Papers

2018
Edmonds JK, O'Hara M, Clarke SP, Shah NT. In Response. J Obstet Gynecol Neonatal Nurs. 2018;47 (2) :234-235.
2017
Lindquist SAI, Shah N, Overgaard C, Torp-Pedersen C, Glavind K, Larsen T, Plough A, Galvin G, Knudsen A. Association of previous cesarean delivery with surgical complications after a hysterectomy later in life. JAMA surgery. 2017;152 (12) :1148-1155.
O'Brien K, Shainker SA, Modest AM, Spiel MH, Resetkova N, Shah N, Hacker MR. Cost Analysis of Following Up Incomplete Low‐Risk Fetal Anatomy Ultrasounds. Birth. 2017;44 (1) :35-40.
WOO VICTORIAG, Shah NT. Cost Outcomes and Finances of Freestanding Birth Centers. Freestanding Birth Centers: Innovation, Evidence, Optimal Outcomes. 2017.
Gupta R, Shah NT, Moriates C, Wallingford S, Arora VM. Disseminating Innovations in Teaching Value-Based Care Through an Online Learning Network. Journal of graduate medical education. 2017;9 (4) :509-513.
Molina R, Gombolay M, Jonas J, Shah J, Golen T, Shah NT. The Effect of Surges in Patient Volume on Resource Management of an Academic Labor and Delivery Unit [5d]. Obstetrics & Gynecology. 2017;129 :42S.
Gourevitch RA, Mehrotra A, Galvin G, Karp M, Plough A, Shah NT. How do pregnant women use quality measures when choosing their obstetric provider?. Birth. 2017;44 (2) :120-127.
Plough AC, Galvin GE, Li Z, Declercq ER, Caughey AB, Shah NT. The Impact of Labor and Delivery Unit Management on Long Childbirth Length of Stay [27l]. Obstetrics & Gynecology. 2017;129 :S128.
Bilazarian A, Plough AC, Galvin GE, Rosenberg D, Sullivan B, Shah NT. Measuring Variation in Design Among American Childbirth Facilities [11R]. Obstetrics & Gynecology. 2017;129 :186S.
Vadnais MA, Hacker MR, Shah NT, Jordan JA, Modest AM, Siegel M, Golen TH. Quality improvement initiatives lead to reduction in nulliparous term singleton vertex cesarean delivery rate. The Joint Commission Journal on Quality and Patient Safety. 2017;43 (2) :53-61.
Gombolay M, Golen T, Shah N, Shah J. Queueing theoretic analysis of labor and delivery. Health care management science. 2017 :1-18.
Plough AC, Galvin G, Li Z, Lipsitz SR, Alidina S, Henrich NJ, Hirschhorn LR, Berry WR, Gawande AA, Peter D. Relationship between labor and delivery unit management practices and maternal outcomes. Obstetrics & Gynecology. 2017;130 (2) :358-365.
Lindquist SAI, Shah N, Overgaard C. Supplementary Online Content. 2017.
Kozhimannil KB, Karaca-Mandic P, Blauer-Peterson CJ, Shah NT, Snowden JM. Uptake and utilization of practice guidelines in hospitals in the United States: The case of routine episiotomy. The Joint Commission Journal on Quality and Patient Safety. 2017;43 (1) :41-48.
Edmonds JK, O'Hara M, Clarke SP, Shah NT. Variation in cesarean birth rates by labor and delivery nurses. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2017;46 (4) :486-493.
Wakeam E, Molina G, Shah N, Lipsitz SR, Chang DC, Gawande AA, Haynes AB. Variation in the cost of 5 common operations in the United States. Surgery. 2017;162 (3) :592-604.
Gourevitch RA, Mehrotra A, Galvin G, Karp M, Plough A, Shah NT. How do pregnant women use quality measures when choosing their obstetric provider?. Birth. 2017;44 (2) :120-127.Abstract
BACKGROUND: Given increased public reporting of the wide variation in hospital obstetric quality, we sought to understand how women incorporate quality measures into their selection of an obstetric hospital. METHODS: We surveyed 6141 women through Ovia Pregnancy, an application used by women to track their pregnancy. We used t tests and chi-square tests to compare response patterns by age, parity, and risk status. RESULTS: Most respondents (73.2%) emphasized their choice of obstetrician/midwife over their choice of hospital. Over half of respondents (55.1%) did not believe that their choice of hospital would affect their likelihood of having a cesarean delivery. While most respondents (74.9%) understood that quality of care varied across hospitals, few prioritized reported hospital quality metrics. Younger women and nulliparous women were more likely to be unfamiliar with quality metrics. When offered a choice, only 43.6% of respondents reported that they would be willing to travel 20 additional miles farther from their home to deliver at a hospital with a 20 percentage point lower cesarean delivery rate. DISCUSSION: Women's lack of interest in available quality metrics is driven by differences in how women and clinicians/researchers conceptualize obstetric quality. Quality metrics are reported at the hospital level, but women care more about their choice of obstetrician and the quality of their outpatient prenatal care. Additionally, many women do not believe that a hospital's quality score influences the care they will receive. Presentations of hospital quality data should more clearly convey how hospital-level characteristics can affect women's experiences, including the fact that their chosen obstetrician/midwife may not deliver their baby.
Shah N. Look, then Leap: Quality and Improving Maternity Care. BJOG. 2017.Abstract
Obstetricians learned this lesson the hard way. A century ago, very little in obstetric practice was codified. Care was artisanal, variable, and sometimes dangerous. Based on a theory that childbirth is inherently "pathogenic," prominent American obstetricians recommended sweeping reforms. (DeLee, JB, Principles and Practice of Obstetrics, 1913, first edition). This article is protected by copyright. All rights reserved.
Lindquist SAI, Shah N, Overgaard C, Torp-Pedersen C, Glavind K, Larsen T, Plough A, Galvin G, Knudsen A. Association of Previous Cesarean Delivery With Surgical Complications After a Hysterectomy Later in Life. JAMA Surg. 2017;152 (12) :1148-1155.Abstract
Importance: In recent decades, the global rates of cesarean delivery have rapidly increased. Nonetheless, the influence of cesarean deliveries on surgical complications later in life has been understudied. Objective: To investigate whether previous cesarean delivery increases the risk of reoperation, perioperative and postoperative complications, and blood transfusion when undergoing a hysterectomy later in life. Design, Setting, and Participants: This registry-based cohort study used data from Danish nationwide registers on all women who gave birth for the first time between January 1, 1993, and December 31, 2012, and underwent a benign, nongravid hysterectomy between January 1, 1996, and December 31, 2012. The dates of this analysis were February 1 to June 30, 2016. Exposure: Cesarean delivery. Main Outcomes and Measures: Reoperation, perioperative and postoperative complications, and blood transfusion within 30 days of a hysterectomy. Results: Of the 7685 women (mean [SD] age, 40.0 [5.3] years) who met the inclusion criteria, 5267 (68.5%) had no previous cesarean delivery, 1694 (22.0%) had 1 cesarean delivery, and 724 (9.4%) had 2 or more cesarean deliveries. Among the 7685 included women, 3714 (48.3%) had an abdominal hysterectomy, 2513 (32.7%) had a vaginal hysterectomy, and 1458 (19.0%) had a laparoscopic hysterectomy. In total, 388 women (5.0%) had a reoperation within 30 days after a hysterectomy. Compared with women having vaginal deliveries, fully adjusted multivariable analysis showed that the adjusted odds ratio of reoperation for women having 1 previous cesarean delivery was 1.31 (95% CI, 1.03-1.68), and the adjusted odds ratio was 1.35 (95% CI, 0.96-1.91) for women having 2 or more cesarean deliveries. Perioperative and postoperative complications were reported in 934 women (12.2%) and were more frequent in women with previous cesarean deliveries, with adjusted odds ratios of 1.16 (95% CI, 0.98-1.37) for 1 cesarean delivery and 1.30 (95% CI, 1.02-1.65) for 2 or more cesarean deliveries. Blood transfusion was administered to 195 women (2.5%). Women having 2 or more cesarean deliveries had an adjusted odds ratio for receiving blood transfusion of 1.93 (95% CI, 1.21-3.07) compared with women having no previous cesarean delivery. Conclusions and Relevance: Women with at least 1 previous cesarean delivery face an increased risk of complications when undergoing a hysterectomy later in life. The results support policies and clinical efforts to prevent cesarean deliveries that are not medically indicated.
Gupta R, Shah NT, Moriates C, Wallingford S, Arora VM. Disseminating Innovations in Teaching Value-Based Care Through an Online Learning Network. J Grad Med Educ. 2017;9 (4) :509-513.Abstract
BACKGROUND : A national imperative to provide value-based care requires new strategies to teach clinicians about high-value care. OBJECTIVE : We developed a virtual online learning network aimed at disseminating emerging strategies in teaching value-based care. METHODS : The online Teaching Value in Health Care Learning Network includes monthly webinars that feature selected innovators, online discussion forums, and a repository for sharing tools. The learning network comprises clinician-educators and health system leaders across North America. We conducted a cross-sectional online survey of all webinar presenters and the active members of the network, and we assessed program feasibility. RESULTS : Six months after the program launched, there were 277 learning community members in 22 US states. Of the 74 active members, 50 (68%) completed the evaluation. Active members represented independently practicing physicians and trainees in 7 specialties, nurses, educators, and health system leaders. Nearly all speakers reported that the learning network provided them with a unique opportunity to connect with a different audience and achieve greater recognition for their work. Of the members who were active in the learning network, most reported that strategies gleaned from the network were helpful, and some adopted or adapted these innovations at their home institutions. One year after the program launched, the learning network had grown to 364 total members. CONCLUSIONS : The learning network helped participants share and implement innovations to promote high-value care. The model can help disseminate innovations in emerging areas of health care transformation, and is sustainable without ongoing support after a period of start-up funding.

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