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
1 to 19 of 19 Research Studies DisplayedPineles BL, Harris AD, Goodman KE
Adverse maternal and delivery outcomes in children and very young (age ≤13 years) US adolescents compared with older adolescents and adults.
This study compared adverse maternal and delivery outcomes of pregnant 10- to 13-year-olds vs 14- to 17-year-olds and 18- to 19-year-olds. This cross-sectional study looked at all patients aged 10 to 19 years who delivered at hospitals in the Premier Healthcare Database from January 2019 through May 2021. The study included 90,876 deliveries across 655 US hospitals. Controlling for patient race and ethnicity, insurance type, and obesity status: 10- to 13-year-olds had significantly higher risks of preterm delivery and cesarean delivery compared with 14- to 17-year-olds. The risk of preeclampsia was not higher for 10- to 13-year-olds compared to 14- to 17-year-olds. There was a higher risk of preterm delivery for 10- to 13-year-olds compared to 18- to 19-year-olds, but not significantly different for cesarean delivery and preeclampsia.
AHRQ-funded; HS028363.
Citation: Pineles BL, Harris AD, Goodman KE .
Adverse maternal and delivery outcomes in children and very young (age ≤13 years) US adolescents compared with older adolescents and adults.
JAMA 2022 Nov 1;328(17):1766-68. doi: 10.1001/jama.2022.18340..
Keywords: Children/Adolescents, Pregnancy, Labor and Delivery, Women, Outcomes, Adverse Events, Maternal Care
Hirai AH, Owens PL, Reid LD
AHRQ Author: Owens PL, Reid LD
Associations between state-level severe maternal morbidity and other perinatal indicators.
This study used the HCUP State Inpatient Databases (HCUP-SID) to determine the correlation between state-level severe maternal morbidity (SMM) rates and perinatal indicators. HCUP-SID was analyzed from 2017 to 2019 using revised code sets for 20 indicators excluding blood transfusions. Perinatal indicators used included prepregnancy hypertension, prepregnancy diabetes, prepregnancy obesity, low-risk cesarean delivery, preterm birth, infant mortality, and maternal mortality. HCUP-SID data for 10,542,942 maternal deliveries and 11,394,752 live births from the National Vital Statistics System (NVSS) were aggregated for state-level analysis. SMM rates were significantly correlated with 2 of the 7 perinatal indicators: prepregnancy hypertension and low-risk cesarean deliveries. All other perinatal indicators were significantly associated with at least 4 of 7 other indicators, and most correlations were higher in magnitude. Maternity mortality rates were highest in the southeast.
AHRQ-authored.
Citation: Hirai AH, Owens PL, Reid LD .
Associations between state-level severe maternal morbidity and other perinatal indicators.
JAMA Netw Open 2022 Jul;5(7):e2224621. doi: 10.1001/jamanetworkopen.2022.24621..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Pregnancy, Women, Labor and Delivery, Hospitalization
Smith AJB, Zhou RA, Sites E
Childbirths at home and in birthing centers rose during COVID-19: Oregon 2020 vs prior years.
This study’s objectives were to compare place of birth between 2020 and years before the COVID-19 pandemic and to investigate whether changes in place of birth differed between system-owned and independent hospitals and urban and rural regions in Oregon. Findings showed that, in Oregon, in-hospital births declined significantly during the first year of COVID-19 and affected system-owned hospitals more than independent ones. Further, shifts toward out-of-hospital births occurred in both urban and rural areas.
AHRQ-funded; HS024072.
Citation: Smith AJB, Zhou RA, Sites E .
Childbirths at home and in birthing centers rose during COVID-19: Oregon 2020 vs prior years.
Am J Obstet Gynecol 2022 Jul;227(1):108-11. doi: 10.1016/j.ajog.2022.03.027..
Keywords: Labor and Delivery, Pregnancy, Women, COVID-19
Hirai AH, Owens PL, Reid LD
AHRQ Author: Owens PL, Reid LD
Trends in severe maternal morbidity in the US across the transition to ICD-10-CM/PCS from 2012-2019.
This study evaluated national and state trends in severe maternal morbidity (SMM) rates from 2012 to 2019, and potential disruptions associated with the transition to International Classification of Diseases, 10th Revision, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS) in October 2015. This repeated cross-sectional analysis examined delivery hospitalizations in the HCUP’s National Inpatient Sample and State Inpatient Databases. There were almost 6 million delivery hospitalizations in the national sample representing a weighted total of 29.8 million deliveries with a mean maternal age of 28.6 years. SMM rates increased from 69.5 per 10,000 deliveries to 79.7 per 10,000 in 2019 without a significant change across the ICD-10-CM/PCS transition. OF 20 SMM indicators, rates for 10 indicators increased while 3 significantly decreased with 5 of those changes associated with the ICD-10-CM/PCS transition. Acute kidney failure had the largest increase, from 6.4 to 15.3 per 10,000 delivery hospitalizations, with no change associated with ICD transition. Disseminated intravascular coagulation had the largest decrease from 31.3 to 21.2 per 10,000, with a significant drop associated with ICD transition. State SMM rates significantly decreased for 1 state and significantly increased for 21 states from 2012 to 2019 and with varying associations with ICD transition.
AHRQ-authored.
Citation: Hirai AH, Owens PL, Reid LD .
Trends in severe maternal morbidity in the US across the transition to ICD-10-CM/PCS from 2012-2019.
JAMA Netw Open 2022 Jul;5(7):e2222966. doi: 10.1001/jamanetworkopen.2022.22966..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Pregnancy, Women, Labor and Delivery, Hospitalization
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
Flannery DD, Mukhopadhyay S, Morales KH
Delivery characteristics and the risk of early-onset neonatal sepsis.
This retrospective cohort study identified term and preterm infants at lowest risk of culture-confirmed early-onset sepsis (EOS) using delivery characteristics and also determined antibiotic use among them. The study cohort included term and preterm infants born 2009 to 2014 with blood culture with or without cerebrospinal fluid culture obtained ≤72 hours after birth. Low EOS risk criteria included: cesarean delivery, without labor or membrane rupture before delivery, and no antepartum concern for intraamniotic infection or nonreassuring fetal status. Among 53,575 births, 7549 (14.1%) were evaluated and 41 (0.5%) of those infants had EOS. For 1121 evaluated infants there were low-risk delivery characteristics and none had EOS. Duration of antibiotics administered to infants born with and without low-risk characteristics was not different.
AHRQ-funded; HS027468.
Citation: Flannery DD, Mukhopadhyay S, Morales KH .
Delivery characteristics and the risk of early-onset neonatal sepsis.
Pediatrics 2022 Feb;149(2). doi: 10.1542/peds.2021-052900..
Keywords: Newborns/Infants, Sepsis, Risk, Labor and Delivery, Antibiotics, Medication
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
Fowler TT, Schiff J, Applegate MS
Early elective deliveries accounted for nearly 9 percent of births paid for by Medicaid.
The authors reported the results of a perinatal project, led by the state Medicaid medical directors, that sought to coordinate quality improvement efforts related to early elective deliveries for the Medicaid population. Using data from 22 states, they found that 8.9% of Medicaid singleton births were early elective deliveries, and they therefore estimated that there are 160,000 early elective Medicaid deliveries nationwide each year. They concluded that their study offers additional evidence and new tools for policy makers pursuing strategies to further reduce the number of such deliveries.
AHRQ-funded; 29020090015C.
Citation: Fowler TT, Schiff J, Applegate MS .
Early elective deliveries accounted for nearly 9 percent of births paid for by Medicaid.
Health Aff 2014 Dec;33(12):2170-8. doi: 10.1377/hlthaff.2014.0534.
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Keywords: Labor and Delivery, Maternal Care, Medicaid, Pregnancy
Rokicki S, Montana L, Fink G
Impact of migration on fertility and abortion: evidence from the household and welfare study of Accra.
The researchers used detailed pregnancy and migration histories collected as part of the Household and Welfare Study of Accra (HAWS) to examine the association between migration and pregnancy outcomes among women residing in the urban slums of Accra, Ghana. They found that the completed fertility patterns of lifetime Accra residents are remarkably similar to those of residents who migrated.
AHRQ-funded; HS000055.
Citation: Rokicki S, Montana L, Fink G .
Impact of migration on fertility and abortion: evidence from the household and welfare study of Accra.
Demography 2014 Dec;51(6):2229-54. doi: 10.1007/s13524-014-0339-0..
Keywords: Pregnancy, Urban Health, Social Determinants of Health, Labor and Delivery
Lorch SA, Martin AE, Ranade R
Lessons for providers and hospitals from Philadelphia's obstetric services closures and consolidations, 1997-2012.
The researchers examined the experience of Philadelphia County, Pennsylvania, where thirteen of nineteen hospital obstetric units closed between 1997 and 2012, and they conducted interviews at eleven hospitals whose obstetric units remained open. Interviewees reported sharp surges in delivery volume and an increase in the proportion of patients with public insurance or no insurance. The authors concluded that their study supports the need for policy makers to anticipate reductions in supply and monitor patient outcomes.
AHRQ-funded; HS018661.
Citation: Lorch SA, Martin AE, Ranade R .
Lessons for providers and hospitals from Philadelphia's obstetric services closures and consolidations, 1997-2012.
Health Aff 2014 Dec;33(12):2162-9. doi: 10.1377/hlthaff.2014.0136.
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Keywords: Labor and Delivery, Pregnancy, Hospitals
Henke RM, Wier LM, Marder WD
AHRQ Author: Friedman BS, Wong HS
Geographic variation in cesarean delivery in the United States by payer.
This study aimed (1) to determine whether the geographic variation in cesarean delivery rate is consistent for private insurance and Medicaid, and (2) to identify the patient, population, and market factors associated with cesarean rate and determine if these factors vary by payer. It concluded that factors associated with geographic variation in cesarean delivery, a frequent and high-resource inpatient procedure, vary somewhat by payer.
AHRQ-authored; AHRQ-funded; 290200600009C.
Citation: Henke RM, Wier LM, Marder WD .
Geographic variation in cesarean delivery in the United States by payer.
BMC Pregnancy Childbirth 2014 Nov 19;14:387. doi: 10.1186/s12884-014-0387-x.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Health Insurance, Labor and Delivery, Medicaid, Pregnancy
Ahrens KA, Louik C, Kerr S
Seasonal influenza vaccination during pregnancy and the risks of preterm delivery and small for gestational age birth.
The researchers examined the associations between seasonal influenza vaccination during pregnancy and the risks of PTD and SGA among a multiyear retrospective cohort of pregnancies. With the exception of pre-term delivery (PTD) associated with the 2009–10 seasonal vaccine, they found no meaningful increases in PTD or small for gestational age risks associated with seasonal trivalent influenza vaccination during pregnancy.
AHRQ-funded; HS018463.
Citation: Ahrens KA, Louik C, Kerr S .
Seasonal influenza vaccination during pregnancy and the risks of preterm delivery and small for gestational age birth.
Paediatr Perinat Epidemiol 2014 Nov;28(6):498-509. doi: 10.1111/ppe.12152..
Keywords: Influenza, Vaccination, Pregnancy, Labor and Delivery
Dublin S, Johnson KE, Walker RL
Trends in elective labor induction for six United States health plans, 2001-2007.
The authors sought to describe trends in labor induction, including elective induction, from 2001 to 2007 for six U.S. health plans and to examine the validity of induction measures derived from birth certificate and health plan data. They found that induction prevalence rose from 28% in 2001 to 32% in 2005, then declined to 29% in 2007, with the trend being similar for subgroups by parity and gestational age. Elective induction prevalence varied considerably across plans.
AHRQ-funded; HS016955.
Citation: Dublin S, Johnson KE, Walker RL .
Trends in elective labor induction for six United States health plans, 2001-2007.
J Womens Health 2014 Nov;23(11):904-11. doi: 10.1089/jwh.2014.4779.
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Keywords: Centers for Education and Research on Therapeutics (CERTs), Health Insurance, Labor and Delivery, Pregnancy, Women
Eden KB, Perrin NA, Vesco KK
A randomized comparative trial of two decision tools for pregnant women with prior cesareans.
The authors evaluated tools to help pregnant women with prior cesareans make informed decisions about having trials of labor. They found that women in both groups felt more informed, were more clear about their birth priorities, felt more supported, and overall reported less conflict after receiving either intervention.
AHRQ-funded; HS011338; HS013959.
Citation: Eden KB, Perrin NA, Vesco KK .
A randomized comparative trial of two decision tools for pregnant women with prior cesareans.
J Obstet Gynecol Neonatal Nurs 2014 Sep-Oct;43(5):568-79. doi: 10.1111/1552-6909.12485.
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Keywords: Education: Patient and Caregiver, Shared Decision Making, Labor and Delivery, Patient-Centered Outcomes Research
Sentell T, Chang A, Cheng Y
Maternal quality and safety outcomes for Asians and Pacific Islanders in Hawaii: an observational study from five years of statewide data.
The authors investigated maternal quality and safety outcomes across heterogeneous Asian and Pacific Islanders subgroups in the United States. They found significant variation for Asian and Pacific Islander subgroups across maternal quality and safety outcomes.
AHRQ-funded; HS019990; HS021903.
Citation: Sentell T, Chang A, Cheng Y .
Maternal quality and safety outcomes for Asians and Pacific Islanders in Hawaii: an observational study from five years of statewide data.
BMC Pregnancy Childbirth 2014 Aug 30;14:298. doi: 10.1186/1471-2393-14-298.
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Keywords: Disparities, Labor and Delivery, Patient-Centered Outcomes Research, Quality Indicators (QIs), Racial and Ethnic Minorities
Darney BG, Caughey AB
Elective induction of labor symposium: nomenclature, research methodological issues, and outcomes.
This article focuses on key method issues in studies of elective induction of labor. The authors first identify methodological concerns with the existing literature and discuss each in return. They then review existing evidence about the relationship between elective induction and cesarean delivery.
AHRQ-funded; HS017582
Citation: Darney BG, Caughey AB .
Elective induction of labor symposium: nomenclature, research methodological issues, and outcomes.
Clin Obstet Gynecol. 2014 Jun;57(2):343-62. doi: 10.1097/GRF.0000000000000029..
Keywords: Research Methodologies, Outcomes, Labor and Delivery, Women
Moore JE, Low LK, Titler MG
AHRQ Author: Moore JE
Moving toward patient-centered care: women's decisions, perceptions, and experiences of the induction of labor process.
The researchers identified factors that influence inductions from the perspective of women. They found that lack of informed decision making was cited as a barrier to optimal care; additional themes emerged from the preinduction and postinduction interviews.
AHRQ-authored.
Citation: Moore JE, Low LK, Titler MG .
Moving toward patient-centered care: women's decisions, perceptions, and experiences of the induction of labor process.
Birth 2014 Jun;41(2):138-46. doi: 10.1111/birt.12080.
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Keywords: Shared Decision Making, Labor and Delivery, Patient-Centered Healthcare, Patient Experience, Pregnancy
Hendrich A, McCoy CK, Gale J
Ascension health's demonstration of full disclosure protocol for unexpected events during labor and delivery shows promise.
This article presents a case study concerning challenges, including physician resistance, to the establishment of a common full disclosure protocol at five labor and delivery demonstration sites. Twenty-seven months after implementation, the rate of full disclosure had increased by 221 percent. Practitioners saw a number of factors as key catalysts for change including consistent and ongoing leadership by local practitioners and hospitals.
AHRQ-funded; HS019608.
Citation: Hendrich A, McCoy CK, Gale J .
Ascension health's demonstration of full disclosure protocol for unexpected events during labor and delivery shows promise.
Health Aff 2014 Jan;33(1):39-45. doi: 10.1377/hlthaff.2013.1009..
Keywords: Adverse Events, Clinician-Patient Communication, Communication, Labor and Delivery, Medical Errors, Medical Liability, Policy, Pregnancy, Women