = State ```

Question 28

Reproductive Health Life Plan refers to:

Answer 28

Thinking about when and if a patient/couple wants to have children

Question 29

List some barriers to Reproductive Health Life Plan.

Answer 29

1. Health 2. Finances 3. Timing (career, education, etc.)

Question 30

What's the base of the "trauma" pyramid? This represents the (earliest/latest) event.

Answer 30

Adverse childhood experience Earliest

Question 31

List the levels of the "trauma" pyramid, from bottom to top.

Answer 31

1. Adverse childhood experience 2. Social/emotional/cognitive impairment 3. Adopts health-risk behavior 4. Disease, disability, and social problems 5. Early death

Question 32

T/F: For minors, reproductive health laws vary based on state.

Answer 32

True

Question 33

In MA, parental consent of (one/both) parent(s) is required for abortion care for minor, unless:

Answer 33

One; 1. Medical emergency 2. Judicial bypass obtaines

Question 34

T/F: In MA, minors can consent for services such as contraception.

Answer 34

True

Question 35

T/F: In MA, minors can consent for services such as STD testing.

Answer 35

True

Question 36

In MA, minors generally need parent/guardian permission for care with these exceptions:

Answer 36

1. Married/parent 2. In armed forces 3. Living independently 4. Determined to be a "mature" minor (understands nature/consequences of treatment)

Question 37

T/F: Today, 1st trimester abortions is an inpatient procedure, requiring a surgical team.

Answer 37

False - 2016 case made it outpatient procedure (no surgical team required)

Question 38

Preconception care is any intervention offered to (X), (before/during/after) pregnancy. Their aim is to improve (Y).

Answer 38

X = women/couples of childbearing age Before; Y = health outcomes (maternity/newborn/infant)

Question 39

T/F: Preconception care is provided, regardless of pregnancy status or desire.

Answer 39

True

Question 40

Pregnant women, who are unaware or not monitored, can be at risk for adverse outcomes. List some examples of this.

Answer 40

1. Chronic diseases 2. Not taking folic acid 3. Teratogenic exposure (meds) 4. Overweight/obese

Question 41

T/F: Current interventions to prevent adverse outcomes in pregnancy are often too late. Aka crucial development period has already occurred.

Answer 41

True

Question 42

(X)% of pregnant women smoke.

Answer 42

X = 10

Question 43

(X)% of women smokers quit during pregnancy.

Answer 43

X = 55

Question 44

Of women who stop smoking during pregnancy, (X)% go back to smoking afterwards.

Answer 44

X = 40

Question 45

(X) glasses per week of alcohol is the safe limit of consumption during pregnancy.

Answer 45

X = ZERO (no amount is safe)

Question 46

List some examples of chronic diseases that would be important to manage in preconception phase to allow for healthier pregnancy.

Answer 46

1. Diabetes 2. HT 3. CVD 4. Asthma

Question 47

In perconception phase, if patient has history of depression, it's important to assess the risks/benefits of (X) action.

Answer 47

X = decreasing their meds during pregnancy

Question 48

(X) has highest risk of fatal injury deaths during pregnancy/postpartum period.

Answer 48

X = intimate partner (current or former) homicide

Question 49

List some medications that can serve as teratogens.

Answer 49

Certain statins, antidepressants, anticoagulants

Question 50

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?

Answer 50

No - during pregnancy

Question 51

T/F: Providing HIV treatment to pregnant woman doesn't prevent transmission to child.

Answer 51

False

Question 52

T/F: It's important to provide live vaccines (i.e. Rubella) during first trimester.

Answer 52

False - before pregnancy! Live vaccines cannot be given during pregnancy

Question 53

List some examples of Family Planning you should implement in preconception care.

Answer 53

1. Genetic counseling/testing | 2. Spacing out pregnancies

Question 54

(X) months between pregnancies is the safest range, to lower risk of (Y) outcomes.

Answer 54

``` X = 18-59 (1.5-5 y) Y = preterm birth/low birth weight ```

Question 55

T/F: Those most in need of preconception services are least likely to receive them

Answer 55

True

Question 56

T/F: Data shows that intervention for all conditions prior to conception is better than intervention early in pregnancy.

Answer 56

False - only certain conditions

Question 57

T/F: Effective health promotion messages requires motivated people on the receiving end.

Answer 57

True

Question 58

T/F: Clinical training often emphasizes risk assessment, but not health promotion skills.

Answer 58

False - emphasizes neither (a barrier to care)

Question 59

T/F: There is not enough reimbursement (thus, provider incentive) for risk assessment and health promotion activities.

Answer 59

True

Question 60

Weathering hypothesis first described by (X) in (Y). What's the hypothesis?

Answer 60

``` X = Geronimus Y = 1992 ``` Life stressors can impact health

Question 61

(X) refers to wear and tear on the body due to exposure to stress.

Answer 61

X = allostatic load

Question 62

Early life events plus the cumulative (X) over the course of life contributes to disparities in health outcomes. This phenomenon is called:

Answer 62

X = allostatic load Life-course perspective

Question 63

T/F: Poor pregnancy outcomes continue to be higher than acceptable.

Answer 63

True - hence importance of preconception care

Question 64

T/F: Only pregnant women with previous adverse pregnancies are "at risk" for adverse pregnancy outcomes.

Answer 64

False! All women entering pregnancy are at risk

Question 65

Women "mean entry" into prenatal care is just prior to critical period of development of which structure(s)/system(s)?

Answer 65

After all critical periods have passed! Around week 12 from gestation

Question 66

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?

Answer 66

CNS and heart (week 5 of gestation)

Question 67

T/F: Maternal tobacco smoking puts baby at increased risk of cleft lip/palate.

Answer 67

True

Question 68

Maternal smoking cessation primarily reduces infant (X).

Answer 68

X = LBW and mortality

Question 69

T/F: Maternal diabetes, especially if poorly controlled, puts child at increased risk of developing diabetes.

Answer 69

True

Question 70

T/F: Poor glycemic control during pregnancy puts the infant/child at risk, but not so much the mother.

Answer 70

False - maternal health at risk also (retinopathy, nephropathy, hypertension)