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- Blood Pressure (1)
- Comparative Effectiveness (2)
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- (-) Maternal Care (8)
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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
1 to 8 of 8 Research Studies DisplayedCantor AG, Jungbauer RM, Skelly AC
Respectful maternity care : a systematic review.
The purpose of this systematic review was to collect information on definitions and valid measurements of respectful maternity care (RMC), its effectiveness for improving pregnant and postpartum maternal and infant health outcomes, and strategies for implementation. Frameworks for RMC were found to be well described but varied in definition. Evidence was lacking on the effectiveness of implementing RMC to improve any maternal or infant health outcome. Tools to measure RMC demonstrated consistency but lacked a gold standard; the authors conclude that further evaluation was needed before implementation in U.S. settings.
AHRQ-funded; 75Q80120D00006
Citation: Cantor AG, Jungbauer RM, Skelly AC .
Respectful maternity care : a systematic review.
Ann Intern Med 2024 Jan; 177(1):50-64. doi: 10.7326/m23-2676..
Keywords: Maternal Care, Women, Patient-Centered Outcomes Research, Evidence-Based Practice
Saldanha IJ, Adam GP, Kanaan G
Delivery strategies for postpartum care: a systematic review and meta-analysis.
This systematic review examined the effects of postpartum health care-delivery strategies on health care utilization and maternal outcomes. The authors searched medical databases from inception to November 16, 2022. They found 64 eligible studies (50 randomized controlled trials, 14 nonrandomized comparative studies; N=543,480). The review found that for general postpartum care, care location (clinic, at home, by telephone) did not affect depression or anxiety symptoms (low strength of evidence), and care integration (by multiple types of health care professionals) did not affect depression symptoms or substance use (low strength of evidence). Providing contraceptive care earlier (compared with later) was associated with greater implant use at 6 months (moderate strength of evidence). Low strength of evidence was found for location of breastfeeding affecting hospitalization, other unplanned care utilization, or mental health symptoms. Peer support was associated with higher rates of any or exclusive breastfeeding at 1 month and any breastfeeding at 3-6 months but not other breastfeeding measures (all moderate strength of evidence). Care by a lactation consultant was associated with higher breastfeeding rates at 6 months but not exclusive breastfeeding (all moderate strength of evidence). Moderate strength of evidence was found for the association of use and nonuse of information technology for breastfeeding care with comparable rates of breastfeeding. Moderate strength of evidence was found for the association of testing reminders for screening or preventive care and greater adherence to oral glucose tolerance testing but not random glucose or hemoglobin A1c testing.
AHRQ-funded; 75Q80120D00001; 75Q80121F32007.
Citation: Saldanha IJ, Adam GP, Kanaan G .
Delivery strategies for postpartum care: a systematic review and meta-analysis.
Obstet Gynecol 2023 Sep 1; 142(3):529-42. doi: 10.1097/aog.0000000000005293..
Keywords: Maternal Care, Women, Healthcare Delivery, Evidence-Based Practice, Patient-Centered Outcomes Research
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
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
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
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
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
Kaplan HC, Sherman SN, Cleveland C
Reliable implementation of evidence: a qualitative study of antenatal corticosteroid administration in Ohio hospitals.
The objective of this study was to understand conditions that enable delivery of antenatal corticosteroid administration (ANCS) with high reliability among hospitals participating in an Ohio Perinatal Quality Collaborative (OPQC) ANCS project. Among the major themes supporting reliable implementation of ANCS at these hospitals that emerged were: (1) presence of a high reliability culture, (2) processes that emphasize high reliability, and (3) timely and efficient administration process.
AHRQ-funded; HS021114.
Citation: Kaplan HC, Sherman SN, Cleveland C .
Reliable implementation of evidence: a qualitative study of antenatal corticosteroid administration in Ohio hospitals.
BMJ Qual Saf 2016 Jun 8;25(3):173-81. doi: 10.1136/bmjqs-2015-003984..
Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Maternal Care