Kristin Maiden

Christiana Care Health System, Wilmington, Delaware, United States

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Publications (11)21.34 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Gestational diabetes and hypertensive disorders of pregnancy identify women with an elevated lifetime risk of diabetes and cardiovascular disease. Methods: Prospective cohort of women recruited from the postpartum service of a large community-based academic obstetrical hospital after delivery of a pregnancy complicated by gestational diabetes (GDM) or a hypertensive disorder of pregnancy (HDP). Interviews were conducted, and validated surveys completed, before hospital discharge and again 3 months postpartum. Results: The study sample included 249 women: 111 with GDM, 127 with HDP, and 11 with both. Most, 230 (92.4%) had a PCP prior to pregnancy and 97 (39.0%) reported an office visit with their PCP during the prenatal period. Of the 176 (70.7%) participants who attended the 3-month study visit, 169 (96.0%) women with either diagnosis reported they had attended their 6-week postpartum visit. By the 3-month study visit, 51 (57.9%) women with GDM had completed follow-up glucose testing; 93 (97.9%) with HDP had follow-up blood pressure testing; and 101 (57.4%) with either diagnosis recalled ever having completed lipid screening. Women least likely to complete screening tests were those who had no college education, less than a high school level of health literacy, and who were not privately insured. Conclusion: There are important opportunities to improve postpartum testing for diabetes and CVD risk factor assessment. Most women were connected to primary care suggesting a "hand-off" to a primary care physician after pregnancy is feasible. More robust strategies may be needed to improve follow-up care for women with less education, lower health literacy, and those without private health insurance.
    Journal of Women's Health 08/2014; 23(9). DOI:10.1089/jwh.2013.4688 · 2.05 Impact Factor
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    ABSTRACT: The present study used data from several sources to 1) present information on mothers and births in a single state (Delaware); 2) present cost data to estimate health-related birth real costs; and 3) use the data to estimate the costs and impact on mothers, health care providers, and taxpayers. In addition, this study explicitly examined costs of births through the lens of unplanned/unintended teen and young adult births. Concomitantly, the medical cost of these pregnancies for most of these young mothers who had not wanted to be pregnant at the time, was paid for through the state's Medicaid program. The percentage of Medicaid funded births was much higher for young mothers than for older mothers. Ultimately, it was estimated that young teen (age 17 and under) births cost about $4.0 million each year, older teens (18-20) births $14.0 million, and young adults (21-24) over $26 million. The State funded almost 75 percent of the health care costs of young teen pregnancy prenatal care, deliveries, and newborn care, through Medicaid. And over 75 percent of these Medicaid costs are for births that were unintended at the time. The cost of unintended teen and young adult births funded through Medicaid in Delaware was approximately $25 million annually.
    Delaware medical journal 04/2014; 86(4):109-16.
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    ABSTRACT: Introduction: Effective communication is an integral component of patient safety, well informed health decisions and overall patient care. Our prior research suggests an underutilization of interpreter services by hospital staff caring for maternity patients. The purpose of this study was to develop an understanding of the attitudes and beliefs of the nursing staff regarding their experience caring for limited English proficiency (LEP) patients and their use of interpreter services. Methods: A focus group study was conducted at a large community-based academic medical center where language services were provided by on-site Spanish interpreters during daytime hours and a telephone interpretation service 24 hours a day 7 days a week. Fifteen nurses from labor and delivery, maternity triage, postpartum, and the neonatal intensive care units participated in one of three independent 1 hour focus groups. Participants were asked scripted questions about their thoughts and experiences caring for LEP patients and utilizing interpreter services. Each was audio-recorded and transcribed verbatim. Thematic analysis was used to identify, analyze and report patterns within the focus group data. Three independent coders were used to identify themes. Results: Analysis of transcripts indicated that nursing staff preferred in-person, qualified hospital interpreters, with telephone interpretation considered to be a sub-optimal alternative. Numerous logistical issues were reported as barriers to obtaining qualified interpretation for patients, making proper utilization of interpretation services on a consistent basis difficult. These included time constraints, high patient acuity, lack of advanced notification of the need for an interpreter, limited availability of in-person interpreters, long phone line waiting times, lack of portable interpretation devices, and a need for translated written information. Participants reported the use of hand gestures, key phrases in the patients' language, or family members, in order to facilitate communication. In addition, participants expressed feeling inadequate and nervous handling culturally sensitive situations with LEP patients. Conclusion: Within an inpatient setting where on-site and telephone interpreters were available to health care providers, communication with LEP patients remained a challenge. Findings from this study suggest a multi-pronged intervention is needed to improve accessibility and use of language services by nursing staff. Staff training on cultural competence, process modifications, and the implementation of tools and resources to assist in providing culturally-appropriate educational materials to LEP patients is needed.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Introduction: Limited English proficiency (LEP) and poor health literacy (HL) are barriers to effective patient-provider communication and impact health outcomes. During the current period of increased language diversity in the US, these are important considerations for health care providers. Starting in 2012, The Joint Commission requires that health systems provide qualified medical interpretation services to all patients in need of assistance. However, health systems are often unaware of the language needs and health literacy of their patients. Methods: Language surveys and HL assessments were administered on weekdays over a 6 week period to all women 1-2 days postpartum at a large community-based academic medical center. A qualified medical interpreter was used for all Spanish-speaking mothers. For other languages a telephone interpretation service was used. Language services were available at the institution from on-site Spanish interpreters during daytime hours and a telephone interpretation service 24 hours a day 7 days a week. Of the 415 women approached, 391 (94%) completed the survey and 361 (92%) completed the HL assessment. Best language, preferred language for health care communication, and use of interpreters during the hospital stay were assessed. Women who preferred a language other than English were classified as LEP. The Newest Vital Sign was administered to mothers 18 and older whose preferred language was English or Spanish. Results: We found 11.0% (95% CI 8.1%-14.5%) of postpartum women were LEP, 77% of whom preferred Spanish. A majority (76.7%) of LEP mothers reported using family members and 39.5% reported using unqualified staff members as interpreters during their hospital stay. Of the LEP mothers, 56% reported use of a qualified interpreter at least once: 17% using the on-site medical interpreter staff, 58% telephone interpretation service, and 25% using both. However, 58.1% of LEP mothers reported an unmet need for communication assistance at some point during their care. In addition, while adequate HL was found in 59.3% of the overall surveyed population, 69% of English Speaking and 100% of Spanish Speaking Hispanic mothers were found to have limited HL. Conclusion: Qualified medical interpreters may be underused when providing care to LEP women of childbearing age. A better understanding of the barriers to their effective use is needed. The high prevalence of poor health literacy suggests written information may not be helpful at improving communication for some populations.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Background: Gestational diabetes and hypertension identify women at high risk for future cardiovascular disease. Methods: We conducted a prospective cohort study of 199 women whose pregnancy was complicated by gestational diabetes (GDM) or pregnancy associated hypertension (HTN) at a large obstetrical hospital. Baseline data obtained at hospital discharge and for 145 (73%) 3 months later included measures of stress, depression, health literacy, and social support using validated scales and self-reported receipt of health care. The predictors of preventive health care were tested using chi-square, t-test, and Mann-Whitney U test. Results: 48.2% had GDM, 55.8% HTN, and 4% both. 85.9% of women had a primary care provider (PCP) and 37.7% saw their PCP during their pregnancy. Among women with GDM: 57% reported follow-up testing for diabetes. Women who were unmarried (p=<0.001) Medicaid-insured (p<0.001), no college education (p=0.02), or low health literacy (p=.03) were less likely to receive follow-up testing for diabetes. Among women with HTN: 51% recalled ever completing a lipid panel. Women <30 years (p<0.01) had Medicaid (p<0.05), or had no college education (p<0.001) were less likely to have had their cholesterol measured. Stress, depression, social support and health literacy were not significantly related. Conclusions: Women with medically complicated pregnancies were well-connected to health care before, during and after pregnancy. Low completed education, marital status, and not having private insurance were each significantly related to not completing follow-up care. These findings suggest a stronger system of care is needed and provides a strategy to address health disparities.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
  • American Journal of Obstetrics and Gynecology 01/2013; 208(1):S319. DOI:10.1016/j.ajog.2012.10.097 · 4.70 Impact Factor
  • American Journal of Obstetrics and Gynecology 01/2013; 208(1):S82. DOI:10.1016/j.ajog.2012.10.332 · 4.70 Impact Factor
  • Deborah Ehrenthal · Kristin Maiden · Linda Daniel
    American Journal of Obstetrics and Gynecology 01/2013; 208(1):S319-S320. DOI:10.1016/j.ajog.2012.10.099 · 4.70 Impact Factor
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    ABSTRACT: : To examine the independent contribution of risk factors developing during pregnancy to subsequent risk of obesity in young children. : We conducted a historical cohort study using data from electronic medical records of mothers and their 3,302 singleton offspring born between 2004 and 2007 at a community-based obstetric facility who attended a 4-year well visit at a pediatric practice network. The child's body mass index (BMI) z score at age 4 years was studied in relation to the mother's gestational weight gain, gestational diabetes mellitus, gestational hypertension or preeclampsia, and prenatal tobacco use. Institute of Medicine categories defined excess and inadequate gestational weight gain at term. Analysis of variance and multiple linear regression were used to test their independent relation to BMI. : Mothers were white (39%), African American (46%), and of Hispanic ethnicity (11%); 46% were privately insured. The association of net gestational weight gain with the child's BMI z score was significant after adjustment for prepregnancy maternal factors (P<.001); gestational diabetes mellitus, gestational hypertension, and tobacco use were not significant in adjusted models. Children of mothers with excess gestational weight gain had a higher mean BMI z score (P<.001) but a significant association was observed only for inadequate gestational weight gain after adjusting for prepregnancy BMI and other covariates. Prepregnancy BMI (P<.001), Hispanic ethnicity (P<.001), and being married (P<.05) were independently associated with increasing BMI z score of the offspring. : Preconception maternal factors had a greater influence on child obesity than prenatal factors. The gestational weight gain category was independently related to BMI z score of 4 year olds, but this association was significant only for mothers with inadequate gestational weight gain. : II.
    Obstetrics and Gynecology 01/2013; 121(1):115-21. DOI:10.1097/AOG.0b013e318278f56a · 5.18 Impact Factor
  • Ashwani Rao · Kristin Maiden · Ben Carterette · Deb Ehrenthal
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    ABSTRACT: Obesity is one of the most important health concerns in United States and is playing an important role in rising rates of chronic health conditions and health care costs. The percentage of the US population affected with childhood obesity and adult obesity has been on a constant upward linear trend for past few decades. According to Center for Disease control and prevention 35.7% of US adults are obese and 17% of children aged 2-19 years are obese. Researchers and health care providers in the US and the rest of world studying obesity are interested in factors affecting obesity. One such interesting factor potentially related to development of obesity is type of feeding provided to babies. In this work we describe an electronic health record (EHR) data set of babies with feeding method contained in the narrative portion of the record. We compare five supervised machine learning algorithms for predicting feeding method as a discrete value based on text in the field. We also compare these algorithms in terms of the classification error and prediction probability estimates generated by them.
    Proceedings of the ACM sixth international workshop on Data and text mining in biomedical informatics; 10/2012
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    ABSTRACT: The United States Preventive Services Task Force and numerous other organizations recommend the use of brief motivational interventions as evidence-based approaches to achieve effective behavior change. The extent to which community primary care providers are familiar or trained in these methods is not known. To assess awareness and training in the use of brief motivational interventions among primary care providers. Cross-sectional assessment of primary care providers' familiarity and training in the use of the 5A's and Motivational Interviewing (MI). Participants include physicians, nurse practitioners, and nurses attending professional education events focused on women and heart disease across a single state. Familiarity with the 5 A's and MI, assessed using a five-point Likert scale, and prior training in MI were measured using cross tabulations and chi-square testing. Of the 186 providers, only 32.1 percent were generally or very familiar with the 5A's and only 17.7 percent were generally or very familiar with MI. Although there were no statistically significant differences by provider types, family physicians may have been more familiar with the 5 A's while family physicians and general internists were significantly more familiar with MI than all provider types (p = .012). There was a significant association between recency of medical training and experience with MI training. There is a low level of familiarity with brief motivational interventions among primary care providers. Increasing post-graduate training in the 5 A's and MI can be an important strategy to increasing the effectiveness of the primary care provider in helping their patients achieve lasting behavior change.
    Delaware medical journal 01/2011; 83(1):17-21.