Sejal Tyle Hathi, MD MBA

All Publications

• #ThisIsOurLane: Incorporating Gun Violence Prevention into Clinical Care CURRENT TRAUMA REPORTS Hathi, S., Sacks, C. A. 2019; 5 (4): 169-173

  View details for DOI 10.1007/s40719-019-00174-6

  View details for Web of Science ID 000518226700001

• The quality of skilled birth attendants in Nepal: High aspirations and ground realities. PloS one Rajbhandari, R., Rai, S., Hathi, S., Thapa, R., Rai, I., Shrestha, A. 2019; 14 (4): e0214577

  Abstract

  BACKGROUND: While Nepal's maternal mortality ratio (MMR) has improved overall, the proportion of maternal deaths occurring in health facilities and attended to by skilled birth attendants (SBAs), has nearly doubled over 12 years. Although there are numerous socioeconomic, environmental and other factors at play, one possible explanation for this discrepancy between utilization of skilled maternal care services and birth outcomes lies in the quality of care being provided by SBAs. The objective of this study is to determine how competent SBAs are after training, across multiple settings and facility types in Nepal.METHODS: We used a quantitative cross-sectional analysis to evaluate a sample of 511 SBAs, all female, from 276 sub-health posts (SHP), health posts (HP), primary healthcare centers (PHC), and district and regional hospitals in the mountain, hill, and terai districts of Nepal. Any SBA actively employed by one of these health facilities was included. SBAs who had received less than three months of training were excluded. Outcomes were measured using SBAs' scores on a standardized knowledge assessment, clinical skills assessment, and monthly delivery volume, particularly as it compared with the WHO's recommendation for minimum monthly volume to maintain competence.RESULTS: SBAs on average exhibit a deficiency of both knowledge and clinical skills, failing to meet even the 80-percent standard that is required to pass training (knowledge: 75%, standard deviation 12%; clinical skills: 48%, standard deviation 15%). Moreover, SBAs are conducting very few deliveries, with only 7 percent (38/511) meeting the minimal volume recommended to maintain competence by the WHO, and a substantial fraction (70/511, 14%) performing an average of no monthly deliveries at all.CONCLUSIONS: Taken together, our findings suggest that while countries like Nepal have made important investments in SBA programs, these healthcare workers are failing to receive either effective training or sufficient practice to stay clinically competent and knowledgeable in the field. This could in part explain why institutional deliveries have generally failed to deliver better outcomes for pregnant women and their babies.

  View details for DOI 10.1371/journal.pone.0214577

  View details for PubMedID 30947314

• Research priorities for adolescent health in low- and middle-income countries: A mixed-methods synthesis of two separate exercises. Journal of global health Nagata, J. M., Hathi, S. n., Ferguson, B. J., Hindin, M. J., Yoshida, S. n., Ross, D. A. 2018; 8 (1): 010501

  Abstract

  In order to clarify priorities and stimulate research in adolescent health in low- and middle-income countries (LMICs), the World Health Organization (WHO) conducted two priority-setting exercises based on the Child Health and Nutrition Research Initiative (CHNRI) methodology related to 1) adolescent sexual and reproductive health and 2) eight areas of adolescent health including communicable diseases prevention and management, injuries and violence, mental health, non-communicable diseases management, nutrition, physical activity, substance use, and health policy. Although the CHNRI methodology has been utilized in over 50 separate research priority setting exercises, none have qualitatively synthesized the ultimate findings across studies. The purpose of this study was to conduct a mixed-method synthesis of two research priority-setting exercises for adolescent health in LMICs based on the CHNRI methodology and to situate the priority questions within the current global health agenda.All of the 116 top-ranked questions presented in each exercise were analyzed by two independent reviewers. Word clouds were generated based on keywords from the top-ranked questions. Questions were coded and content analysis was conducted based on type of delivery platform, vulnerable populations, and the Survive, Thrive, and Transform framework from the United Nations Global Strategy for Women's, Children's, and Adolescents' Health, 2016-2030.Within the 53 top-ranked intervention-related questions that specified a delivery platform, the platforms specified were schools (n = 17), primary care (n = 12), community (n = 11), parenting (n = 6), virtual media (n = 5), and peers (n = 2). Twenty questions specifically focused on vulnerable adolescents, including those living with HIV, tuberculosis, mental illness, or neurodevelopmental disorders; victims of gender-based violence; refugees; young persons who inject drugs; sex workers; slum dwellers; out-of-school youth; and youth in armed conflict. A majority of the top-ranked questions (108/116) aligned with one or a combination of the Survive (n = 39), Thrive (n = 67), and Transform (n = 28) agendas.This study advances the CHNRI methodology by conducting the first mixed-methods synthesis of multiple research priority-setting exercises by analyzing keywords (using word clouds) and themes (using content analysis).

  View details for PubMedID 29497507

  View details for PubMedCentralID PMC5825976

• The Right Way to Reform Health Care To Cut Costs, Empower Patients FOREIGN AFFAIRS Hathi, S., Kocher, B. 2017; 96 (4): 17–25

  View details for Web of Science ID 000403166600003

• Evaluation of Pain Management During First Trimester Surgical Abortions Using Moderate Sedation Falik, R., Alton, K., Hathi, S., Semere, L. LIPPINCOTT WILLIAMS & WILKINS. 2017: 9S

  View details for DOI 10.1097/01.AOG.0000514238.67563.a3

  View details for Web of Science ID 000402705800027

• RESEARCH PRIORITIES FOR ADOLESCENT HEALTH IN LOW- AND MIDDLE-INCOME COUNTRIES: A MIXED-METHODS SYNTHESIS OF TWO SEPARATE EXERCISES Nagata, J. M., Hathi, S., Ferguson, B., Hindin, M. J., Yoshida, S., Ross, D. A. ELSEVIER SCIENCE INC. 2017: S56-S57

  View details for DOI 10.1016/j.jadohealth.2016.10.295

  View details for Web of Science ID 000406846500104

• Electronic Health Records and the Frequency of Diagnostic Test Orders AMERICAN JOURNAL OF MANAGED CARE Hakim, I., Hathi, S., Nair, A., Narula, T., Bhattacharya, J. 2017; 23 (1): E16-?

  Abstract

  To determine whether electronic health record (EHR) access influences the number of laboratory and imaging tests ordered, which is a frequently cited mechanism for EHR-enabled cost savings.We analyzed data on non-federally employed office-based physicians from the 2008 to 2012 Electronic Health Medical Records Survey, a supplement to the National Ambulatory Medical Care Survey.We estimated logistic regressions to determine the relationship between EHR utilization and the volume of laboratory and imaging tests ordered in our study population, controlling for age, sex, race, clinic type, payer type, health status, comorbidities, and new patients.Physicians who actively used an EHR system ordered more complete blood count (CBC) tests than physicians who did not (odds ratio [OR], 1.34; P <.001), even after adjusting for patient demographics, health status, and case mix. EHR-using physicians also ordered more computerized tomography scans (OR, 1.41; P <.001) and x-rays (OR, 1.39; P <.001); the difference for magnetic resonance imaging scans was not significant (OR, 1.08; P = .449). Subgroup analysis highlighted differences in ordering among various patient cohorts.Using the most recent available nationally representative data, excluding federal and Veterans Affairs' hospitals, we found that physicians with EHR access ordered more tests than their non-EHR counterparts, thus contradicting a common rationale for EHR implementation. We argue that EHR use may actually increase healthcare expenditures by facilitating the ease of ordering tests. Whether these extra tests carry clinical utility requires further analysis.

  View details for Web of Science ID 000392952800003

  View details for PubMedID 28141935

• What Works in Fundraising Do Good Well: Your Guide to Leadership, Action, and Social Innovation Hathi, S., Kaur, R., Massachi, D. edited by Przybylo, J., Vasan, N. Jossey-Bass. 2013
• Building hospital management capacity to improve patient flow for cardiac catheterization at a cardiovascular hospital in Egypt. Joint Commission journal on quality and patient safety Wong, R., Hathi, S., Linnander, E. L., El Banna, A., El Maraghi, M., El Din, R. Z., Ahmed, A., Hafez, A. R., Allam, A. A., Krumholz, H. M., Bradley, E. H. 2012; 38 (4): 147-153

  Abstract

  Quality improvement (QI) has been shown to be effective in improving hospital care in high-income countries, but evidence of its use in low- and middle-income countries has been limited to date. The impact of a QI intervention to reduce patient waiting time and overcrowding for cardiac catheterization-the subset of procedures associated with the most severe bottlenecks in patient flow at the National Heart Institute in Cairo-was investigated.A pre-post intervention study was conducted to examine the impact of a new scheduling system on patient waiting time and overcrowdedness for cardiac catheterization. The sample consisted of 628 consecutive patients in the pre-intervention period (July-August 2009) and 1,607 in the postintervention period (September-November 2010).The intervention was associated with significant reductions in waiting time and patient crowdedness. On average, total patient waiting time from arrival to beginning the catheterization procedure decreased from 208 minutes to 180 minutes (13% decrease, p < .001). Time between arrival at registration and admission to inpatient ward unit decreased from 33 minutes to 24 minutes (27% decrease, p < .001). Patient waiting time immediately prior to the catheterization laboratory procedure decreased from 79 minutes to 58 minutes (27% decrease, p < .001). The percentage of patients arriving between 7:00 A.M. and 9:00 A.M. decreased from 88% to 44% (50% decrease, p < .001), reducing patient crowding.With little financial investment, the patient scheduling system significantly reduced waiting time and crowdedness in a resource-limited setting. The capacity-building effort enabled the hospital to sustain the scheduling system and data collection after the Egyptian revolution and departure of the mentoring team in January 2011.

  View details for PubMedID 22533126

  View details for PubMedCentralID PMC3427659

• Helping Others: Finding the Will and the Way Dreams of a Nation Hathi, S. edited by Miller, T. SEE Innovation. 2011
• Effective Practices for Engaging At-Risk Youth in Service Hathi, S., Bhaerman, B. Youth Service America . 2008