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    Maintaining excellence in obstetrics and gynecology

    A call to action from leaders in the field.

     

    3. Lessen student debt

    Since tuition accounts for only 4%–6% of total medical school financial support, some academic medical centers could continue to function without it, and most could afford to freeze tuition for several years.

    Another debt reduction opportunity is collaboration with the Accreditation Council for Graduate Medical Education (ACGME), state Medicaid agencies, and Public Health Service agencies to develop programs that allow graduating residents to work off debt by working in underserved communities, an ob/gyn “Peace Corps.”22 For example, for each year of such service post-graduation, a certain portion of a student’s medical school debt could be forgiven by being paid through state Medicaid funds.

    4. Streamline documentation

    EHR changes are needed. Regulators must be more pragmatic, and software designers must rethink and redesign processes that are now tailored for regulatory and insurance compliance rather than for patient care and physician productivity. In addition to simplifying data entry processes, employing scribes to shadow busy ob/gyns and enter data during every patient encounter will provide more “eye-to-eye” time with patients.

    5. Improve patient safety

    The new Republican administration and Congress may renew efforts at federal tort reform, although it failed to materialize under the Bush administration and is unlikely to be prioritized. In any case, we should focus on avoiding harm by using the best evidence-based medicine available.

    Team training, crew resource management, checklists, and evidence-based protocols are now widespread. However, while making EHR systems more user-friendly, the technology should also be used to create patient safety tools such as decision support and enhanced documentation in high-risk settings. The latter could include presenting concrete evidence of surveillance, problem anticipation, proactive and reactive planning and execution, details of outcomes, and assurance that adequate information has been conveyed to the patient.

    Next: The big healthcare disappointment

    Improved patient record-keeping could be taught through tutorials, video simulations, and hands-on demonstrations, proven methods to enhance patient outcomes and experience.23 Because “avoidance of harm” is the best defense against liability suits, hospitals, local American College of Obstetricians and Gynecologists districts, and State Perinatal Quality Improvement Programs should focus on developing checklists, tool kits, and EHR decision support tools to prevent adverse outcomes.

    References

    1. Rysavy MA, Li L, Bell EF, et al. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med. 2015;372(19):1801-1811.

    2. Mercer B, Milluzzi C, Collin M. Periviable birth at 20 to 26 weeks of gestation: proximate causes, previous obstetric history and recurrence risk. Am J Obstet Gynecol. 2005;193(3 Pt 2):1175-1180.

    3. Osterman MJK, Kochanek KD, MacDorman MF, Strobino DM, Guyer B. Annual summary of vital statistics: 2012-2013. Pediatrics. 2015;135(6):1115-1125.

    4. Ingraham C. Our maternal mortality rate is a national embarrassment. Washington Post. https://www.washingtonpost.com/news/wonk/wp/2015/11/18/our-maternal-mort.... Published 2015.

    5. Robeznieks A. U.S. has highest maternal death rate among developed countries. May 6 . http://www.modernhealthcare.com/article/20150506/NEWS/150509941. Published 2015. Accessed July 18, 2015.

    6. Abortion. http://www.cdc.gov/reproductivehealth/data_stats/#Abortion. Accessed July 18, 2015.

    7. Secura GM, Madden T, McNicholas C, et al. Provision of no-cost, long-acting contraception and teenage pregnancy. N Engl J Med. 2014;371(14):1316-1323..

    8. Pear R. Passions Flare as House Debates Birth Control Rule. http://www.nytimes.com/2012/02/17/us/politics/birth-control-coverage-rul.... Published 2012.

    9. Wright JD, Herzog TJ, Tsui J, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol. 2013;122(2 Pt 1):233-241.

    10. Changes in Cesarean Delivery Rates by Gestational Age: United States. NCHS Data Brief No. 124 . http://www.cdc.gov/nchs/data/databriefs/db124.htm#x2013;2011%3C/a%3E. Published 2013. Accessed July 18, 2015.

    11. Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol. 1997;177(1):210-214.

    12. Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005;192(5):1458-1461.

    13. Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol. 2012;207(1):14-29.

    14. Asch DA, Nicholson S, Vujicic M. Are We in a Medical Education Bubble Market? http://dx.doi.org/101056/NEJMp1310778. 2013.

    15. Medical Student Education: Debt, Costs, and Loan Repayment Fact Card. 2014.

    16. Grayson MS, Newton DA, Thompson LF. Payback time: the associations of debt and income with medical student career choice. Med Educ. 2012;46(10):983-991.

    17. Medical Liability Climate Hurts Patients and Ob-Gyns. ACOG Sept 5. http://www.acog.org/About-ACOG/News-Room/News-Releases/2012/Medical-Liab.... Published 2012. Accessed June 28, 2016.

    18. Hill RG, Sears LM, Melanson SW. 4000 clicks: a productivity analysis of electronic medical records in a community hospital ED. Am J Emerg Med. 2013;31(11):1591-1594.

    19. Jena AB, Seabury S, Lakdawalla D, Chandra A. Malpractice Risk According to Physician Specialty. http://dx.doi.org/101056/NEJMsa1012370. 2011.

    20. Medicine I of. Graduate Medical Education That Meets the Nation’s Health Needs. Washington, D.C.: National Academies Press; 2014.

    21. Reece EA, Chrencik RA, Miller ED. Fully aligned academic health centers: a model for 21st-century job creation and sustainable economic growth. Acad Med. 2012;87(7):982-987.

    22. Gallin EK, Bond E, Califf RM, et al. Forging stronger partnerships between academic health centers and patient-driven organizations. Acad Med. 2013;88(9):1220-1224.

    23. Quinn MA, Kats AM, Kleinman K, et al. The Relationship Between Electronic Health Records and Malpractice Claims. Arch Intern Med. 2012;172(15):505-516. 

    John C Hobbins, MD
    Dr Hobbins is Professor of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, Colorado.
    E. Albert Reece, MD, PhD
    DR. REECE is Vice Chancellor and Dean of the College of Medicine and Professor, Departments of Obstetrics and Gynecology, Internal ...
    Nathan Kase, MD, MS
    Dr Kase is Dean Emeritus, Professor of Obstetrics, Gynecology and Reproductive Sciences, Mount Sinai Health System, New York, New York.
    Hugh Taylor, MD
    Dr Taylor is Chair and Anita O’Keefe Professor of Obstetrics, Gynecology and Reproductive Sciences and Professor of Molecular, Cellular, ...
    Thomas Hanson, MD
    Dr Hanson is Clinical of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.
    Joshua A. Copel, MD
    DR. COPEL is Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Director of ...

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