SACRAMENTO – Smart Care California, a coalition of public and private health care purchasers that collectively purchase or manage care for more than 16 million people statewide, released the third annual C-Section Honor Roll.
The Honor Roll recognizes 122 hospitals that met or surpassed a federal target aimed at reducing births via Cesarean section (C-section) in first-time mothers with low-risk pregnancies.
On the list are both of Lake County’s hospitals, Adventist Health Clear Lake in Clearlake and Sutter Lakeside Hospital in Lakeport.
The U.S. Department of Health and Human Services adopted the Healthy People 2020 target of reducing nationwide C-section rates for low-risk, first-births to 23.9 percent, in part to respond to a rapid rise in medically unnecessary C-sections across the United States.
The California Health and Human Services Agency (CHHS) announced the awards, which reflect 2017 hospital discharge and birth certificate data from 240 California hospitals that offer maternity services. The 122 hospitals represent more than half of all hospitals that offer maternity services in California. By comparison, 111 hospitals made the 2017 Honor Roll.
“I congratulate these hospitals and providers for their work in reducing medically unnecessary C-sections,” said Michael Wilkening, CHHS Secretary. “The data shows that we are heading in the right direction, but we have more work to do.”
Evidence suggests that the chance of having a C-section delivery largely depends on aspects such as where a woman delivers and the practice patterns of her obstetric care team. Even for low-risk, first-birth pregnancies, huge variations are noted in rates of C-sections at individual hospitals. In California hospitals, these rates range from less than 15 percent to more than 70 percent.
Overuse of C-sections matters. For mothers, it can result in higher rates of complications like hemorrhage, transfusions, infection, and blood clots. Once a mother has had a C-section, she has a greater than 90 percent chance of having one again for subsequent births, leading to higher risks of additional major complications. The surgery also brings risks for babies, including higher rates of infection, respiratory complications, and neonatal intensive care unit stays.
Of the 122 hospitals being recognized this year, 71 have achieved Honor Roll status three years in a row.
"The increasing number of hospitals making the Honor Roll shows that collaborative action can lead to positive change,” said Elliott Main, MD, medical director for the California Maternal Quality Care Collaborative (CMQCC), which is leading a quality- improvement collaborative to promote vaginal birth in more than 100 California hospitals. “Thanks to the efforts of key stakeholders, we’ve been able to enhance data transparency, create a toolkit for obstetric providers, form hospital quality improvement collaboratives, engage purchasers and health plans, and much more.”
Health care purchasers are working with health plans to narrow variation around the national performance target for C-sections for low-risk, first time pregnancies.
Hospitals that submit data to the CMQCC Maternal Data Center and participate in CMQCC sponsored collaboratives to adopt best practices are progressively moving toward that target.
“Purchasers understand that variation starts with us if we each ask the delivery system to focus on different improvement targets,” said Lance Lang, MD, Chief Medical Officer at Covered California. “Through Smart Care California, the three state purchasers and the Pacific Business Group on Health have together made improving maternity care a priority and the results of the latest honor roll reflect how the delivery system has responded and we are delighted.”
To further address the problem, earlier this year the California Health Care Foundation, in partnership with CMQCC and Consumer Reports, launched My Birth Matters, a statewide educational campaign aimed at informing expectant mothers about the overuse of C-sections and encouraging meaningful conversations between patients and their care team.
The impact of obesity and overweight on the U.S. economy has eclipsed $1.7 trillion, an amount equivalent to 9.3 percent of the nation’s gross domestic product, according to a new Milken Institute report on the role excess weight plays in the prevalence and cost of chronic diseases.
The estimate includes $480.7 billion in direct health-care costs and $1.24 trillion in lost productivity, as documented in America’s Obesity Crisis: The Health and Economic Impact of Excess Weight.
The study draws on research that shows how overweight and obesity elevate the risk of diseases such as breast cancer, heart disease, and osteoarthritis, and estimates the cost of medical treatment and lost productivity for each disease.
For example, the treatment cost for all type 2 diabetes cases – one of the most prevalent chronic diseases connected to excess weight – was $121 billion and indirect costs were $215 billion. On an individual basis, that comes to $7,109 in treatment costs per patient and $12,633 in productivity costs.
America’s Obesity Crisis assesses the role excess weight plays in the prevalence of 23 chronic diseases and the economic consequences that result. To mention a few, obesity and overweight are linked to:
– 75 percent of osteoarthritis cases; – 64 percent of Type 2 diabetes cases; – 73 percent of kidney disease cases.
The findings suggest that more effective weight-control strategies could reduce both the health and economic burdens of chronic diseases, according to co-author Hugh Waters, director of health economics research at the Milken Institute.
“Despite the billions of dollars spent each year on public health programs and consumer weight-loss products, the situation isn’t improving,” Waters said. “A new approach is needed.”
The impact of obesity on chronic disease is not limited to the stress that added weight places on joints and the cardiovascular system.
For example, research indicates that hormones secreted by fat cells may trigger inflammation and increase insulin resistance. These reactions can, in turn, contribute to greater risk of type 2 diabetes, cardiovascular disease, and some cancers.
Nearly 40 percent of Americans were obese and 33 percent were overweight but not obese in 2016, according to the Centers for Disease Control and Prevention. The numbers have climbed steadily since 1962, when 13 percent of the population were obese and 32 percent were overweight.
Direct medical costs include payments made by individuals, families, employers, and insurance companies to treat the diseases in question. Indirect costs include the economic impact of work absences, lost wages, and reduced productivity of patients and caregivers.
The estimates in America’s Obesity Crisis are based on an analysis of data compiled by the Centers for Disease Control and Prevention, the National Center for Health Statistics, the U.S. Agency for Healthcare Research and Quality, and the Bureau of Labor Statistics.
The report relies on the World Health Organization’s definition of overweight as a body mass index of 25 to 29.9 and obesity as a BMI of 30 or higher.
NORTHERN CALIFORNIA – The Adventist Heart & Vascular Institute at Adventist Health St. Helena performed the Institute’s first implant of the WATCHMAN left atrial appendage closure device on a patient with atrial fibrillation.
Adventist Health St. Helena is one of the only medical centers in the North Bay to offer the WATCHMAN device as an alternative to the lifelong use of oral anticoagulant medications, such as warfarin, Xarelto and Eliquis, for people with atrial fibrillation not caused by a heart valve problem (also known as non-valvular atrial fibrillation).
The first procedure was performed in the cardiac catheterization lab at the hospital on Oct. 22.
An estimated five million Americans are affected by atrial fibrillation, an irregular heartbeat that feels like a quivering heart. People with atrial fibrillation have a five times greater risk of stroke than those with normal heart rhythms.
The WATCHMAN device closes off a blind pouch of the heart called the left atrial appendage, or LAA, to keep harmful blood clots that can form in the LAA from entering the bloodstream and potentially causing a stroke. By closing off the LAA, the risk of stroke may be reduced and, over time, patients may be able to stop taking warfarin or other blood thinners.
“The WATCHMAN device is a novel alternative for patients with non-valvular atrial fibrillation at risk for a stroke, especially those with a compelling reason not to be on blood thinners,” said Dr. Monica Divakaruni, an interventional cardiologist and medical director of the hospital’s structural heart program. “I’m proud we are offering this option as it provides patients with potentially life-saving stroke risk treatment.”
The WATCHMAN device has been implanted in more than 50,000 patients worldwide and is done in a one-time procedure. It is a permanent device that doesn’t have to be replaced and can’t be seen outside the body. The procedure is done under general anesthesia and takes about an hour. Patients commonly stay in the hospital overnight and leave the next day.
At the Adventist Heart & Vascular Institute, the WATCHMAN implant physician team is led by Dr. Divakaruni, interventional cardiologist Dr. Stewart Allen and cardiac electrophysiologists Dr. Daniel Kaiser and Dr. Peter Chang-Sing. Structural heart coordinator Christina Dovas, NP-BC, provides dedicated support, including patient education and facilitating communication between physicians, patients and referring providers.
The multidisciplinary structural heart team at the Adventist Heart & Vascular Institute is made up of cardiothoracic surgeons, interventional cardiologists, a dedicated nurse coordinator, highly skilled cardiac nurses, anesthesiologists and imaging professionals that collaborate to evaluate, diagnose and treat patients with atrial fibrillation or other structural heart conditions. Together, they are unified by a vision to help patients access new advances in treating these conditions to improve their quality of life.
Patients or physicians interested in learning more about the WATCHMAN procedure can call the Adventist Heart & Vascular Institute at 707-963-6322 or can visit www.adventistheart.org.
In California, 15.6 percent of young people ages 10 to 17 have obesity, giving California the 20th highest rate among all states, according to the newest national data released today. Mississippi has the highest youth obesity rate, at 26.1 percent, while Utah has the lowest, at 8.7 percent.
The data and analysis were released today by the Robert Wood Johnson Foundation. They come from the 2016 and 2017 National Survey of Children’s Health (NSCH), along with analysis conducted by the Health Resources and Services Administration’s Maternal and Child Health Bureau.
The new data show that racial and ethnic disparities persist. Nationally, black youth had nearly double the rate (22.5%) as white youth did (12.5%).
The rate for Hispanic youth falls between those two, at 20.6 percent, and Asian youth have the lowest rate, at just 6.4 percent. A new data brief from RWJF, including obesity rates for white, black, and Hispanic youth in California, is available at https://stateofobesity.org/.
“Childhood obesity continues to be major public health challenge, with significant financial and societal implications,” said Jamie Bussel, senior program officer at the Robert Wood Johnson Foundation (RWJF). “Far too many young people in this country are facing increased chances of diabetes, heart disease, and high blood pressure, all due to a preventable condition. And black and Latino youth are still more likely than their white peers to face these problems. We must help all children grow up at a healthy weight, so they can lead healthy lives, and save the nation billions in healthcare costs.”
The new analysis uses combined data from the 2016 and 2017 editions of the NSCH. Comparing the combined 2016-17 data to 2016 alone, only one state, North Dakota, had a statistically significant change in its obesity rate, which dropped from 15.8 percent to 12.5 percent.
Scientists predict that more than half of today’s children will be obese by age 35 if current trends continue. To help prevent that scenario, RWJF urges policymakers at all levels to prioritize obesity prevention and help all children have a healthier future.
Specific recommendations include:
– Congress and the Administration should maintain and strengthen essential nutrition supports for low-income children, families, and individuals through programs—like the Supplemental Nutrition Assistance Program (SNAP), the Child and Adult Care Food Program (CACFP), and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)—and expand programs and pilots to make healthy foods more available and affordable through the program.
– The U.S. Department of Agriculture should maintain nutrition standards for school meals that were in effect prior to USDA’s interim final rule from November 2017, as well as current nutrition standards for school snacks.
– The U.S. Department of Education should maintain the Office of Safe and Healthy Schools, as well as Title I and Title IV programs under the Every Students Succeeds Act (ESSA), through which schools can receive funding for physical education and physical activity initiatives.
– States should ensure that all students receive at least 60 minutes of physical education or activity during each school day.
– States should follow expert guidance and adopt and implement best practices—including by investment in Quality Rating and Improvement Systems—for nutrition, activity and screen time requirements and regulations covering child care and day care settings.
– States should support access for low-income families to targeted home visiting and community-based programs that provide families with resources and connections to parenting education, nutrition programs and other services.
– States and localities should ensure all restaurant meals marketed to children meet nutrition standards, and remove sugary drinks from all restaurant children’s meals.
– Food and beverage companies should eliminate children’s exposure to advertising and marketing of unhealthy products.
– States should refrain from adopting preemption policies that limit the ability of local communities to improve the health of their residents.
The National Survey of Children’s Health (NSCH) collects information on the health of children in the United States who are 0-17 years old. Parents or caregivers are asked to report their child’s height and weight, which can be used to calculate body-mass index (BMI) for children 10-17 years.
An advantage of the NSCH is that it supports both national and state-by-state estimates, so obesity rates between states can be compared. A limitation is that the survey collects parents’ report of their child’s height and weight, not direct measures.
Prior to 2016, the NSCH was significantly redesigned. Due to changes in the survey’s mode of data collection and sampling frame it is not possible to directly compare results from the 2016 or 2017 NSCH to earlier iterations.
Starting in 2016, the NSCH is being conducted as an annual survey and will continue to collect new data each year going forward, so trends over time can be evaluated, with 2016 data serving as a new baseline.
The Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA MCHB) funds and directs the NSCH and develops survey content in collaboration with a national technical expert panel and the U.S. Census Bureau, which then conducts the survey on behalf of HRSA MCHB.
The Robert Wood Johnson Foundation worked with HRSA MCHB to disseminate the latest obesity data.