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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
101 to 125 of 550 Research Studies DisplayedHunte R, Klawetter S, Paul S
"Black nurses in the home is working": advocacy, naming, and processing racism to improve Black maternal and infant health.
The purpose of this qualitative study was to examine how Black women’s health, pregnancy and parenting are impacted by racism, and how the relationship between Black women’s health, pregnancy and parenting and racism-related stress are affected by a culturally-specific perinatal care program. The researchers conducted focus groups and utilized a Black Feminist approach to center the perspectives and lived experiences of Black women. Four themes surfaced in the analysis, including: 1) The widespread reach of structural racism, 2) Trust and healing facilitated through shared identities, 3) Racism directly impacts mental health, and 4) Advocacy at all levels is a vital service. The researchers concluded that structural racism has chronic and toxic effects on Black women’s physical and mental health, and Black perinatal care should include: culturally-specific approaches, advocacy, mental health support with specific attention to racism-related stress, and examination of implicit biases.
AHRQ-funded; HS026370.
Citation: Hunte R, Klawetter S, Paul S .
"Black nurses in the home is working": advocacy, naming, and processing racism to improve Black maternal and infant health.
Matern Child Health J 2022 Apr;26(4):933-40. doi: 10.1007/s10995-021-03283-4..
Keywords: Racial and Ethnic Minorities, Women, Maternal Care, Pregnancy, Newborns/Infants, Cultural Competence
Eliason EL, Daw JR, Steenland MW
Changes in postpartum insurance coverage in the US during the COVID-19 pandemic.
The purpose of this study was to examine changes in postpartum insurance loss or changes (churn) in Medicaid-insured pregnant people during the COVID-19 pandemic. The researchers utilized the 2019 to 2021 Current Population Survey, Annual Social and Economic Supplement
(CPS-ASEC), with an annual sample size of approximately 98,000 households. The study covered 3 time periods: prepandemic (2019), early pandemic (2020), and pandemic (2021), and included female respondents aged 18 to 44 years who were living with a child
younger than 1 year at the time. Coverage was assigned to one of three categories: private, Medicaid, or uninsured. Churn was defined as loss of insurance or changes in insurance type between current insurance and insurance in the previous year. The study found that in 2019 (before the pandemic), among postpartum respondents with Medicaid during the last year, 88.2% had consistent Medicaid, 10.3% lost coverage, and 1.6%switched to private coverage. In 2021 (during the pandemic), consistent Medicaid increased by 6.8 percentage points and Medicaid-uninsured churn decreased by 6.6 percentage points representing a 64% decline from 2019. The researchers concluded that postpartum insurance loss decreased during the pandemic, primarily associated with large increases in consistent Medicaid coverage, and that these findings suggest that the Families First Coronavirus Response Act, which prevented Medicaid disenrollment, was associated with substantial reductions in postpartum Medicaid loss.
(CPS-ASEC), with an annual sample size of approximately 98,000 households. The study covered 3 time periods: prepandemic (2019), early pandemic (2020), and pandemic (2021), and included female respondents aged 18 to 44 years who were living with a child
younger than 1 year at the time. Coverage was assigned to one of three categories: private, Medicaid, or uninsured. Churn was defined as loss of insurance or changes in insurance type between current insurance and insurance in the previous year. The study found that in 2019 (before the pandemic), among postpartum respondents with Medicaid during the last year, 88.2% had consistent Medicaid, 10.3% lost coverage, and 1.6%switched to private coverage. In 2021 (during the pandemic), consistent Medicaid increased by 6.8 percentage points and Medicaid-uninsured churn decreased by 6.6 percentage points representing a 64% decline from 2019. The researchers concluded that postpartum insurance loss decreased during the pandemic, primarily associated with large increases in consistent Medicaid coverage, and that these findings suggest that the Families First Coronavirus Response Act, which prevented Medicaid disenrollment, was associated with substantial reductions in postpartum Medicaid loss.
AHRQ-funded; HS000011; HS027464.
Citation: Eliason EL, Daw JR, Steenland MW .
Changes in postpartum insurance coverage in the US during the COVID-19 pandemic.
JAMA Health Forum 2022 Apr;3(4):e220688. doi: 10.1001/jamahealthforum.2022.0688..
Keywords: COVID-19, Health Insurance, Maternal Care, Women, Pregnancy
Bui LN, Marshall C, Miller-Rosales C
Hospital adoption of electronic decision support tools for preeclampsia management.
Maternal morbidity and mortality can be reduced by the utilization of evidence-based clinical guidelines for preeclampsia management. Electronic health record (EHR)-based clinical decision support tools can improve the use of those guidelines. The purpose of this study was to investigate the organizational capabilities and hospital adoption of HER-based decision tools for preeclampsia management. The researchers conducted a cross-sectional analysis of hospitals that provided obstetric care in 2017. A total of 739 hospitals that responded to the 2017-2018 National Survey of Healthcare Organizations and Systems (NSHOS) and their results were linked to the 2017 Area Health Resources File (AHRF) and the American Hospital Association (AHA) Annual Survey Database. A final total of 425 hospitals from 49 states were analyzed. The primary outcome of the analysis was whether a hospital adopted EHR-based clinical decision support tools for preeclampsia management. The study found that 68% of the hospitals utilized EHR-based decision support tools for preeclampsia, and that hospitals with a single EHR system were more likely to adopt EHR-based decision support tools for preeclampsia than hospitals with multiple systems, including a combination of EHR and paper-based systems. The researchers also determined that hospitals with more processes to disseminate best patient care practices were more likely to adopt EHR-based decision support tools for preeclampsia management. The study concluded that having standardized EHRs and policies to disseminate evidence can help hospitals advance the use of EHR-based decision support tools for preeclampsia management in those hospitals that have not yet adopted them.
AHRQ-funded; HS024075.
Citation: Bui LN, Marshall C, Miller-Rosales C .
Hospital adoption of electronic decision support tools for preeclampsia management.
Qual Manag Health Care 2022 Apr-Jun;31(2):59-67. doi: 10.1097/qmh.0000000000000328..
Keywords: Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Pregnancy, Women
Tang LA, Jeffery AD, Leech AA
A comparison of methods to identify antenatal substance use within electronic health records.
This study described the development of a natural-language-processing-based algorithm for detecting antenatal substance use among individuals receiving perinatal care. Findings showed that the accuracy of antenatal substance use detection was improved with more stringent case definitions; however, the overall proportion of true cases confirmed by manual chart review decreased.
AHRQ-funded; HS026395.
Citation: Tang LA, Jeffery AD, Leech AA .
A comparison of methods to identify antenatal substance use within electronic health records.
Am J Obstet Gynecol MFM 2022 Mar;4(2):100535. doi: 10.1016/j.ajogmf.2021.100535..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Substance Abuse, Pregnancy, Women, Behavioral Health
Kramer RD, Higgins JA, Everett B
A prospective analysis of the relationship between sexual acceptability and contraceptive satisfaction over time.
This analysis examined the relationship between contraceptive method and sex life satisfaction. Eligible participants were individuals in the HER Salt Lake Contraceptive Initiative who switched contraceptive methods and continued their new method for at least 1 month and completed all relevant surveys. Primary predictor variables included changes in sexual functioning, sexual satisfaction, and perceived impact of the contraceptive method of sex life at one month. The sample included 1879 individuals. At 3 months 52.1% of participants were completely satisfied with their contraceptive method, 30.7% were somewhat satisfied, and 6.2% were completely dissatisfied. Patients at 3 months who said the method improved their sex life “a lot” had 7.7 times increased odds of greater satisfaction at 3 months than patients who said their contraceptive method made their sex life “a lot” worse at 1 month. Patients whose method improved their sex life a “little” had 5.88 times increased odds of greater satisfaction. Experiencing less or no vaginal bleeding was significantly associated with increased satisfaction.
AHRQ-funded; HS027220.
Citation: Kramer RD, Higgins JA, Everett B .
A prospective analysis of the relationship between sexual acceptability and contraceptive satisfaction over time.
Am J Obstet Gynecol 2022 Mar;226(3):396.31-96.e11. doi: 10.1016/j.ajog.2021.10.008..
Keywords: Sexual Health, Women
Wallace K, Stewart EA, Wise LA
Anxiety, depression, and quality of life after procedural intervention for uterine fibroids.
The authors studied quality of life (QOL) and psychological health following treatment for uterine fibroids (UFs). Using data from the COMPARE-UF registry, they found that UF symptoms were more severe among women reporting anxiety/depression at baseline. At the 1-year follow-up, health-related QOL scores improved among all women and the prevalence of anxiety/depression decreased in most, but not all, women. However, the severity of anxiety/depression worsened in a small percentage of women.
AHRQ-funded; HS023418.
Citation: Wallace K, Stewart EA, Wise LA .
Anxiety, depression, and quality of life after procedural intervention for uterine fibroids.
J Womens Health 2022 Mar;31(3):415-24. doi: 10.1089/jwh.2020.8915..
Keywords: Women, Quality of Life
Moniz MH, Dalton VK, Smith RD
Feasibility and acceptability of a toolkit-based process to implement patient-centered, immediate postpartum long-acting reversible contraception services.
The objectives of this single-site study were to develop a theory-informed toolkit, to evaluate the feasibility of toolkit-based implementation of immediate postpartum long-acting reversible contraception services, and to refine the toolkit. The study was conducted at a large academic medical center. The authors concluded that the toolkit-based process was associated with high acceptability but mixed healthcare quality outcomes. They suggested that future research should test the effectiveness of the refined toolkit in a multisite, prospective trial.
AHRQ-funded; HS025465.
Citation: Moniz MH, Dalton VK, Smith RD .
Feasibility and acceptability of a toolkit-based process to implement patient-centered, immediate postpartum long-acting reversible contraception services.
Am J Obstet Gynecol 2022 Mar; 226(3):394.e1-94.e16. doi: 10.1016/j.ajog.2021.10.009..
Keywords: Maternal Care, Patient-Centered Healthcare, Women, Sexual Health
Clowse MEB, Eudy AM, Balevic S
Hydroxychloroquine in the pregnancies of women with lupus: a meta-analysis of individual participant data.
The purpose of this meta-analysis study was to identify the possible benefits and harms of hydroxychloroquine (HCQ) use in lupus pregnancies. The researchers selected 7 datasets which met the inclusion criteria and compared pregnancy outcomes and lupus activity for pregnancies with a visit in the first trimester in women who did or did not take HCQ throughout pregnancy. The researchers evaluated 938 pregnancies in 804 women, and 668 pregnancies were included, representing one pregnancy per patient with a first trimester visit. Of those, 63% took HCQ throughout their pregnancy. The study reported those with HCQ had lower odds of highly active lupus than those without HCQ, but there was no difference in odds of pre-eclampsia, pre-term delivery or fetal loss. HCQ lowered the odds of preterm delivery in women with low lupus activity. The researchers concluded that among women who continue HCQ through pregnancy, there is a decrease in lupus activity, and no harm to pregnancy outcomes.
AHRQ-funded; HS023443.
Citation: Clowse MEB, Eudy AM, Balevic S .
Hydroxychloroquine in the pregnancies of women with lupus: a meta-analysis of individual participant data.
Lupus Sci Med 2022 Mar;9(1):e000651. doi: 10.1136/lupus-2021-000651..
Keywords: Medication, Pregnancy, Women, Chronic Conditions
Saulsberry L, Liao C, Huo D
Hypofractionated radiation therapy for breast cancer: financial risk and expenditures in the United States, 2008 to 2017.
This study examined the costs of hypofractionated whole breast irradiation (HF-WBI) compared with conventional whole breast irradiation (CF-WBI) and investigated the influences of patient characteristics and commercial insurance on HF-WBI use. This retrospective study used private employer-sponsored insurance claims to obtain a pooled cross-sectional evaluation of radiation therapy in patients with commercial insurance from 2008 to 2017. The study population included female patients with early-stage breast cancer treated with lumpectomy and whole breast irradiation. A total of 15,869 women received HF-WBI, and 59,328 CF-WBI. A higher proportion of college graduates and greater mixed racial composition was associated with increased HF-WBI use. Mean insurer-paid radiation therapy expenditures were significantly lower for HB-WBI versus CF-WBI (adjusted difference $6375). Mean patient out-of-pocket expenditures for HF-WBI was $139 less than for CF-WBI. Geographic variation existed across the United States with no consistent relationship between HF-WBI use and correspondent average cost differences.
AHRQ-funded; HS025806.
Citation: Saulsberry L, Liao C, Huo D .
Hypofractionated radiation therapy for breast cancer: financial risk and expenditures in the United States, 2008 to 2017.
Int J Radiat Oncol Biol Phys 2022 Mar;112(3):654-62. doi: 10.1016/j.ijrobp.2021.10.005..
Keywords: Cancer: Breast Cancer, Cancer, Healthcare Costs, Women
Sanders JN, Kean J, Zhang C
Measuring the sexual acceptability of contraception: psychometric examination and development of a valid and reliable prospective instrument.
This study’s objective was to develop and examine the psychometric properties of reliability, separation, and item fit of a new Contractive Sexual Acceptability (CSA) instrument among enrolled participants of the longitudinal cohort study HER Salt Lake. Study elements included the Female Sexual Function Index, the New Sexual Satisfaction Scale, measures of physical and mood-related side effects, and self-reported perceptions of contraception's sexual impacts. The authors evaluated (i) the reproducibility of relative measure location on the modeled linear latent variable, (ii) the number of statistically unique performance levels that can be distinguished by the measure, and (iii) the discrepancy between item responses and expectations of the model. They developed a 10-item CSA scale that exceeded the thresholds and sufficiently covered domains for use in contraceptive research and clinical settings. Starting with data on 39-items from 4,387 individuals, they identified 10-items that best measured the CSA latent construct. Final items included questions with scaled responses about pleasure and orgasm (orgasm quality, orgasm frequency, giving partner pleasure), physical (arousal and function) and psychological (emotional connection, surrender) components, general questions of satisfaction and frequency, and a measure of perceived impact of contraception on sexual experiences in the previous 4 weeks.
AHRQ-funded; HS027220.
Citation: Sanders JN, Kean J, Zhang C .
Measuring the sexual acceptability of contraception: psychometric examination and development of a valid and reliable prospective instrument.
J Sex Med 2022 Mar; 19(3):507-20. doi: 10.1016/j.jsxm.2021.12.007..
Keywords: Sexual Health, Women
Dude AM, Schueler K, Schumm LP
Preconception care and severe maternal morbidity in the United States.
This study’s objective was to measure the association between preconception care and the odds of severe maternal morbidity among women with Medicaid using a secondary analysis of Medicaid claims using Medicaid Analytic Extract files. Findings showed that contraceptive services in the year before conception and routine exams for women with chronic disease were associated with decreased odds of severe maternal morbidity or death for Medicaid enrollees.
AHRQ-funded; HS027027.
Citation: Dude AM, Schueler K, Schumm LP .
Preconception care and severe maternal morbidity in the United States.
Am J Obstet Gynecol MFM 2022 Mar;4(2):100549. doi: 10.1016/j.ajogmf.2021.100549..
Keywords: Maternal Care, Pregnancy, Women, Labor and Delivery, Sexual Health
Higashi RT, Rodriguez SA, Betts AC
Anal cancer screening among women with HIV: provider experiences and system-level challenges.
This article described current practices and barriers met in conducting anal cancer screenings for women living with HIV (WLWH) in an urban integrated safety-net system and in a non-profit community-based HIV clinic. Semi-structured interviews with clinical and administrative stakeholders were conducted to assess their screening for anal cancer experiences, knowledge, clinic practices and procedures. Barriers included limited knowledge of guidelines by providers and system-level issues such as lack of coordination between clinics and limitations on available resources. The authors concluded that screenings and follow-up require organization and coordination between multiple care teams, as well as improved clinical information systems to facilitate communication and infrastructure for managing abnormal results.
AHRQ-funded; HS022418.
Citation: Higashi RT, Rodriguez SA, Betts AC .
Anal cancer screening among women with HIV: provider experiences and system-level challenges.
AIDS Care 2022 Feb; 34(2):220-26. doi: 10.1080/09540121.2021.1883512..
Keywords: Cancer, Human Immunodeficiency Virus (HIV), Women, Screening
Mabry-Hernandez IR, Legg M
AHRQ Author: Mabry-Hernandez IR
Behavioral counseling interventions for healthy weight and weight gain in pregnancy.
This AHRQ-authored Putting Prevention Into Practice (PPIP) article is a quiz on the Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy U.S. Preventive Services Task Force (USPSTF) recommendation. Three questions are included with the answers and references at the end of the quiz. The questions are 1) Under what circumstances should physicians offer behavioral interventions; 2) What is the recommended gestational weight gain for the case study patient; and 3) Which of the 3 approaches to promote healthy weight gain during pregnancy are correct for the patient?
AHRQ-authored.
Citation: Mabry-Hernandez IR, Legg M .
Behavioral counseling interventions for healthy weight and weight gain in pregnancy.
Am Fam Physician 2022 Feb;105(2):187-88..
Keywords: U.S. Preventive Services Task Force (USPSTF), Pregnancy, Prevention, Women, Case Study, Evidence-Based Practice
Tice JA, Gard CC, Miglioretti DL
Comparing mammographic density assessed by digital breast tomosynthesis or digital mammography: the Breast Cancer Surveillance Consortium.
This study’s purpose was to assess the consistency of Breast Imaging Reporting and Data System (BI-RADS) breast density reporting comparing digital breast tomosynthesis (DBT) with digital mammography (DM) and to evaluate density as a breast cancer risk factor when assessed using DM versus DBT. A secondary analysis of data from the Breast Cancer Surveillance Consortium was used from 342,149 women aged 40-79 years who underwent at least two screening mammography examinations less than 36 months apart. There were no significant differences in breast density assessment in pairs consisting of one DM and one DBT examination (57,516 of 74,729 [77%]), two DM examinations (238,678 of 301,743 [79%]), and two DBT examinations (20,763 of 26,854). Results were similar when pair analysis was restricted to readings by the same radiologist. The breast cancer hazard ratios (HRs) for breast density were similar for DM and DBT. The HRs for density acquired using DM and DBT, respectively, were 0.55 and 0.37 for almost entirely fat, 1.47 and 1.36 for heterogeneously dense, and 1.72 and 2.05 for extremely dense breasts.
AHRQ-funded; HS018366.
Citation: Tice JA, Gard CC, Miglioretti DL .
Comparing mammographic density assessed by digital breast tomosynthesis or digital mammography: the Breast Cancer Surveillance Consortium.
Radiology 2022 Feb; 302(2):286-92. doi: 10.1148/radiol.2021204579..
Keywords: Cancer: Breast Cancer, Cancer, Women, Imaging, Screening, Diagnostic Safety and Quality
Reid LD, Weiss AJ, Fingar KR
AHRQ Author: Reid LD
Contributors to disparities in postpartum readmission rates between safety-net and non-safety-net hospitals: a decomposition analysis.
The authors assessed how patient, hospital, and community characteristics explain the safety-net hospital (SNH)/non-SNH disparity in postpartum readmission rates. Using HCUP data, they found that higher postpartum readmission rates at SNHs versus non-SNHs were largely due to differences in the patient mix rather than hospital factors. They recommended hospital initiatives to reduce the risk of postpartum readmissions among SNH patients. They concluded that improving factors that contribute to the disparity, including underlying health conditions and health inequities associated with race, will require enduring investments in public health.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Reid LD, Weiss AJ, Fingar KR .
Contributors to disparities in postpartum readmission rates between safety-net and non-safety-net hospitals: a decomposition analysis.
J Hosp Med 2022 Feb;17(2):77-87. doi: 10.1002/jhm.2769..
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Hospital Readmissions, Maternal Care, Women, Disparities
Cliff BQ
Do high-deductible health plans affect price paid for childbirth?
The purpose of this study was to test whether out-of-pocket costs and negotiated hospital prices for childbirth change after enrollment in high-deductible health plans (HDHPs) and whether price effects differ in markets with more hospitals. Administrative medical claims data from three large commercial insurers with plans in all U.S. states was provided by the Health Care Cost Institute. Findings showed that prices for childbirth in markets with more hospitals decreased after HDHP switch due to lower hospital prices for HDHPs relative to prices at those same hospitals for non-HDHPs.
AHRQ-funded; HS025614.
Citation: Cliff BQ .
Do high-deductible health plans affect price paid for childbirth?
Health Serv Res 2022 Feb;57(1):27-36. doi: 10.1111/1475-6773.13702..
Keywords: Labor and Delivery, Health Insurance, Healthcare Costs, Women
Lyndon A, Simpson KR, Spetz J
Psychometric properties of The Perinatal Missed Care Survey and missed care during labor and birth.
The purpose of this study was to confirm reliability and validity of the Perinatal Missed Care Survey in a large sample of nurses and hospitals, test construct validity with confirmatory factor analysis, and describe the prevalence of missed nursing care during labor and birth. The study found the survey to be a valid and reliable adaptation of the original MISSCARE instrument. This survey could potentially be used to measure nursing care quality and to assess the effectiveness of structural interventions to improve quality and safety.
AHRQ-funded; HS025715.
Citation: Lyndon A, Simpson KR, Spetz J .
Psychometric properties of The Perinatal Missed Care Survey and missed care during labor and birth.
Appl Nurs Res 2022 Feb;63:151516. doi: 10.1016/j.apnr.2021.151516..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Women
Rosenberg SM, O'Neill A, Sepucha K
Quality of life following receipt of adjuvant chemotherapy with and without bevacizumab in patients with lymph node-positive and high-risk lymph node-negative breast cancer.
The authors sought to describe and evaluate factors associated with diminished quality of life (QOL) following completion of active breast cancer treatment. They conducted a survey with patients 18 months after enrollment and found that the addition of bevacizumab to chemotherapy was not negatively associated with QOL at 18 months. A substantial proportion of participants reported problems related to pain or discomfort and anxiety or depression; as many reported problems can be amenable to intervention, timely referral to supportive resources, especially for women of color and those who have more extensive local therapy, is indicated.
AHRQ-funded; HS023680.
Citation: Rosenberg SM, O'Neill A, Sepucha K .
Quality of life following receipt of adjuvant chemotherapy with and without bevacizumab in patients with lymph node-positive and high-risk lymph node-negative breast cancer.
JAMA Netw Open 2022 Feb;5(2):e220254. doi: 10.1001/jamanetworkopen.2022.0254..
Keywords: Quality of Life, Cancer: Breast Cancer, Cancer, Women
Roman LA, Raffo JE, Strutz K
The impact of a population-based system of care intervention on enhanced prenatal care and service utilization among Medicaid-insured pregnant women.
Enhanced prenatal/postnatal care home visiting programs for Medicaid-insured women have significant positive impacts on care and health outcomes. However, enhanced prenatal care participation rates are typically low, enrolling <30% of eligible women. This study investigated the impacts of a population-based systems approach on timely enhanced prenatal care participation and other healthcare utilization. The investigators concluded that a population systems approach improved selected enhanced prenatal care participation and service utilization for Medicaid-insured women in a county population, those in practices with established clinical-community linkages, and Black women.
AHRQ-funded; HS020208.
Citation: Roman LA, Raffo JE, Strutz K .
The impact of a population-based system of care intervention on enhanced prenatal care and service utilization among Medicaid-insured pregnant women.
Am J Prev Med 2022 Feb;62(2):e117-e27. doi: 10.1016/j.amepre.2021.08.012..
Keywords: Maternal Care, Pregnancy, Medicaid, Women
Tabaac AR, Sutter ME, Haneuse S
The interaction of sexual orientation and provider-patient communication on sexual and reproductive health in a sample of U.S. women of diverse sexual orientations.
This study’s goal was to examine associations among provider-patient communication, past-year contraceptive use, and lifetime sexually transmitted infection. The authors analyzed data cross-sectionally from 22,554 women in the Growing Up Today Study and Nurses' Health Study 3 for the follow-up period of 1996 to 2020. Provider-patient communication was associated with higher likelihood of using all methods of past-year contraceptive use and lifetime STI diagnosis. Completely heterosexual women were 13% more likely than lesbians and 4% less likely than other groups to report a provider ever discussed their sexual and reproductive health (SRH). Sexual minority women whose providers discussed their SRH were less likely to report contraceptive non-use in the past year.
AHRQ-funded; HS026120.
Citation: Tabaac AR, Sutter ME, Haneuse S .
The interaction of sexual orientation and provider-patient communication on sexual and reproductive health in a sample of U.S. women of diverse sexual orientations.
Patient Educ Couns 2022 Feb; 105(2):466-73. doi: 10.1016/j.pec.2021.05.022..
Keywords: Sexual Health, Women, Clinician-Patient Communication, Communication
Dossett LA, Mott NM, Bredbeck BC
Using tailored messages to target overuse of Low-Value breast cancer care in older women.
The purpose of this study was to examine the role that an individual’s maximizing-minimizing trait, an inherent preference for more or less medical care, may influence the preference for low-value care in the omission of sentinel lymph node biopsy (SLNB) and post-lumpectomy radiotherapy in women 70 years of age or higher with early-stage, hormone-receptor positive invasive breast cancer. The researchers recruited women 70 years of age or higher (n=1600) who were maximizers (515), minimizers (550), or neutral (535), and presented them with a hypothetical breast cancer diagnosis and then randomized exposure to one of three follow-up messages. Messages included: 1) maximizer-tailored, 2) minimizer-tailored, or 3) neutral. The study reported that higher maximizing tendency correlated positively with electing both SLNB and radiotherapy on logistic regression. Any maximizer- or minimizer-tailoring decreased preference for SLNB in maximizing and neutral women but had no effect in minimizing women. Tailoring had no impact on radiotherapy decision, except for an increased probability of minimizers electing radiotherapy when presented with maximizer-tailored messaging. The study concluded that among women facing a hypothetical breast cancer diagnosis, tendencies for maximizing-minimizing are correlated with preferences for treatment.
AHRQ-funded; HS026030.
Citation: Dossett LA, Mott NM, Bredbeck BC .
Using tailored messages to target overuse of Low-Value breast cancer care in older women.
J Surg Res 2022 Feb;270:503-12. doi: 10.1016/j.jss.2021.10.005..
Keywords: Elderly, Cancer: Breast Cancer, Cancer, Women, Shared Decision Making, Clinician-Patient Communication, Communication
Schapira L, Zheng Y, Gelber SI
Trajectories of fear of cancer recurrence in young breast cancer survivors.
This prospective cohort study examined the effects of fear of cancer recurrence (FCR) among 965 young women enrolled in the Young Women’s Breast Cancer Study who are ≤40 years and had been diagnosed with stage 0 to stage III breast cancer. These women completed the 3-item Lasry Fear or Recurrence Index survey. Five FCR trajectories were identified with a majority of participants having moderate or high FCR that improved over time. A total of 6.9% participants had moderate FCR that worsened, and 21.7% had a high FCR at baseline that didn’t go lower throughout the study. White women had higher odds of being in a trajectory that improved over time than non-White women. One-third of women with severe FCR did not improve or worsened over 5 years after diagnosis. The authors indicated these women may require targeted mental health intervention.
AHRQ-funded; HS023680.
Citation: Schapira L, Zheng Y, Gelber SI .
Trajectories of fear of cancer recurrence in young breast cancer survivors.
Cancer 2022 Jan 15;128(2):335-43. doi: 10.1002/cncr.33921..
Keywords: Cancer: Breast Cancer, Cancer, Women
Cham S, Landrum MB, Keating NL
Use of germline BRCA testing in patients with ovarian cancer and commercial insurance.
The authors examined commercially insured populations to identify patient-, physician-, and practice-level characteristics associated with ovarian cancer testing rates. They found that only 33.9% of patients with commercial insurance were tested during the time period studied. Medical and gynecologic oncologists had similar rates of testing, while other physicians tested less often. Although independent practices often lack access to genetic counselors, women in this study had insurance coverage for in-person and telephonic counseling.
AHRQ-funded; HS024072.
Citation: Cham S, Landrum MB, Keating NL .
Use of germline BRCA testing in patients with ovarian cancer and commercial insurance.
JAMA Netw Open 2022 Jan 4;5(1):e2142703. doi: 10.1001/jamanetworkopen.2021.42703..
Keywords: Cancer: Ovarian Cancer, Cancer, Screening, Genetics, Health Insurance, Women
Kho RM, Desai VB, Schwartz PE
Endometrial sampling for preoperative diagnosis of uterine leiomyosarcoma.
This retrospective cohort study examined the effectiveness of endometrial sampling for preoperative detection of uterine leiomyosarcoma in women undergoing hysterectomy, identified factors associated with missed diagnosis, and compared the outcomes of patients who had a preoperative diagnosis with those patients who had a missed diagnosis. A total of 79 patients with uterine leiomyosarcoma were included in the study. Of those patients, 46 (58.2%) were diagnosed preoperatively and 33 postoperatively. The groups were similar in age, race/ethnicity, bleeding symptoms, and comorbidities. Women who had endometrial sampling performed with hysteroscopy had a higher likelihood of preoperative diagnosis. Patients with localized stage (vs distant stage) or tumor size >11 cm were less likely to be diagnosed preoperatively.
AHRQ-funded; HS024702.
Citation: Kho RM, Desai VB, Schwartz PE .
Endometrial sampling for preoperative diagnosis of uterine leiomyosarcoma.
J Minim Invasive Gynecol 2022 Jan;29(1):119-27. doi: 10.1016/j.jmig.2021.07.004.
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Keywords: Cancer, Diagnostic Safety and Quality, Surgery, Women
Gordon SH, Hoagland A, Admon LK
Extended postpartum Medicaid eligibility is associated with improved continuity of coverage in the postpartum year.
The purpose of this study was to explore whether states that adopt the American Rescue Plan Act 0f 2021 option to provide eligibility for pregnancy-related benefits for a full year after birth are likely to improve continuity of postpartum insurance coverage. The researchers utilized linked birth records, income, and all-payer claims data for Medicaid-paid births in Colorado during the period 2014-19. Continuity of coverage during one year postpartum among people eligible for low-income adult Medicaid as compared with those ineligible for Medicaid. The study found that retention of Medicaid coverage as a low-income adult was associated with 1.5 additional months of postpartum insurance enrollment and a 12-percentage-point increase in the probability of continuous insurance coverage during the first year after birth. The study concluded that states adopting the American Rescue Plan Act’s option to extend pregnancy-related benefits for a year after birth are likely to increase continuity of postpartum insurance coverage.
AHRQ-funded; HS027640.
Citation: Gordon SH, Hoagland A, Admon LK .
Extended postpartum Medicaid eligibility is associated with improved continuity of coverage in the postpartum year.
Health Aff 2022 Jan;41(1):69-78. doi: 10.1377/hlthaff.2021.00730..
Keywords: Maternal Care, Medicaid, Women, Pregnancy, Access to Care, Policy