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- Comparative Effectiveness (1)
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- (-) Sexual Health (15)
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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 DisplayedSchulte A, Biggs MA
Association between facility and clinician characteristics and family planning services provided during U.S. outpatient care visits.
The purpose of this study was to characterize the provision of family planning services in outpatient care settings and evaluate variation by facility and clinician characteristics. The researchers utilized National Ambulatory Medical Care Survey data, to evaluate family planning service provision by facility location, facility type, physician specialty, types of clinicians seen, and if the patient was seen by their primary care provider. The sample used for analysis included 53,489 patient visits between 2011 and 2019 with reproductive-age (15-49 years) individuals. Family planning services were provided at 8% of total sampled visits and were more likely to be provided in urban compared with rural areas and at community health centers compared with private physician practices. Family planning services were also more likely to be provided when the patient saw a physician assistant or nurse compared with only a physician. After controlling for observed covariates, measures of between-clinician heterogeneity demonstrated broad variation in which clinicians offered family planning services.
AHRQ-funded; HS022241.
Citation: Schulte A, Biggs MA .
Association between facility and clinician characteristics and family planning services provided during U.S. outpatient care visits.
Womens Health Issues 2023 Nov-Dec; 33(6):573-81. doi: 10.1016/j.whi.2023.06.008..
Keywords: Ambulatory Care and Surgery, Maternal Care, Women, Sexual Health
Routh D, Simmons R, Sanders J
Building an implementation framework to address unmet contraceptive care needs in a carceral setting: a systematic review.
The purpose of this study was to conduct a systematic review of policy and practice recommendations to improve contraceptive care to reproductive-aged, incarcerated individuals in the US. The researchers used the Joanna Briggs Institute methodology, framed within the National Implementation Research Network's (NIRN) Exploration stage. Sources included MedLine, ProQuest, PSYCInfo, PubMed, SCOPUS, Social Science Citation Index, and Web of Science, as well as the reference sections of included materials. A total of 45 materials met the inclusion criteria. The researchers identified seven themes: 1. policy changes needed for care implementation; 2. the need for contraceptive care in carceral systems; 3. Barriers from justice agencies regarding the provision of contraceptive care; 4. policy barriers to access to contraceptives; 5. funding strategies to improve care; 6. patient preferences for contraceptive care delivery; and 7. healthcare provider knowledge about contraceptive care. The seven themes highlighted the need for contraceptive care provision to incarcerated individuals, as well as gaps, barriers, and facilitators of current contraceptive care provision for this population.
AHRQ-funded; HS027220.
Citation: Routh D, Simmons R, Sanders J .
Building an implementation framework to address unmet contraceptive care needs in a carceral setting: a systematic review.
Health Justice 2023 Oct 20; 11(1):43. doi: 10.1186/s40352-023-00243-8..
Keywords: Sexual Health, Vulnerable Populations
Darney BG, Biel FM, Oakley J
Contraceptive method switching and long-acting reversible contraception removal in U.S. safety net clinics, 2016-2021.
The objective of this retrospective cohort study was to describe patterns of contraceptive method switching and long-acting reversible contraception (LARC) removal in a large network of community health centers. Data was taken from individual-level electronic health record data from clinics in 20 states. Contraceptive switching and LARC removal were found to be common in community health centers. The authors recommended that clinicians normalize switching and LARC removal among patients.
AHRQ-funded; HS025155.
Citation: Darney BG, Biel FM, Oakley J .
Contraceptive method switching and long-acting reversible contraception removal in U.S. safety net clinics, 2016-2021.
Obstet Gynecol 2023 Sep; 142(3):669-78. doi: 10.1097/aog.0000000000005277..
Keywords: Women, Sexual Health
Miller ME, Rahim MQ, Coven SL
Pediatric hematology and oncology physician and nurse practitioner views of the HPV vaccine and barriers to administration.
This study’s goal was to examine provider views regarding HPV vaccination for pediatric survivors of cancer and pediatric patients with sickle cell disease. The authors conducted qualitative interviews with 20 pediatric hematology/oncology physicians and nurse practitioners. They found that 90% of interviewees support HPV vaccination in their population. The number of providers who reported that they counsel about HPV or provide HPV vaccination was 45%, even in stem cell and sickle cell clinics, where other childhood vaccines are commonly provided. Clinicians identified provider-level, clinic-level, and system-level barriers to giving the HPV vaccination, that included but was not limited to time/flow constraints, lack of resources, and continued education regarding the HPV vaccine.
AHRQ-funded; HS026390.
Citation: Miller ME, Rahim MQ, Coven SL .
Pediatric hematology and oncology physician and nurse practitioner views of the HPV vaccine and barriers to administration.
Hum Vaccin Immunother 2023 Aug 1; 19(2):2224089. doi: 10.1080/21645515.2023.2224089..
Keywords: Vaccination, Sexual Health, Infectious Diseases, Prevention, Provider: Clinician, Provider: Physician
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
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
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
Ahmad FA, Chan P, McGovern C
Adapting an electronic STI risk assessment program for use in pediatric primary care.
This study’s goal was to evaluate the usability of an electronic risk assessment tool to support sexually transmitted disease (STI) testing in the authors’ pediatric emergency department that they had previously designed and implemented. They conducted qualitative interviews of pediatricians, clinic staff, and adolescents from 4 pediatric practices as part of a study whose goal is to ultimately implement STI screening in pediatric primary care. The goal of the interviews was (1) to understand contextual factors related to STI screening in primary care, which they reported previously, and (2) to obtain feedback on their electronic platform, the questionnaire content, and their perspective on implementing it in primary care settings. They received quantitative feedback using the System Usability Scale (SUS). The SUS is a validated, reliable tool to measure the usability of hardware, software, websites, and applications, with a score of 68 (range 0-100) being average usability. They recruited 14 physicians, 9 clinic staff, and 12 adolescents. Participants rated the tool with a median score of 92.5, which shows a high level of usability.
AHRQ-funded; HS026704.
Citation: Ahmad FA, Chan P, McGovern C .
Adapting an electronic STI risk assessment program for use in pediatric primary care.
J Prim Care Community Health 2023 Jan-Dec; 14:21501319231172900. doi: 10.1177/21501319231172900..
Keywords: Children/Adolescents, Sexual Health, Infectious Diseases, Primary Care, Health Information Technology (HIT), Screening, Prevention
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
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
Glenn BA, Crespi CM, Herrmann AK
Effectiveness and feasibility of three types of parent reminders to increase adolescent human papillomavirus (HPV) vaccination.
Efforts to boost human papillomavirus (HPV) vaccination rates among adolescents have seen moderate success with the use of parent notifications. Nonetheless, there is limited research on the comparative efficacy and practicality of various HPV reminder methods in settings with restricted resources. The purpose of this quasi-experimental study (2016-2017) assessed the impact of three types of parent reminders (written correspondence, automated phone calls, and SMS messages) on HPV vaccine uptake for the subsequent dose among 12-year-olds at a prominent Federally Qualified Health Center in Los Angeles County. The researchers matched six clinics into three groups, randomly allocating one clinic from each group to either intervention or control. The intervention clinics were randomly assigned one of the three reminder methods. The researchers determined the rates of vaccine uptake for the next dose and analyzed intervention outcomes using logistic regression models. The proportion of successfully delivered reminders for each method was used as a measure of feasibility. The study included 877 12-year-olds due for an HPV vaccine dose (47% female, more than 85% Latino). The study found that after a 4-month follow-up, 23% of those in the intervention group received an HPV vaccine dose, compared to just 12% in the control group. Overall, receiving any reminder led to higher rates of the next-required HPV vaccine compared to standard care (p = 0.046). Notable improvements were seen with SMS reminders (p = 0.036) and among boys (p = 0.006). Automated phone calls proved to be the least feasible method. Text message reminders are both effective and practical in encouraging HPV vaccination.
AHRQ-funded; HS000044
Citation: Glenn BA, Crespi CM, Herrmann AK .
Effectiveness and feasibility of three types of parent reminders to increase adolescent human papillomavirus (HPV) vaccination.
Prev Med 2023 Apr;169:107448. doi: 10.1016/j.ypmed.2023.107448.
Keywords: Children/Adolescents, Vaccination, Sexual Health
Asher GN, Feltner C, Harrison WN
Serologic screening for genital herpes: updated evidence report and systematic review for the US Preventive Services Task Force.
Genital herpes, a viral sexually transmitted infection (STI) caused by herpes simplex virus (HSV) subtypes HSV-1 or HSV-2, is a prevalent STI in the US. Early identification of unrecognized HSV-2 infection could reduce transmission and morbidity. In 2016, the US Preventive Services Task Force (USPSTF) recommended against routine serologic screening for genital herpes in asymptomatic individuals. This updated evidence report aimed to identify studies published since the previous 2016 evidence review. A literature search was conducted from September 30, 2015, through January 16, 2022, with ongoing surveillance through July 22, 2022. The review identified no new eligible studies, leading to unchanged overall conclusions from the 2016 recommendation against screening. The prior recommendation was based on psychosocial harms from false-positive test results due to poor screening test accuracy and uncertain benefit of preventive viral medications for reducing viral shedding or improving health outcomes. The review focused on the general population of asymptomatic adolescents and adults and may not be applicable to populations at higher risk for infection, such as those with HIV or other immunosuppressive conditions.
AHRQ-funded; 75Q80120D00007.
Citation: Asher GN, Feltner C, Harrison WN .
Serologic screening for genital herpes: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Feb 14; 329(6):510-12. doi: 10.1001/jama.2022.20356..
Keywords: U.S. Preventive Services Task Force (USPSTF), Sexual Health, Infectious Diseases, Screening, Guidelines, Evidence-Based Practice, Prevention
Levander XA, Foot CA, Magnusson SL
Contraception and healthcare utilization by reproductive-age women who use drugs in rural communities: a cross-sectional survey.
This study’s goal was to compare contraceptive use prevalence among women who use drugs (WWUD) in rural communities with women who do not use drugs from similar rural areas. The authors used survey data from the Rural Opioids Initiative (ROI), a cross-sectional survey using respondent-driven sampling (RDS) involving eight rural U.S. regions (January 2018-March 2020) and the National Survey on Family Growth (NSFG), a nationally representative U.S. household reproductive health survey (2017-2019). Women aged 18-49 with prior 30-day non-prescribed opioid and/or non-opioid injection drug use were included. Of 855 women in the ROI, 36.8% and 38.6% reported contraceptive use, compared to 66% of rural women in the NSFG sample. Among the ROI women, 27% had received prior 30-day SUD treatment via outpatient counseling or inpatient program and these women had increased odds of contraceptive use. There was a positive association between contraception use and recent medications for opioid use disorder and prior 6-month primary care utilization that did not meet the threshold for statistical significance.
AHRQ-funded; HS02637; HS027088.
Citation: Levander XA, Foot CA, Magnusson SL .
Contraception and healthcare utilization by reproductive-age women who use drugs in rural communities: a cross-sectional survey.
J Gen Intern Med 2023 Jan; 38(1):98-106. doi: 10.1007/s11606-022-07558-6..
Keywords: Sexual Health, Women, Healthcare Utilization, Rural Health