AHRQ Grant HS021868: Related Publication Summaries

Building the Science of Public Reporting—Activating Consumer Interest

1. "Factors associated with increased cesarean risk among African American women: Evidence from California, 2010."

Huesch M, Doctor JN.
American Journal of Public Health 2015 May; 105(5):956-62.
PUBMED link:

These authors examined whether both observed and unobserved maternal health factors in African American women in hospitals or communities were associated with cesarean delivery of infants. They studied the relationship between African American race and cesarean delivery among 493,433 women discharged from 255 Californian hospitals in 2010. Cesarean rates were significantly higher overall for African American women than other women. Elevated risks persisted after risk adjustment (odds ratio >1.27), but the prevalence of particular risk factors varied. The researchers urge more research on patient-level health factors and higher likelihood of cesarean delivery in this group.

2. "Social media versus privacy and credibility."

Huesch MD.
IEEE Intelligent Systems 2015 Mar-Apr; 29(2):71-4. 

No PUBMED link.

In this commentary, the author discusses examples of potential conflicts with the growth of more powerful and intensive uses of health data and more extensive sources of data from non-traditional sources such as social media. For example, should a liver transplant team be allowed to use Instagram pictures of transplant candidates drinking alcohol to reject a patient’s eligibility on the waiting list? The author concludes that the fundamental tradeoff between legitimate patient privacy or free speech interests and reasonable health care system performance objectives should include the best care for patients or their dependents and the public availability of medical information that is not deliberately deceptive or manipulative. Another topic of debate is whether and how deceptive, manipulative, or harmful medical information spread through social media should be regulated.

3. "Privacy threats when seeking online health information."

Huesch MD.
JAMA Internal Medicine 2013 Oct 28; 173(19):1838-9.
PUBMED link:

This author comments on the lack of patient privacy for patients using the Internet to access free health-related information. Patients may assume that their inquiry on a particular disease, for example, is anonymous and won’t be divulged to others. However, both assumptions may be wrong.  Anonymity is threatened by the visible Internet address of the patient's computer or the often unique configuration of the patient's Web browser. Patient confidentiality is also threatened by the leakage of information to third parties through code on Web sites (e.g., iframes, conversion pixels, social media plug-ins) or implanted on patients’ computers (e.g., cookies, beacons). The author found visitor tracking to be less common on government and professional society Web sites, and recommends that consumers with privacy concerns either visit these sites or utilize privacy software.

4. "Measurement and risk adjustment of prelabor cesarean rates in a large sample of California hospitals."

Huesch MD, Currid-Halkett E, and Doctor JN.
American Journal of Obstetrics and Gynecology 2014 May; 210(5):443.el-17. 
PUBMED link:

For a proposed quality metric on prelabor cesareans in women without a prior cesarean, the researchers estimated patient-level risks and calculated how sensitive hospital rankings were to risk adjustment. They found that their models predict primary prelabor cesareans with good discrimination. Systematic hospital-level variation in patient risk factors required risk adjustment to avoid considerably different classification of hospitals by outcome performance.

5. "Cesarean delivery on maternal request."

Huesch MD, Doctor JN.
Journal of the American Medical Association 2013 September 4; 310(9):978.
PUBMED link:

The author criticizes an article by Ecker (JAMA 2103; 309(18):1930-36) on cesarean delivery on maternal request (CDMR) for not covering the long-term health risks to the infant. He mentions evidence linking CDMR to a variety of diseases and disorders that may, under one theory, be linked to the CDMR infant not being exposed to maternal vaginal microbes.

6. "Public hospital quality report awareness: evidence from National and Californian Internet searches and social media mentions."

Huesch MD, Currid-Halkett E, and Doctor JN.
BMJ Open 2014; 4(3):e004417. 
PUBMED link:

The researchers sought to understand how much consumers search for publicly available hospital quality reports, whether they mention such information in social media, and how positively they view this information. Using Google Trends and Google Adwords keyword analyses for 75 hospital quality-related terms, they concluded that consumers are somewhat aware of hospital quality based on internet search activity and social media disclosures.

7. "Using social media, online social networks, and Internet search as platforms for public health interventions: a pilot study."

Huesch MD, Galstyan A, Ong MK, Doctor JN.
Health Services Research 2016 Jun;51 Suppl 2:1273-90.
PUBMED link:

The researchers analyzed public health interventions aimed at women potentially interested in maternity care via campaigns on social media (Twitter), social networks (Facebook), and online search engines (Google Search). They found that the campaigns reached a little more than 140,000 consumers each day across the three platforms, with a little more than 400 engagements each day. Facebook and Google search had broader reach, better engagement rates, and lower costs than Twitter.


Page last reviewed May 2018
Page originally created October 2012
Internet Citation: AHRQ Grant HS021868: Related Publication Summaries. Content last reviewed May 2018. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/sciencepubreport/hs021868.html
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