National Healthcare Quality and Disparities Report
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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
26 to 50 of 549 Research Studies DisplayedPutnam KE, Biel FM, Hoopes M
Landscape of pregnancy care in US community health centers.
This retrospective cohort study utilized EHR data from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) to describe clinic and patient characteristics associated with longitudinal prenatal care delivery in community health centers (CHCs). Results showed that 41% of CHCs provided longitudinal prenatal care, and these CHCs were more likely to be larger, have multidisciplinary teams, and serve higher proportions of nonwhite or non-English speaking patients. Patients who received longitudinal prenatal care at CHCs were racially and ethnically diverse and many had comorbidities. The authors concluded that CHCs provided critical access to care for vulnerable populations and will be important in addressing inequities in maternal morbidity and mortality.
AHRQ-funded; HS025155.
Citation: Putnam KE, Biel FM, Hoopes M .
Landscape of pregnancy care in US community health centers.
J Am Board Fam Med 2023 Aug 9; 36(4):574-82. doi: 10.3122/jabfm.2023.230025R1..
Keywords: Maternal Care, Community-Based Practice, Women, Access to Care
Viswanathan M, Urrutia RP, Hudson KN
Folic acid supplementation to prevent neural tube defects: updated evidence report and systematic review for the US Preventive Services Task Force.
The objective of this evidence review was to evaluate new evidence on the benefits and harms of folic acid supplementation for the prevention of neural tube defects to inform the US Preventive Services Task Force. New evidence from observational studies provided evidence of the benefit of folic acid supplementation and no evidence of harms related to multiple gestation, autism, or maternal cancer. The new evidence was consistent with previously reviewed evidence on benefits and harms.
AHRQ-funded; 75Q80120D00007.
Citation: Viswanathan M, Urrutia RP, Hudson KN .
Folic acid supplementation to prevent neural tube defects: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Aug 1; 330(5):460-66. doi: 10.1001/jama.2023.9864..
Keywords: U.S. Preventive Services Task Force (USPSTF), Evidence-Based Practice, Guidelines, Newborns/Infants, Maternal Care, Women
Steele DW, Adam GP, Saldanha IJ
Postpartum home blood pressure monitoring: a systematic review.
This systematic review’s objective was to assess the effectiveness of postpartum home blood pressure (BP) monitoring compared with clinic-based follow-up and the comparative effectiveness of alternative home BP-monitoring regimens. The authors included randomized controlled trials (RCTs), nonrandomized comparative studies, and single-arm studies that evaluated the effects of postpartum home BP monitoring (up to 1 year), with or without telemonitoring, on postpartum maternal and infant outcomes, health care utilization, and harm outcomes. After double screening, they extracted demographics and outcomes to SRDR+. Thirteen studies (3 RCTs, 2 nonrandomized comparative studies, and 8 single-arm studies) met eligibility criteria. Home BP monitoring was not associated with the rate of BP treatment initiation but was associated with reduced unplanned hypertension-related hospital admissions. Home BP monitoring, compared with office-based follow-up, was associated with reduced racial disparities in BP ascertainment by approximately 50%. Most patients (ranging from 83.3% to 87.0%) were satisfied with management related to home BP monitoring.
AHRQ-funded; 75Q80120D00001; 75Q80121F32006.
Citation: Steele DW, Adam GP, Saldanha IJ .
Postpartum home blood pressure monitoring: a systematic review.
Obstet Gynecol 2023 Aug 1; 142(2):285-95. doi: 10.1097/aog.0000000000005270..
Keywords: Maternal Care, Blood Pressure, Women, Evidence-Based Practice, Patient-Centered Outcomes Research
Gupta N, Kucirka L, Semerjian A
Practice patterns regarding female reproductive organ-sparing and nerve-sparing radical cystectomy among urologic oncologists in the United States.
The purpose of this study was to describe practice patterns regarding female reproductive organ-sparing (ROS) and nerve-sparing radical cystectomy nerve-sparing radical cystectomy (RC) among US urologists. The researchers conducted a cross-sectional survey of members of the Society of Urologic Oncology to evaluate provider-reported frequency of ROS and nerve-sparing RC in premenopausal and postmenopausal patients with non-muscle-invasive bladder cancer that failed intravesical therapy or clinically localized muscle-invasive bladder cancer. The study found that among 101 urologists, 79.2% reported that they routinely resect the uterus/cervix, 67.3% the neurovascular bundle, 48.5% the ovaries, and 18.8% a portion of the vagina when performing RC in premenopausal patients with organ-confined disease. When asked about changes to approach in postmenopausal patients, 70.3% reported that they were less likely to spare the uterus/cervix, 43.6% were less likely to spare the neurovascular bundle, 69.3% were less likely to spare the ovaries, and 22.8% were less likely to spare a portion of the vagina.
AHRQ-funded; HS026120.
Citation: Gupta N, Kucirka L, Semerjian A .
Practice patterns regarding female reproductive organ-sparing and nerve-sparing radical cystectomy among urologic oncologists in the United States.
Clin Genitourin Cancer 2023 Aug; 21(4):e236-e41. doi: 10.1016/j.clgc.2023.01.010..
Keywords: Practice Patterns, Women, Sexual Health, Surgery, Cancer
Foraker R, Phommasathit C, Clevenger K
Using the sociotechnical model to conduct a focused usability assessment of a breast reconstruction decision tool.
The purpose of this study was to collect patients' and clinicians' perspectives on barriers and facilitators for implementing BREASTChoice, a web-based breast reconstruction decision aid, into the clinical workflow. From August 2020 to April 2021, the researchers conducted 12 qualitative interviews with patients and clinicians from two Midwestern medical specialty centers. The study found patients and clinicians agreed that BREASTChoice could provide benefits in a number of areas including: 1) BREASTChoice could assist patients make more informed decisions about their reconstruction and improve preparation for their first plastic surgery appointment; 2) BREASTChoice could improve communication and processes if the patient could view the tool at home and/or in the waiting room; 3) Clinicians recommended the information from BREASTChoice about patients' risks and preferences could be included in the patient's chart or the clinician electronic health record (EHR) inbox for access during the consultation; 5) Patients and clinicians indicated that the BREASTChoice tool does not require much time for the patient to use, efficiently fills gaps in knowledge, includes helpful information. Patients did report requiring time to properly read and digest the information.
AHRQ-funded; HS026699.
Citation: Foraker R, Phommasathit C, Clevenger K .
Using the sociotechnical model to conduct a focused usability assessment of a breast reconstruction decision tool.
BMC Med Inform Decis Mak 2023 Jul 28; 23(1):140. doi: 10.1186/s12911-023-02236-x..
Keywords: Shared Decision Making, Women, Cancer: Breast Cancer, Cancer
Smith DC, Phillippi JC, Tilden EL
Comparing cesarean birth utilization between US hospitals: a demonstration of the robson ten-group classification system for use in quality improvement and benchmarking.
The objective of this study was to describe the application and utility of the World Health Organization-endorsed Robson Ten-Group Classification System (TGCS) to compare hospital-level cesarean births rates for use in quality improvement and benchmarking. The authors conducted a descriptive, secondary data analysis of the Consortium on Safe Labor dataset using data from births from 2002-08 at 12 sites across the US. Results showed a variation in use of cesarean birth, labor induction, and trial of labor after cesarean (TOLAC) across the 12 sites. The authors concluded that TGCS provides a method for between-hospital comparisons and adoption of TGCS in the US would provide an effective benchmarking tool to assist in reducing the use of cesarean birth and increasing the support of TOLAC.
AHRQ-funded; HS024733.
Citation: Smith DC, Phillippi JC, Tilden EL .
Comparing cesarean birth utilization between US hospitals: a demonstration of the robson ten-group classification system for use in quality improvement and benchmarking.
J Perinat Neonatal Nurs 2023 Jul-Sep; 37(3):214-22. doi: 10.1097/jpn.0000000000000670..
Keywords: Hospitals, Healthcare Utilization, Maternal Care, Women, Quality Improvement, Quality Measures, Quality of Care
Bossick AS, Painter I, Williams EC
Development of a composite risk index of reproductive autonomy using state laws: association with maternal and neonatal outcomes.
This study investigated whether greater reproductive autonomy would be associated with lower rates of severe maternal morbidity (SMM), pregnancy-related mortality (PRM), preterm birth (PTB), and low birthweight. It was hypothesized that greater reproductive autonomy would lower the risks of poor maternal and neonatal outcomes. The authors developed a composite index to quantify state legislation, which was used to examine the association with maternal and neonatal outcomes. A Delphi panel was used to inform index development, and restrictive policies were assigned values of -1 and enabling policies +1. Publicly available data was used to conduct a cross-sectional study of all live births in the 50 US states for people ages 15 to 44 from 2016 to 2018 to examine the association between the risk index and PRM, SMM, PTB, and low birthweight. There were 11,530,785 births, 2,846 pregnancy-related deaths, and 154,384 cases of SMM from 2016 to 2018. The Delphi panel found a summed state measure of 106 laws in 8 categories that could affect reproductive anatomy. In adjusted analyses, states in the most enabling reproductive autonomy quartile had a 44.7 per 10,000 higher rate of SMM compared with the most restrictive quartile. However, the most enabling quartile was associated with a 9.87 per 100,000 lower rate of PRM and 0.67 per 100 lower rate of PTB compared with the most restrictive quartile.
AHRQ-funded; HS013853.
Citation: Bossick AS, Painter I, Williams EC .
Development of a composite risk index of reproductive autonomy using state laws: association with maternal and neonatal outcomes.
Womens Health Issues 2023 Jul-Aug; 33(4):359-66. doi: 10.1016/j.whi.2023.03.008..
Keywords: Maternal Care, Sexual Health, Women, Newborns/Infants, Outcomes, Patient-Centered Outcomes Research
Estenson L, Kim N, Jacobson M
Do age-based discontinuation recommendations influence cervical cancer screening rates? Evidence from the United States' Behavioral Risk Factor Surveillance System, 2016 and 2018.
The purpose of this study was to determine how the United States Preventive Services Task Force (USPSTF) recommendation of discontinuing routine cervical cancer screening for certain women after age 65 affects Papanicolaou (Pap) test rates among women at age 66 in the United States. The researchers utilized nationally representative 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) data for 226,031 women ages 56-76 to calculate changes in annual Pap test rates at age 66. Among women 66-76, 22.5% indicated they had received a Pap test within the past year. At age 66, annual Pap rates decreased by 5.9 percentage points (p.p.) off a pre-66 rate of 39 percent. The change differed by race/ethnicity, education, and marital status. Pap rates did not change discretely for non-Hispanic Black women but did change for women from other racial/ethnic groups. The decrease was larger for women who graduated college than for women without a college degree and for women who were never married than for women who were married/partnered or divorced/separated. The USPSTF recommendation to stop cervical cancer screening after the age of 65 resulted in a substantial decrease in the rate of Pap tests at age 66 but disparately affects women based on marital status, education and race.
AHRQ-funded; HS026488.
Citation: Estenson L, Kim N, Jacobson M .
Do age-based discontinuation recommendations influence cervical cancer screening rates? Evidence from the United States' Behavioral Risk Factor Surveillance System, 2016 and 2018.
Prev Med 2023 Jul; 172:107543. doi: 10.1016/j.ypmed.2023.107543..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Cervical Cancer, Cancer, Screening, Prevention, Evidence-Based Practice, Women, Sexual Health
Eliason E, Admon LK, Steenland MW
Late postpartum coverage loss before COVID-19: implications for Medicaid unwinding.
The purpose of this study was to explore the loss of Medicaid coverage in toward the end of the postpartum period prior to COVID-19 and describe the implications for Medicaid unwinding. The researchers utilized unique Pregnancy Risk Assessment Monitoring System follow-up data from prior to the COVID-19 pandemic. The study found that only 68% of enrollees in prenatal Medicaid maintained continuous Medicaid coverage through 9 or 10 months postpartum. Of the total prenatal Medicaid enrollees who lost their coverage in the early postpartum period, two-thirds continued to be uninsured 9 to 10 months postpartum. The researchers concluded that extensions to state postpartum Medicaid could prevent a return to postpartum coverage loss rates similar to the level in the prepandemic period.
AHRQ-funded; HS027464; HS000011.
Citation: Eliason E, Admon LK, Steenland MW .
Late postpartum coverage loss before COVID-19: implications for Medicaid unwinding.
Health Aff 2023 Jul; 42(7):966-72. doi: 10.1377/hlthaff.2022.01659..
Keywords: COVID-19, Maternal Care, Medicaid, Women, Access to Care, Uninsured, Health Insurance
Balk EM, Danilack VA, Bhuma MR
Reduced compared with traditional schedules for routine antenatal visits: a systematic review.
This systematic review’s objective was to assess differences in maternal and child outcomes in studies comparing reduced routine antenatal visit schedules with traditional schedules. The search was conducted in multiple databases searching for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms. Abstrackr was used for double independent screening for studies comparing televisits and in person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. The authors found five randomized controlled trials and five nonrandomized comparative studies that compared reduced routine antenatal visit schedules with traditional schedules. The studies did not find differences between schedules in gestational age at birth, likelihood of being small for gestational age, likelihood of a low Apgar score, likelihood of neonatal intensive care unit admission, maternal anxiety, likelihood of preterm birth, and likelihood of low birth weight. There was also insufficient evidence for numerous prioritized outcomes of interest, including completion of the American College of Obstetricians and Gynecologists-recommended services and patient experience measures.
AHRQ-funded; 75Q80120D00001.
Citation: Balk EM, Danilack VA, Bhuma MR .
Reduced compared with traditional schedules for routine antenatal visits: a systematic review.
Obstet Gynecol 2023 Jul 1; 142(1):8-18. doi: 10.1097/aog.0000000000005193..
Keywords: Maternal Care, Newborns/Infants, Women, Patient-Centered Outcomes Research, Outcomes, Comparative Effectiveness, Evidence-Based Practice
Balk EM, Danilack VA, Cao W
Televisits compared with in-person visits for routine antenatal care: a systematic review.
This systematic review’s objective was to compare benefits and harms of televisits and in-person visits in people receiving routine antenatal visit care. The search was conducted in multiple databases searching for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms. Abstrackr was used for double independent screening for studies comparing televisits and in person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. The authors found two randomized controlled trials, four nonrandomized comparative studies, and one survey that compared visit types between 2004 and 2020, three of which were conducted during the COVID-19 pandemic. The studies found low-strength evidence that hybrid (televisits and in-person visits) and all in-person visits did not indicate differences in rates of neonatal intensive care unit admission of the newborn or preterm births. However, the COVID-19 pandemic confounded the association between the use of hybrid visits and preterm birth. The authors also found there is low-strength evidence that satisfaction with overall antenatal care was greater in people who were pregnant and receiving hybrid visits.
AHRQ-funded; 75Q80120D00001.
Citation: Balk EM, Danilack VA, Cao W .
Televisits compared with in-person visits for routine antenatal care: a systematic review.
Obstet Gynecol 2023 Jul 1; 142(1):19-29. doi: 10.1097/aog.0000000000005194..
Keywords: Telehealth, Health Information Technology (HIT), Maternal Care, Women
Blebu BE, Liu PY, Harrington M
Implementation of cross-sector partnerships: a description of implementation factors related to addressing social determinants to reduce racial disparities in adverse birth outcomes.
The purpose of this mixed methods design study was to integrate the perspectives of healthcare staff and community-based partner organizations to describe the implementation of a cross-sector partnership developed for the purpose of addressing social and structural determinants in pregnancy. The researchers utilized in-depth interviews and social network analysis to incorporate the perspectives of healthcare clinicians and staff with the views of community-based partner organizations to identify implementation factors related to cross-sector partnerships. The study identified 7 implementation variables related to 3 themes: strengths of a network approach to cross-sector collaboration, relationship-centered care, and barriers and facilitators of cross-sector partnerships. The study results highlighted establishing relationships between healthcare staff, patients, and community-based partner organizations.
AHRQ-funded; HS026407.
Citation: Blebu BE, Liu PY, Harrington M .
Implementation of cross-sector partnerships: a description of implementation factors related to addressing social determinants to reduce racial disparities in adverse birth outcomes.
Front Public Health 2023 Jun 16; 11:1106740. doi: 10.3389/fpubh.2023.1106740..
Keywords: Social Determinants of Health, Disparities, Racial and Ethnic Minorities, Maternal Care, Women, Implementation
Venkatesh KK, Grobman WA, Wu J
Association of a large-for-gestational-age infant and maternal prediabetes mellitus and diabetes mellitus 10 to 14 years after delivery in the Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study.
Hypothesizing that having a large-for-gestational-age (LGA) infant even without gestational diabetes mellitus (GDM) may be a precursor to postpartum dysglycemia, researchers estimated the association of having had an LGA infant with developing maternal prediabetes mellitus and type 2 diabetes mellitus after delivery among individuals without GDM. They conducted a secondary analysis of the prospective Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO FUS). Their findings suggested that having an LGA infant was associated with a higher risk of prediabetes mellitus or diabetes mellitus by 10 to 14 years
after delivery.
after delivery.
AHRQ-funded; HS028822.
Citation: Venkatesh KK, Grobman WA, Wu J .
Association of a large-for-gestational-age infant and maternal prediabetes mellitus and diabetes mellitus 10 to 14 years after delivery in the Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study.
Am J Obstet Gynecol 2023 Jun; 228(6):756-58.e3. doi: 10.1016/j.ajog.2023.02.017..
Keywords: Newborns/Infants, Maternal Care, Women, Diabetes
Saldanha IJ, Adam GP, Kanaan G
Health insurance coverage and postpartum outcomes in the US: a systematic review.
The objective of this evidence review was to assess whether extension of health insurance coverage or improvements in health care access are associated with postpartum health care utilization and maternal outcomes. Findings with moderate strength of evidence suggested that more comprehensive association was likely to be related to greater postpartum visit attendance; findings with low strength of evidence indicated a possible association between more comprehensive insurance, fewer preventable readmissions, and emergency department visits. The authors concluded that these findings suggested that evidence evaluating insurance coverage and postpartum visit attendance and unplanned care utilization is, at best, of moderate strength of evidence. They recommended that future research should evaluate clinical outcomes associated with more comprehensive insurance coverage.
AHRQ-funded; 75Q80120D00001.
Citation: Saldanha IJ, Adam GP, Kanaan G .
Health insurance coverage and postpartum outcomes in the US: a systematic review.
JAMA Netw Open 2023 Jun; 6(6):e2316536. doi: 10.1001/jamanetworkopen.2023.16536..
Keywords: Health Insurance, Maternal Care, Women, Outcomes, Medicaid, Patient-Centered Outcomes Research, Evidence-Based Practice
Tracer H, Haselby C
AHRQ Author: Tracer H
Hormone therapy for the primary prevention of chronic conditions in postmenopausal people.
This case study described a 50-year-old woman whose last menstrual cycle was more than a year previous. Case study questions related to the USPSTF recommendation on hormone therapy addressed whether this patient would benefit from hormone therapy to prevent the onset of chronic conditions that become more common after menopause.
AHRQ-authored.
Citation: Tracer H, Haselby C .
Hormone therapy for the primary prevention of chronic conditions in postmenopausal people.
Am Fam Physician 2023 Jun; 107(6):645-46..
Keywords: U.S. Preventive Services Task Force (USPSTF), Guidelines, Evidence-Based Practice, Prevention, Chronic Conditions, Women
Teixeira da Silva D, Makeneni S, Wall H
Measuring quality STI care among adolescent female primary care patients in Philadelphia.
The purpose of this study was to develop and apply a cross-setting, sexually transmitted infection (STI) Care Continuum to improve STI care quality, to assess adherence to guideline-recommended care, and to standardize progress measurement toward National Strategic goals. Review of the CDC STI treatment guidelines identified seven distinct steps of care for gonorrhea, chlamydia, and syphilis; researchers used Youth Risk Behavior Surveillance Survey data to estimate step 1, and electronic health record data for steps 2, 3, 4, 6 and 7. The researchers concluded that local application of an STI Care Continuum identified STI testing, retesting, and HIV testing as areas for improvement. Similar methods may be applied to target resources, standardize data collection and reporting, and improve STI care quality.
AHRQ-funded; HS026116.
Citation: Teixeira da Silva D, Makeneni S, Wall H .
Measuring quality STI care among adolescent female primary care patients in Philadelphia.
Sex Transm Infect 2023 Jun; 99(4):272-75. doi: 10.1136/sextrans-2022-055623..
Keywords: Children/Adolescents, Sexual Health, Infectious Diseases, Primary Care, Women, Human Immunodeficiency Virus (HIV), Quality Measures, Quality of Care
Field C, Lynch CD, Fareed N
Association of community walkability and glycemic control among pregnant individuals with pregestational diabetes mellitus.
The role of community walkability in influencing glycemic regulation in expectant individuals with pre-existing diabetes is yet to be established. The purpose of this study was to explore the relationship between the walkability of a neighborhood at the community level and glycemic control, as indicated by hemoglobin A1c (A1C), in pregnant individuals with pregestational diabetes. The researchers conducted a retrospective examination of expectant individuals with pregestational diabetes who participated in a combined prenatal and diabetic care program from 2012 to 2016. The determinant of interest was community walkability, determined by the US Environmental Protection Agency National Walkability Index (score range 1-20), which includes intersection concentration (design), closeness to transit stops (distance), and a combination of job and household varieties (diversity). Participants from the most walkable neighborhoods were contrasted with those from less walkable neighborhoods as per the National Environmental Protection Agency's definition. The outcomes were glycemic control, including A1C, measured both in early and late pregnancy, and the average change in A1C throughout pregnancy. The study found that out of 417 expectant individuals, 10% resided in the most walkable areas. All 417 participants had an A1C assessment in early pregnancy, and 376 had another A1C assessment in late pregnancy. Pregnant individuals living in the most walkable areas were more likely to have an A1C <6.0% in early pregnancy, and an A1C <6.5% in late pregnancy compared with those in less walkable areas. The change in A1C across pregnancy was not related to walkability. The study concluded that individuals with pre-existing diabetes residing in more walkable areas demonstrated better glycemic control during both early and late pregnancy.
AHRQ-funded; HS028822.
Citation: Field C, Lynch CD, Fareed N .
Association of community walkability and glycemic control among pregnant individuals with pregestational diabetes mellitus.
Am J Obstet Gynecol MFM 2023 May; 5(5):100898. doi: 10.1016/j.ajogmf.2023.100898..
Keywords: Diabetes, Maternal Care, Social Determinants of Health, Women
Quinlan TAG, Lindrooth RC, Guiahi M
Medicaid payment for postpartum long-acting reversible contraception prompts more equitable use.
In addition to providing a global payment for maternity care, an increasing number of state Medicaid programs pay for immediate postpartum long-acting reversible contraception (LARC). The purpose of this study was to examine postpartum LARC utilization by race and ethnicity and overall among respondents with Medicaid-paid births during 2012-2018 in eight states that implemented immediate postpartum LARC payment and eight states without immediate postpartum LARC payment. The study found that the policy resulted in a 2.1-percentage-point increase in postpartum LARC use overall. Further analysis found no significant change among White mothers and a 3.7-percentage-point increase in use among Black mothers compared with White mothers. The researchers concluded that additional research is required to determine whether the increase was related with patients' preferences and whether hospitals' immediate postpartum LARC policies and practices utilize a patient-centered approach that reinforces reproductive autonomy and equity.
AHRQ-funded; HS028762.
Citation: Quinlan TAG, Lindrooth RC, Guiahi M .
Medicaid payment for postpartum long-acting reversible contraception prompts more equitable use.
Health Aff 2023 May; 42(5):665-73. doi: 10.1377/hlthaff.2022.01178..
Keywords: Medicaid, Maternal Care, Women, Access to Care, Policy
Lee CI, Abraham L, Miglioretti DL
National performance benchmarks for screening digital breast tomosynthesis: update from the Breast Cancer Surveillance Consortium.
The purpose of this study was to develop performance benchmarks for digital breast tomosynthesis (DBT) screening and assess longitudinal performance patterns in United States community practice. Between 2011 and 2018 the researchers collected DBT screening examinations from five Breast Cancer Surveillance Consortium (BCSC) registries. Measures of performance were calculated based on the American College of Radiology Breast Imaging Reporting and Data System, fifth edition and included abnormal interpretation rate (AIR), cancer detection rate (CDR), sensitivity, specificity, and false-negative rate (FNR). These rates were compared with previously published BCSC and National Mammography Database benchmarks, concurrent BCSC DM screening examinations, and expert opinion acceptable performance ranges. The study included a total of 896,101 women undergoing 2,301,766 screening examinations and 1,843,591 DM examinations were included in this study. All performance measures were higher for DBT except sensitivity and FNR, when compared with BCSC DM screening examinations from the same time period and previously published BCSC and National Mammography Database performance benchmarks. The following rates of radiologists received acceptable performance ranges with DBT: 97.6% for CDR, 91.8% for sensitivity, 75.0% for AIR, and 74.0% for specificity.
AHRQ-funded; HS018366.
Citation: Lee CI, Abraham L, Miglioretti DL .
National performance benchmarks for screening digital breast tomosynthesis: update from the Breast Cancer Surveillance Consortium.
Radiology 2023 May; 307(4):e222499. doi: 10.1148/radiol.222499..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Prevention, Women
Cantor AG, Nelson HD, Pappas M
Telehealth for women's preventive services for reproductive health and intimate partner violence: a comparative effectiveness review.
This comparative effectiveness review was conducted on the effectiveness and harms of telehealth interventions for women's reproductive health and intimate partner violence (IPV) services. A literature search was conducted for randomized controlled trials (RCTs) and observational studies of telehealth strategies for women's reproductive health and IPV versus usual care for the period July 2016 to May 2022. Eight RCTs, 1 nonrandomized trial, and 7 observational studies were included (7 studies of contraceptive care and 9 of IPV services). Telehealth services demonstrated similar care as usual care for contraceptive use, sexually transmitted infections, and pregnancy (low strength of evidence [SOE]). Evidence on abortion was insufficient. Outcomes were also similar between telehealth and usual care interventions to replace or supplement IPV services and comparators for repeat IPV, depression, posttraumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors (low SOE). Telehealth barriers identified included limited internet access, digital literacy, technical challenges, and confidentiality concerns. Safety strategies increased telehealth use for IPV services. Evidence lacked on access, health equity, or harms.
AHRQ-funded; 75Q80120D00006.
Citation: Cantor AG, Nelson HD, Pappas M .
Telehealth for women's preventive services for reproductive health and intimate partner violence: a comparative effectiveness review.
J Gen Intern Med 2023 May; 38(7):1735-43. doi: 10.1007/s11606-023-08033-6..
Keywords: Telehealth, Health Information Technology (HIT), Women, Prevention, Domestic Violence, Evidence-Based Practice, Maternal Care, Sexual Health, Patient-Centered Outcomes Research, Comparative Effectiveness
Gupta N, Zebib L, Wittmann D
Understanding the sexual health perceptions, concerns, and needs of female partners of prostate cancer survivors.
The adverse effects of prostate cancer (PCa) and its treatment can critically undermine the sexual well-being of patients and couples. However, limited research has been dedicated to understanding the influence of PCa-induced sexual dysfunction on the female partners of survivors. The purpose of this study was to carry out a qualitative investigation to comprehensively capture the perceptions of female partners regarding the repercussions of PCa on their sex lives, and their partners’ sexual health concerns and unfulfilled needs. The researchers conducted semi-structured telephonic interviews concerning sexual health and unfulfilled needs with female partners of PCa survivors. Participants were recruited from multiple clinical sites and PCa caregivers' support groups from September 2021 to March 2022. Interviews were recorded, transcribed, and independently coded. The study outcomes were on the sexual health concerns and unfulfilled needs of the female partners. Of the 12 participants, the median age was 65 (between 53 and 81), nine identified as White, the median duration since their partner's PCa diagnosis was 2.25 years (ranging from 11 months to 20 years), and most reported their partner had undergone radical prostatectomy, radiation, and/or hormonal therapy. Major themes emerging from the study concerned the substantial effect of age- and PCa-related sexual dysfunction on the sexual quality of life for women, the joint nature of sexual dysfunction and recovery, the partner's role in managing and adapting to sexual dysfunction, communication barriers regarding sexual dysfunction within an intimate relationship, the absence of sexual health counseling and support from physicians, and the advantage of peer interactions and proactive information seeking in addressing unfulfilled sexual health needs. The study concluded that female partners perceive PCa-related sexual dysfunction as a shared issue for couples, express sorrow due to age- and PCa-related sexual losses, and experience a void in physician-led sexual health counseling and information.
AHRQ-funded; HS026120.
Citation: Gupta N, Zebib L, Wittmann D .
Understanding the sexual health perceptions, concerns, and needs of female partners of prostate cancer survivors.
J Sex Med 2023 Apr 27; 20(5):651-60. doi: 10.1093/jsxmed/qdad027..
Keywords: Cancer: Prostate Cancer, Cancer, Sexual Health, Women
Lowry KP, Ichikawa L, Hubbard RA
Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status.
This study examined the timing of second breast cancers by primary cancer estrogen receptor (ER) status in the Breast Cancer Surveillance Consortium. The cohort studied included women who were diagnosed with American Joint Commission on Cancer stage I-III breast cancer identified within six Breast Cancer Surveillance Consortium registries from 2000 to 2017. Characteristics collected during primary breast cancer diagnosis included demographics, ER status, and treatment. Second breast cancer events included subsequent ipsilateral or contralateral breast cancers diagnosed >6 months after primary diagnosis. Cumulative incidence and second breast cancer rates by primary cancer ER status during 1-5 versus 6-10 years after diagnosis was examined. At 10 years, the cumulative second breast cancer incidence was 11.8% for women with ER-negative disease and 7.5% for those with ER-positive disease. Women with ER-negative cancer had higher second breast cancer rates than those with ER-positive cancer during the first 5 years of follow-up. After 5 years, second breast cancer rates were similar for women with ER-negative versus ER-positive breast cancer.
AHRQ-funded; HS018366.
Citation: Lowry KP, Ichikawa L, Hubbard RA .
Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status.
Cancer 2023 Apr 15;129(8):1173-82. doi: 10.1002/cncr.34679.
Keywords: Cancer: Breast Cancer, Cancer, Women, Risk
Goodsmith N, Dossett EC, Gitlin R
Acceptability of reproductive goals assessment in public mental health care.
The purpose of this study was to evaluate the perspectives of patients and clinicians on the feasibility of assessing reproductive objectives in public mental health facilities and provide insights for potential customization in these environments. The researchers analyzed primary qualitative data from clients and healthcare providers at four urban public mental health centers catering to individuals with persistent mental disorders (gathered between November 2020 and October 2021). This exploratory qualitative investigation involved female patients of reproductive age who spoke English and were predominantly Black or Latina, as well as mental health professionals (psychiatrists, therapists, case managers, nurses). The study focused on the acceptability of evaluating reproductive aspirations in mental health treatment and gathered input on two discussion guides for reproductive goals assessment: PATH (Pregnancy Attitudes, Timing, and Importance of Pregnancy Prevention) and OKQ (One Key Question). Semi-structured phone interviews were conducted with 22 patients and 36 healthcare providers. Rapid qualitative analysis was employed to summarize interview transcripts, and matrix analysis was used to identify themes. The study found that attitudes towards reproductive goals assessment were generally favorable. Clinicians believed that the discussion guides would "initiate" essential conversations, enhance comprehension of patients' objectives, and aid in medication guidance and planning. A small number of patients expressed unease or uncertainty; some recommended that providers seek permission or enable patients to introduce the subject. Additional themes encompassed the necessity for contextual framing to address personal inquiries, the importance of establishing rapport before posing questions, and the difficulty of managing multiple priorities. Several participants found both PATH and OKQ prompts acceptable; some favored the "dialogue-based" and "open-ended" phrasing of PATH.
AHRQ-funded; HS026407
Citation: Goodsmith N, Dossett EC, Gitlin R .
Acceptability of reproductive goals assessment in public mental health care.
Health Serv Res 2023 Apr;58(2):510-20. doi: 10.1111/1475-6773.14111.
Keywords: Behavioral Health, Women, Sexual Health
Lucchini M, Rayport Y, Valeri L
Racial/ethnic disparities in sleep-disordered breathing during pregnancy in the nuMoM2b study.
This study’s aim was to assess the prevalence and severity of sleep-disordered breathing (SDB) across racial/ethnic groups in 3702 pregnant people at 6 to 15 and 22 to 31 weeks gestational age; examine whether BMI modifies the association between race/ethnicity and SDB; and investigate whether interventions to reduce weight might reduce racial/ethnic disparities in SDB. The study cohort consisted of comprised 61.2% non-Hispanic White (nHW), 11.9% non-Hispanic Black (nHB), 18.5% Hispanic, and 3.7% Asian persons. SDB prevalence was higher for nHB compared with nHW pregnant people at 6 to 15 weeks, whereas at 21 to 32 weeks, Asian pregnant people had a higher SDB prevalence than nHW. The severity of SDB differed across racial/ethnic groups in early pregnancy, with nHB pregnant people having a higher apnea-hypopnea index (AHI) compared with nHW. Having overweight/obesity was associated with a higher AHI.
AHRQ-funded; HS024274.
Citation: Lucchini M, Rayport Y, Valeri L .
Racial/ethnic disparities in sleep-disordered breathing during pregnancy in the nuMoM2b study.
Obesity 2023 Apr;31(4):923-33. doi: 10.1002/oby.23697.
Keywords: Racial and Ethnic Minorities, Sleep Problems, Women, Maternal Care
de Assis V, Shields AD, Johansson A
Resuscitation of traumatic maternal cardiac arrest: a case report and summary of recommendations from Obstetric Life Support.
The authors in this report highlight critical techniques in the resuscitation of reproductive-age women with traumatic cardiac arrest using recommendations from Obstetric Life Support™ (OBLS™). In this report they examined a case of a morbidly obese female presenting to the Emergency Department (ED) with ongoing CPR and massive hemorrhage from two gunshot wounds to the chest. The report summarizes critical techniques addressing Maternal Cardiac Arrest recommended in OBLS™ courses. Including 1) expanding the FAST exam to assess for pregnancy status, 2) estimating gestational age by fundal height or point-of-care ultrasound, 3) performing a RCD via midline vertical incision at 4 min if pregnancy is suspected to be ≥20 weeks' gestation (fundal height at or above the umbilicus, femoral length of ≥30 mm or biparietal diameter of ≥45 mm), and 4) execution of ECPR for refractory cardiac arrest.
AHRQ-funded; HS026169.
Citation: de Assis V, Shields AD, Johansson A .
Resuscitation of traumatic maternal cardiac arrest: a case report and summary of recommendations from Obstetric Life Support.
Trauma Case Rep 2023 Apr; 44:100800. doi: 10.1016/j.tcr.2023.100800..
Keywords: Maternal Care, Cardiovascular Conditions, Women, Guidelines