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Intervention Focused - Coggle Diagram

- - - - collective responsibility
      - duty to enhance SRHS
  - - - to patients
      - to visitors
      - to staff
      - culture of respect
        
        build a case for urgency
        
        define the scope of the problem
  - - - findings demonstrating specific racial and ethnic minority groups receive less quality care
      - documented HCP who self report holding equality as a core value
    - - Immigrants
      - Women
      - Limited English Proficiency
      - Racial and Ethnic Minority Subgroups
      - Religious Minorities
  - - - capacity
      - availability
      - service delivery
- - - - PPH
      - premie birth reduction
    - - incarceration
      - insurance status
      - economic
      - education
      - social policies - segregation
- - - - understanding early warning signs associated with PRD
      - signs and symptoms of pregnancy
      - signs and symptoms of perinatal complications
      - optimal management of pregnancy and conditions associated with or exacterbated by pregnancy
      - participation in shared decision making
      - knowledge of coverage options
      - knowledge of SRHS
  - - - Staff Involvement, routine data collection
        
        Understand the purpose of collection
        
        Understand the history of race based research
        
        Have the ability to communicate the importance and purpose to paitents
      - System Learning
        
        Organization Culture
        
        Organizational factors (successful organizations have):
        
        substantial administrative support
        
        goals for improvement
        
        use of credible fedback
        
        strong physician leadership advocating beta blocker use
        
        quality
        
        safety
        
        justice
        
        equity
        
        accountability
        
        no blame no shame
        
        Donebedian model
        
        Structure monitoring and evaluation
        
        Process monitoring and evaluation
        
        outcome monitoring and evaluation
      - Data collection Standards
        
        Safety
        
        Quality
        
        Reliabile
        
        Respectful
        
        Consistent
  - - - Implicit bias reduction strategies
        
        mindfulness
        
        intergroup contact
        
        individuating
        
        perspective taking
      - communication training
    - - increase personal knowledge of implicit biases and stereotypes
      - disseminate knowledge from implicit bias reviews
      - disseminate knowledge on the impact of primary care visitis
      - raise awareness on health interventions focused on equity
      - raise awareness on importance of shared decision making
- - - - Funding Cuts
        
        Reduced number of clinics per state
        
        reduced access to contraception
        
        reduced access to SRHS
        
        Increasing necessity to travel to secure SRHS
        
        National Network of Abortion Funds
      - Economic consequences of unintended pregnancies
        
        Turnaway Study
        
        TRAP Laws
        
        gestational age limits
        
        coverage percentage of abortion during insurance exchanges
        
        Requiring admitting privileges
    - - Expansion and removal of cost barriers to SRHS
      - State mandated coverage for specific SRHS
      - Patient Protection and ACA - approved contraception without co-payments
    - - Insurance Status
      - reimbursement amount
      - eligibility criteria
      - Hyde Amendment
      - affects primarily patients of low SES
    - - MMRC Implementation
      - Capacity to review maternal deaths
      - quality of data
      - comprehensiveness
      - Scaling interventions - quality and safety bundles
      - administrative support
  - - - neighbourhood deprivation
      - concentration of crime
      - availability of SRHS
      - quality of SRHS
      - contraception
      - abortion
      - perinatal care
      - area of concentrated poverty
- - - - EACH Woman Act
        
        to restore abortion coverage for those who receive health coverage and care through other federal programs
        
        would prohibit states and federal government from banning or limiting abortion coverage in private insurance market
        
        to restore abortion coverage for those insured by Medicaid program
      - All Above All Network - nationwide network of reproductive rights and justice organizations
      - Womens Health Protection Act
        
        to reaffirm women’s right to abortion by making it unlawful for states to enact burdensome requirements that do not advance women’s health and safety, and make abortion services more difficult to access
        
        e.g., pre-viability abortion bans, unwarranted doctors and clinic regulations
    - - Hyde - designed disproportionate affect low SES women
      - right to access =/= right to funding
      - changes in federal and state funding
      - congress and senate
      - SCOTUS - Roe vs Dobbs
    - - Abortion Diaries
      - ShoutYourAbortion
  - - - Clinical Decision Making
      - Higher vs Lower Tiered Residency Programs
      - Seen by attending vs resident physicians
    - - 24 hr anesthesiology on site
      - pain management during labour
      - language services
      - shift length
      - time of day (MMR worse between 11pm-7am)
      - Off hours
    - - VLBW/LBW Premie
      - Level of care designations
      - neonatal house to staffing ratio
      - NICU outcomes
    - - Communication
      - Implicit bias
      - stereotypes
      - pain assessments
      - listening
      - shared decision making
      - respect
  - - - Educational Attainment
      - Crime
      - Neighbourhood Deprivation
    - - Smoking and Alcohol
      - Perinatal care
        
        adherence
        
        accessibility
    - - clinic closures
      - gestational age limits and eligibility
      - sexual and reproductive services
      - Short term politican decisions vs long term impact to womens care
      - Family planning services