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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 15 of 15 Research Studies DisplayedDanilack VA, Siegel-Reamer L, Lum L
From "disappointing" to "fantastic": women's experiences with labor induction in a U.S. tertiary hospital.
This study examined women’s expectations and experiences regarding labor induction. Labor induction patients were recruited in a US tertiary care hospital's postpartum mother-baby unit and invited to participate in semi-structured qualitative interviews. From April to September 2018, 26 women were interviewed about expectations and experiences of the labor induction process, side effects and health outcomes of concern, reflections on personal tolerance of different interventions, and thoughts about an ideal process. A wide range of experiences were described- with characterizations from horrible, frustrating, and terrifying to simple, fast and smooth. The Foley balloon catheter was the most polarizing induction method. Other concerns centered on the health of their baby, and an ideal induction involved fewer interventions.
AHRQ-funded; HS025013.
Citation: Danilack VA, Siegel-Reamer L, Lum L .
From "disappointing" to "fantastic": women's experiences with labor induction in a U.S. tertiary hospital.
Birth 2023 Dec; 50(4):959-67. doi: 10.1111/birt.12750..
Keywords: Women, Maternal Care, Hospitals, Patient Experience
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
Admon LK, Ford ND, Ko JY
Trends and distribution of in-hospital mortality among pregnant and postpartum individuals by pregnancy period.
The purpose of this study was to examine long-term trends in inpatient death rates among pregnant and postpartum individuals and proportion of deaths by pregnancy period (antenatal, delivery, and postpartum). The researchers examined patterns of inpatient mortality during pregnancy-associated hospitalizations utilizing data from the National Inpatient Sample for 1994 to 2015 and 2017 to 2019. The study found that between 1994 and 2015, among 84,181,338 hospitalizations an estimated 12,654 inpatient deaths occurred among pregnant and postpartum individuals with a mean age of 29.37. Inpatient deaths during delivery hospitalizations decreased from 10.6 deaths per 100 000 delivery hospitalizations to 4.7 deaths per 100 000 delivery hospitalizations between 1994 to 1995 and 2014 to 2015. The rate of inpatient deaths in antenatal and postpartum periods remained unchanged between 1994 to 1995 and 2014 to 2015. The researchers concluded that resources directed toward improving quality of care at obstetric delivery have been associated with decreased rates of severe morbidity and may be associated with decreased mortality, but additional efforts need to be directed toward antenatal and postpartum hospitalizations.
AHRQ-funded; HS027640.
Citation: Admon LK, Ford ND, Ko JY .
Trends and distribution of in-hospital mortality among pregnant and postpartum individuals by pregnancy period.
JAMA Netw Open 2022 Jul;5(7):e2224614. doi: 10.1001/jamanetworkopen.2022.24614..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Mortality, Pregnancy, Women, Hospitals
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
Burris HH, Passarella M, Handley SC
Black-white disparities in maternal in-hospital mortality according to teaching and black-serving hospital status.
This study’s objective was to determine whether black-white disparities in maternal in-hospital mortality during delivery vary across hospital types (black-serving vs non-black and teaching vs non-teaching) and whether overall maternal mortality differs across hospital types. The authors performed a population-based, retrospective cohort study of 5,679,044 deliveries among black (14.2%) and white patients (85.8%) in 3 states (California, Missouri, and Pennsylvania) from 1995 to 2009. Examination of black-white disparities found that after risk adjustment, black patients had significantly greater risk of death and that the disparity was similar within each of the hospital types. At teaching hospitals, mortality was similar in black-serving and nonblack-serving hospitals. Among non-teaching hospitals, mortality was significantly higher in black-serving vs nonblack-serving hospitals. Over half (53%) of black patients delivered in nonteaching black-serving hospitals compared with just 19% of white patients.
AHRQ-funded; HS018661.
Citation: Burris HH, Passarella M, Handley SC .
Black-white disparities in maternal in-hospital mortality according to teaching and black-serving hospital status.
Am J Obstet Gynecol 2021 Jul;225(1):83.e1-83.e9. doi: 10.1016/j.ajog.2021.01.004..
Keywords: Maternal Care, Pregnancy, Mortality, Women, Racial and Ethnic Minorities, Disparities, Hospitals
Moniz MH, Bonawitz K, Wetmore MK
Implementing immediate postpartum contraception: a comparative case study at 11 hospitals.
Researchers examined how organizational context and implementation strategies drive successful implementation of immediate postpartum long-acting reversible contraception services, with a goal of informing the design of future implementation interventions. Semi-structured interviews were conducted with clinicians, nurses, residents, pharmacy and revenue cycle staff, and hospital administrators. They found that implementation efforts in maternity settings may be more successful if they select strategies to optimize local conditions for success. They recommended future research to evaluate whether these strategies effectively optimize local conditions for successful implementation in a variety of settings.
AHRQ-funded; HS025465; HS023784.
Citation: Moniz MH, Bonawitz K, Wetmore MK .
Implementing immediate postpartum contraception: a comparative case study at 11 hospitals.
Implement Sci Commun 2021 Apr 12;2(1):42. doi: 10.1186/s43058-021-00136-7..
Keywords: Maternal Care, Women, Hospitals, Implementation, Sexual Health
Kunz SN, Phibbs CS, Profit J
The changing landscape of perinatal regionalization.
This article discusses the need for consistent perinatal regionalization policies across regions and between countries to reduce neonatal morbidity and mortality. Regionalization emphasizes matching patient needs with the capabilities of the hospital in which care is provided. The need to account for geographic and other regional differences when determining the feasibility of regionalization for a specific regions is emphasized.
AHRQ-funded; HS025749.
Citation: Kunz SN, Phibbs CS, Profit J .
The changing landscape of perinatal regionalization.
Semin Perinatol 2020 Jun;44(4):151241. doi: 10.1016/j.semperi.2020.151241..
Keywords: Pregnancy, Maternal Care, Women, Policy, Hospitals
Lundsberg LS, Main EK, Lee HC
Low-interventional approaches to intrapartum care: hospital variation in practice and associated factors.
This study compared hospitals in California with low and high-interventional practices for labor and delivery. A total of 185 California hospitals completed a survey of intrapartum care, including questions on low- versus high-interventional practices. They identified 2 distinct groups of hospitals that tended to use low- or high-interventional practices. Hospitals that used low-interventional practices tended to have midwife-led or physician-midwife collaborative labor management or were in rural locations. High-interventional practice hospitals had a higher proportion of women covered by Medicaid or other safety-net programs as well as hospitals located in counties with higher liability insurance premiums. Both sets of hospitals had comparable morbidity rates but low-intervention hospitals had lower rates of cesarean birth and episiotomies. Only one-quarter of hospitals were found to use low-interventional practices.
AHRQ-funded; HS023801.
Citation: Lundsberg LS, Main EK, Lee HC .
Low-interventional approaches to intrapartum care: hospital variation in practice and associated factors.
J Midwifery Womens Health 2020 Jan;65(1):33-44. doi: 10.1111/jmwh.13017..
Keywords: Labor and Delivery, Pregnancy, Women, Maternal Care, Hospitals, Quality of Care
Alexander LT, Fuentes-Rivera E, Saavedra-Avendano B
Utilisation of second-trimester spontaneous and induced abortion services in public hospitals in Mexico, 2007-2015.
This study examined data on utilization of in-facility second-trimester abortion services in Mexico. Data from Mexico’s Automated Hospital Discharge System (SAEH) from 2007-2015 was used to identify second-trimester abortions in public hospitals across Mexico’s 32 states. A total 145,956 second-trimester abortion services or 13.4% of total documented hospitalizations for abortion were identified. The rate remained constant for women aged 15-44 years. Women living in poorer socioeconomic conditions or highly marginalized municipalities were most likely to have second-trimester abortions compared to women in higher socioeconomic conditions who were able to utilize services in their first trimester.
AHRQ-funded; HS025155; HS022981.
Citation: Alexander LT, Fuentes-Rivera E, Saavedra-Avendano B .
Utilisation of second-trimester spontaneous and induced abortion services in public hospitals in Mexico, 2007-2015.
BMJ Sex Reprod Health 2019 Oct;45(4):283-89. doi: 10.1136/bmjsrh-2018-200300..
Keywords: Pregnancy, Women, Healthcare Utilization, Hospitals, Healthcare Delivery
Triebwasser JE, Kamdar NS, Langen ES
Hospital contribution to variation in rates of vaginal birth after cesarean.
The purpose of this retrospective cohort study was to determine the influence of delivery hospital on the rate of vaginal birth after cesarean (VBAC). Claims data were obtained from Blue Cross and Blue Shield of Michigan and included women with a prior cesarean and a singleton live birth. Hospital-specific risk-standardized VBAC rates and the median odds ratio as a measure of variation were calculated. From their results, the authors conclude that the individual delivery hospital contributes to the significant variation in rates of VBAC, after adjustment for patient and hospital characteristics.
AHRQ-funded; HS025465.
Citation: Triebwasser JE, Kamdar NS, Langen ES .
Hospital contribution to variation in rates of vaginal birth after cesarean.
J Perinatol 2019 Jul;39(7):904-10. doi: 10.1038/s41372-019-0373-2..
Keywords: Hospitals, Labor and Delivery, Maternal Care, Pregnancy, Women
Campbell KH, Illuzzi JL, Lee HC
Optimal maternal and neonatal outcomes and associated hospital characteristics.
The goal of this study was to examine hospital variation in both maternal and neonatal morbidities and to identify institutional characteristics associated with hospital performance in a combined measure of maternal and neonatal outcomes. The authors found that hospitals with low maternal morbidity rates may not have low neonatal morbidity rates and vice versa, highlighting the importance of assessing joint maternal-newborn outcomes in order to fully characterize a hospital's obstetrical performance.
AHRQ-funded; HS023801.
Citation: Campbell KH, Illuzzi JL, Lee HC .
Optimal maternal and neonatal outcomes and associated hospital characteristics.
Birth 2019 Jun;46(2):289-99. doi: 10.1111/birt.12400.
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Keywords: Hospitals, Newborns/Infants, Outcomes, Pregnancy, Provider Performance, Quality of Care, Women
Vanderlaan J, Rochat R, Williams B
Associations between hospital maternal service level and delivery outcomes.
This study explored the associations between delivery hospital self-reported level of maternal service, as defined by the American Hospital Association, and both maternal and neonatal outcomes among women at high maternal risk, as defined by the Obstetric Comorbidity Index. The investigators concluded that for the group of pregnant women in need of maternal transfer, delivery hospital self-reported level of maternal care was not associated with the odds of poor maternal or neonatal outcomes.
AHRQ-funded; HS024655.
Citation: Vanderlaan J, Rochat R, Williams B .
Associations between hospital maternal service level and delivery outcomes.
Womens Health Issues 2019 May - Jun;29(3):252-58. doi: 10.1016/j.whi.2019.02.004..
Keywords: Maternal Care, Labor and Delivery, Pregnancy, Women, Outcomes, Hospitals, Quality of Care, Newborns/Infants, Mortality
Milla C, Guo M, Chang A
Patient perspectives in comparing hospitals for childbirth: insights from Hawai'i.
Childbirth is a national priority area for healthcare quality improvement. Patient perspectives are increasingly valued in healthcare, yet Asian American and Pacific Islander (AAPI) perspectives of healthcare quality are often understudied, particularly from individuals with limited English proficiency (LEP). In this study, the goal was to understand factors that consumers in Hawai'i, including AAPI and those with LEP, used to compare patient care in hospitals, especially for childbirth.
AHRQ-funded; HS021903.
Citation: Milla C, Guo M, Chang A .
Patient perspectives in comparing hospitals for childbirth: insights from Hawai'i.
Hawaii J Med Public Health 2019 Mar;78(3):89-97..
Keywords: Labor and Delivery, Pregnancy, Hospitals, Quality Improvement, Quality of Care, Cultural Competence, Women
Gourevitch RA, Mehrotra A, Galvin G
Does comparing cesarean delivery rates influence women's choice of obstetric hospital?
This study examined whether pregnant women who use cesarean delivery rate data from hospitals influences their choice of obstetric hospital. A randomized controlled trial of 18,293 users of the Ovia Health mobile app from 2016-2017 was conducted. Enrollees were given an explanation of the cesarean rate data and were randomized to an intervention group who also were given an interactive tool to display data for the 10 closest hospitals with obstetric services. There was no significant difference between the intervention and control groups in their hospital selection.
AHRQ-funded; HS000055.
Citation: Gourevitch RA, Mehrotra A, Galvin G .
Does comparing cesarean delivery rates influence women's choice of obstetric hospital?
Am J Manag Care 2019 Feb;25(2):e33-e38..
Keywords: Pregnancy, Women, Hospitals, Maternal Care, Labor and Delivery
Calderwood MS, Huang SS, Keller V
Variable case detection and many unreported cases of surgical-site infection following colon surgery and abdominal hysterectomy in a statewide validation.
This study assesses hospital surgical-site infection (SSI) identification and reporting following colon surgery and abdominal hysterectomy via a statewide external validation. The authors concluded that claims-based surveillance is a standardized approach that hospitals can use to augment traditional surveillance methods and health departments can use for external validation.
AHRQ-funded; HS021424.
Citation: Calderwood MS, Huang SS, Keller V .
Variable case detection and many unreported cases of surgical-site infection following colon surgery and abdominal hysterectomy in a statewide validation.
Infect Control Hosp Epidemiol 2017 Sep;38(9):1091-97. doi: 10.1017/ice.2017.134..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Injuries and Wounds, Patient Safety, Women, Adverse Events, Diagnostic Safety and Quality, Hospitals