AimsJejunal feeding is increasingly seen as an alternative to fundoplication in neurologically impaired children. However, fundoplication may offer important advantages. This study aimed to determine: (i) contemporary outcomes of fundoplication from a sub-specialised service; and (ii) whether outcomes were influenced by neurological characteristics.MethodsSingle-centre retrospective review of consecutive children undergoing fundoplication by three surgeons over five years (2017-2022) using a standardised technique. Children were stratified as neurologically unimpaired, static brain injury, neuromuscular condition or neurodegenerative impairment. Failure was defined as a requirement for subsequent jejunal feeding or further surgery. Data are presented as median (IQR) unless stated. Comparisons used Fisher's test.Results144 children underwent fundoplication at 1.9 years (1-5 years): 97/144 (67%) had neurological impairment. Surgery was completed laparoscopically 128/144 (89%) and converted in 9/137 (7%). 84/144 (60%) underwent concomitant gastrostomy formation. At 35 months (22-47), absolute failure was 16% (23/144). Failure was higher in those with neurodegenerative conditions (not significant). Persistence of symptoms was noted in 23/144 (16%). Two (1.4%) required reoperation (<30 days). Nine (6.4%) required admission to critical care. One death within 30 days was unrelated.ConclusionsGiven fundoplication may provide significant benefits (avoiding pump feeds, frequent tube failure/changes and risk of jejunal perforation), success rates are high and morbidity low, fundoplication should be offered to families as an alternative to jejunal feeding as part of comprehensive counselling. There was no significant difference in outcome between neurological impairment subtypes in this sample size.

Objectives: To validate the Person-Centered Contraceptive Counseling (PCCC) patient-reported outcome performance measure and assess for differences by sociodemographic attributes using survey data from a multistate contraceptive access program.Study design: This analysis explored internal reliability and construct validity of the PCCC using survey data from 1413 patients who visited 15 health centers in Washington state and Massachusetts that had partnered with Upstream USA.Results: Multiple psychometric indicators provided evidence of reliability and validity. Significant associations between the highest PCCC rating and conceptually-related survey questions (i.e., experience with bias/coercion and shared decision-making) provided further evidence of construct validity.Conclusions: Our findings demonstrate that the PCCC is valid and reliable. The results also highlight differences in experience of care by patient-reported race and ethnicity, income level, and language.& COPY; 2023 Elsevier Inc. All rights reserved.

Advancing quality in healthcare is essential for optimizing population health; yet how to define and operationalize quality is complex and evolving. The National Academy of Medicine (NAM), previously the Institute of Medicine, developed a framework for defining healthcare quality consisting of six domains: effective, safe, efficient, patient-centered, equitable, and timely [ [1] Institute of Medicine Committee on Quality of Health Care in America Crossing the quality chasm: a new health system for the 21st century. National Academies Press, Washington, DC2001https://doi.org/10.17226/10027 Crossref Google Scholar ]. Healthcare addressing these aims can positively impact health status, contributing to better patient outcomes. In reproductive health, population-level outcome measures are typically related to teen and unintended pregnancy, infant mortality, and maternal mortality and morbidity [ [2] National Quality Forum Perinatal and reproductive health 2015-2016 final report. Department of Health and Human Services, Washington, DC2016 Google Scholar ]. There also are intermediate outcome measures like contraceptive use, collected at the institutional level, which rely on a causal pathway that infers that, by gaining access to effective contraceptive methods, individuals will use those methods consistently and delay or prevent pregnancy, translating to positive long-term outcomes [ 3 Gavin L. Frederiksen B. Robbins C. Pazol K. Moskosky S. New clinical performance measures for contraceptive care: their importance to healthcare quality. Contraception. 2017; 96: 149-157https://doi.org/10.1016/j.contraception.2017.05.013 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar , 4 Gavin L.E. Ahrens K.A. Dehlendorf C. Frederiksen B.N. Decker E. Moskosky S. Future directions in performance measures for contraceptive care: a proposed framework. Contraception. 2017; 96: 138-144https://doi.org/10.1016/j.contraception.2017.06.001 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar , 5 Loyola Briceno A.C. Kawatu J. Saul K. DeAngelis K. Frederiksen B.N. Moskosky S. et al. From theory to application: using performance measures for contraceptive care in the Title X family planning program. Contraception. 2017; 96: 166-174https://doi.org/10.1016/j.contraception.2017.06.009 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar , 6 Dehlendorf C. Bellanca H. Policar M. Performance measures for contraceptive care: what are we actually trying to measure?. Contraception. 2015; 91: 433-437https://doi.org/10.1016/j.contraception.2015.02.002 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar ]. Accordingly, work to advance contraceptive care quality initially focused on developing performance measures focused on the intermediate outcome of access to a broad range of contraceptive methods, especially more effective methods with cost barriers and gaps in provider knowledge of clinical practice guidelines.

Upstream selected clinical sites for recruitment based on patient volume, current state of contraceptive care, regional variation, patient demographics, and health center buy-in to implement Upstream's program with fidelity. Programming content for both teams included the following: 1. educating and coaching clinicians and support staff on how to provide patient-centered contraceptive counseling that is free of bias or coercion;2. providing technical assistance to stock the full range of contraceptive methods;3. supporting billing and coding to optimize reimbursement ofcontraceptive services and methods;4. revising or creating department or agency policies to enable highquality, sustainable practice change related to contraceptive care;5. incorporating a pregnancy intention screening or contraceptive needs assessment question, contraceptive counseling, and documentation of contraceptive method use into clinical workflows, often including the hospital's or agency's electronic health record (EHR) system;6. establishing strategies to ensure that a patient can receive their desired contraceptive method on the same day as their visit, including long-acting reversible contraceptive (LARC) methods;and 7. enhancing emergency contraception services. The additional programming areas and technical assistance of the Upstream intervention with partner health practices included: (1) training all agency staff on current best practices and clinical knowledge of high-quality contraceptive care;(2) coordinating clinician precepting for LARC placement and removal;(3) where necessary, providing funding to stock the full range of contraceptive methods;and (4) providing patient education materials for use during clinical visits. EVALUATION STRATEGIES AND EARLY FINDINGS At the outset of the Massachusetts initiative, both teams and representatives from the Massachusetts Department of Public Health and Massachusetts' Medicaid program worked collaboratively to design an evaluation plan for the fiveyear project.

BACKGROUND:Appreciative Inquiry is a motivational, organisational change intervention, which can be used to improve the quality and safety of healthcare. It encourages organisations to focus on the positive and investigate the best of 'what is' before thinking of 'what might be', deciding 'what should be' and experiencing 'what can be'. Its effects in healthcare are poorly understood. This review seeks to evaluate whether Appreciative Inquiry can improve healthcare.METHODS:Major electronic databases and grey literature were searched. Two authors identified reports of Appreciative Inquiry in clinical settings by screening study titles, abstracts and full texts. Data extraction, in duplicate, grouped outcomes into an adapted Kirkpatrick model: participant reaction, attitudes, knowledge/skills, behaviour change, organisational change and patient outcomes.RESULTS:We included 33 studies. One randomised controlled trial, 9 controlled observational studies, 4 qualitative studies and 19 non-controlled observational reports. Study quality was generally poor, with most having significant risk of bias. Studies report that Appreciative Inquiry impacts outcomes at all Kirkpatrick levels. Participant reaction was positive in the 16 studies reporting it. Attitudes changed in the seventeen studies that reported them. Knowledge/skills changed in the 14 studies that reported it, although in one it was not universal. Behaviour change occurred in 12 of the 13 studies reporting it. Organisational change occurred in all 23 studies that reported it. Patient outcomes were reported in eight studies, six of which reported positive changes and two of which showed no change.CONCLUSION:There is minimal empirical evidence to support the effectiveness of Appreciative Inquiry in improving healthcare. However, the qualitative and observational evidence suggests that Appreciative Inquiry may have a positive impact on clinical care, leading to improved patient and organisational outcomes. It is, therefore, worthy of consideration when trying to deliver improvements in care. However, high-quality studies are needed to prove its effects.PROSPERO REGISTRATION NUMBER:CRD42015014485.

Objective This article describes lessons learned from the collaborative creation of logical models and standard Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) profiles for family planning and reproductive health. The National Health Service delivery program will use the FHIR profiles to improve federal reporting, program monitoring, and quality improvement efforts. Materials and Methods Organizational frameworks, work processes, and artifact testing to create FHIR profiles are described. Results Logical models and FHIR profiles for the Family Planning Annual Report 2.0 dataset have been created and validated. Discussion Using clinical element models and FHIR to meet the needs of a real-world use case has been accomplished but has also demonstrated the need for additional tooling, terminology services, and application sandbox development. Conclusion FHIR profiles may reduce the administrative burden for the reporting of federally mandated program data.

ObjectivesTo describe the types of contraception used by women attending Title X-funded clinics and a comparable group of low-income reproductive-age women at risk of unintended pregnancy.Study designWe estimated the percentage of reproductive aged (15–44 years) women using contraception, by method type and level of effectiveness in preventing pregnancy (i.e., most, moderately, and less effective), using Title X Family Planning Annual Report (2006–2016) and National Survey of Family Growth (2006–2015) data. We divided most effective methods into permanent (female and male sterilization) and reversible (long-acting reversible contraceptives [LARCs]) methods.ResultsAmong Title X clients during 2006–2016, use of LARCs increased (3–14%); use of moderately effective methods decreased (64–54%); and use of sterilization (~2%), less effective methods (21–20%), and no method (8–7%) was unchanged. These same trends in contraceptive use were observed in a comparable group of women nationally during 2006–2015, during which LARC use increased (5–19%, p<.001); moderately effective method use decreased (60–48%, p<.001); and use of sterilization (~5%), less effective methods (19%), and no method (11–10%) was unchanged.ConclusionsThe contraceptive method mix among Title X clients differs from that of low-income women at risk of unintended pregnancy nationally, but general patterns and trends are similar in the two populations. Research is needed to understand whether method use patterns among low-income women reflect their preferences, access, or the conditions of the supply environment.ImplicationsThis study contributes to our understanding of patterns and trends in contraceptive use among two groups of reproductive-age women — Title X clients and low-income women nationally who are at risk of unintended pregnancy. The findings highlight areas for further research.

Background The relationship between unintended pregnancy and interpregnancy interval (IPI) across maternal age is not clear. Methods Using data from the National Survey of Family Growth, we estimated the percentages of pregnancies that were unintended among IPI groups (<6, 6–11, 12–17, 18–23, 24+ months) by maternal age at last live birth (15–19, 20–24, 25–29, 30–44 years). Results Approximately 40% of pregnancies were unintended and 36% followed an IPI<18 months. Within each maternal age group, the percentage of pregnancies that were unintended decreased as IPI increased. Conclusion Unintended pregnancies are associated with shorter IPI across the reproductive age spectrum.

Background: The federal Title X Family Planning Program supports the delivery of family planning services and related preventive care to 4 million individuals annually in the United States. The implementation of the 2010 Affordable Care Act's (ACA's) Medicaid expansion and provisions expanding access to health insurance, which took effect in January 2014, resulted in higher rates of health insurance coverage in the U.S. population; the ACA's impact on individuals served by the Title X program has not yet been evaluated. Methods: Using administrative data we examined changes in health insurance coverage among Title X clinic patients during 2005-2015. Results: We found that the percentage of clients without health insurance decreased from 60% in 2005 to 48% in 2015, with the greatest annual decrease occurring between 2013 and 2014 (63% to 54%). Meanwhile, between 2005 and 2015, the percentage of clients with Medicaid or other public health insurance increased from 20% to 35% and the percentage of clients with private health insurance increased from 8% to 15%. Conclusions: Although clients attending Title X clinics remained uninsured at substantially higher rates compared with the national average, the increase in clients with health insurance coverage aligns with the implementation of ACA-related provisions to expand access to affordable health insurance.

In the United States, almost half (45%) of the approximately 6 million pregnancies each year are unintended [ [1] Finer L.B. Zolna M.R. Declines in unintended pregnancy in the United States, 2008–2011. N Engl J Med. 2016; 374: 843-852 Crossref PubMed Scopus (1269) Google Scholar ]. These statistics indicate that many women experience barriers to achieving their desired reproductive outcomes, which has potential adverse consequences for women, children and society at large, such as higher rates of preterm birth, lower rates of breastfeeding and lower educational attainment [ 2 Conde-Agudelo A. Rosas-Bermudez A. Kafury-Goeta A.C. Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. JAMA. 2006; 295: 1809-1823 Crossref PubMed Scopus (765) Google Scholar , 3 DeFranco E.A. Seske L.M. Greenberg J.M. Muglia L.J. Influence of interpregnancy interval on neonatal morbidity. Am J Obstet Gynecol. 2015; 212: 386.e381-386.e389 Abstract Full Text Full Text PDF Scopus (38) Google Scholar , 4 Gipson J.D. Koenig M.A. Hindin M.J. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plan. 2008; 39: 18-38 Crossref PubMed Scopus (601) Google Scholar , 5 Sawhill I. Karpilow Q. Venator J. Families CoCa The impact of unintended childbearing on future generations. Brookings Institution, Washington, DC2014 Google Scholar , 6 Tsui A.O. McDonald-Mosley R. Burke A.E. Family planning and the burden of unintended pregnancies. Epidemiol Rev. 2010; 32: 152-174 Crossref PubMed Scopus (240) Google Scholar ]. Contraceptive care is a highly effective clinical intervention that can substantially reduce those adverse outcomes, help individuals and couples achieve their desired number and spacing of children, and save money [ 7 Foster D.G. Biggs M.A. Malvin J. Bradsberry M. Darney P. Brindis C.D. Cost-savings from the provision of specific contraceptive methods in 2009. Womens Health Issues. 2013; 23: e265-e271 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar , 8 Frost J. Finer L. Tapales A. The impact of publicly funded family planning clinic services on unintended pregnancies and government cost savings. J Health Care Poor Underserved. 2008; 19: 778-796 Crossref PubMed Scopus (57) Google Scholar , 9 Frost J.J. Sonfield A. Zolna M.R. Finer L.B. Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program. Milbank Q. 2014; 92: 696-749 Crossref PubMed Scopus (61) Google Scholar , 10 Sonfield A. Kost K. Institute TG Public costs from unintended pregnancies and the role of public insurance programs in paying for pregnancy and infant care: estimates for 2010. The Guttmacher Institute, New York, NY2015 Google Scholar , 11 Trussell J. Contraceptive failure in the United States. Contraception. 2011; 83: 397-404 Abstract Full Text Full Text PDF PubMed Scopus (982) Google Scholar ]. However, many women at risk of unintended pregnancy do not use contraception or use it incorrectly or inconsistently [ 12 Daniels K. Daugherty J. Jones J. Mosher W. Current contraceptive use and variation by selected characteristics among women aged 15–44: United States, 2011–2013. US National Center for Health Statistics, Hyattsville, MD2015 Google Scholar , 13 Jones R. Tapales A. Lindberg L. Frost J. Using longitudinal data to understand changes in consistent contraceptive use. Perspect Sex Reprod Health. 2015; 47: 131-139 Crossref PubMed Scopus (36) Google Scholar ], and there are documented barriers in access to and quality of contraceptive care services available [ [14] Obstet Gynecol. 2015; 125: 250-255 Crossref PubMed Google Scholar ].