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AHRQ Research Studies Date
Topics
- Adverse Events (3)
- Care Management (1)
- Communication (1)
- Diabetes (1)
- Disparities (1)
- Education: Continuing Medical Education (1)
- Evidence-Based Practice (1)
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- (-) Labor and Delivery (15)
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- Patient Experience (1)
- Patient Safety (2)
- Practice Patterns (1)
- Pregnancy (13)
- Provider: Health Personnel (1)
- Quality of Care (2)
- Risk (2)
- Shared Decision Making (2)
- Social Determinants of Health (3)
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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 DisplayedAustin N, Kristensen-Cabrera A, Sherman J
Analyzing the heterogeneity of labor and delivery units: a quantitative analysis of space and design.
This study evaluated the effect of space and design on labor and deliver (L&D) hospital units. A quantitative analysis was done to see if it made an impact on the risk of deliveries. The researchers recommend standardization of the space based on number of deliveries and cesarean sections.
AHRQ-funded; HS023506.
Citation: Austin N, Kristensen-Cabrera A, Sherman J .
Analyzing the heterogeneity of labor and delivery units: a quantitative analysis of space and design.
PLoS One 2018 Dec 26;13(12):e0209339. doi: 10.1371/journal.pone.0209339..
Keywords: Labor and Delivery, Pregnancy, Women
Neal JL, Lowe NK, Caughey AB
Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women.
The aims of this study were to assess associations of labor status at admission (i.e., preactive or active) and active labor progress (i.e., dystocic or physiologic) with oxytocin augmentation, cesarean birth, and adverse neonatal outcome rates. The authors suggest that adoption of evidence-based, standardized approaches for diagnosing active labor onset, assessing labor progress, and diagnosing dystocia may safely decrease oxytocin augmentation and cesarean birth rates in the United States.
AHRQ-funded; HS024733.
Citation: Neal JL, Lowe NK, Caughey AB .
Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women.
Birth 2018 Dec;45(4):358-67. doi: 10.1111/birt.12358..
Keywords: Labor and Delivery, Pregnancy, Women
Neal JL, Lowe NK, Phillippi JC
Likelihood of cesarean birth among parous women after applying leading active labor diagnostic guidelines.
The goals of this study were: Determine the proportions of women admitted to the hospital before or in active labor per the leading National Institute for Health and Care Excellence (NICE), and the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) guidelines; Compare associations of labor status at admission with oxytocin augmentation, cesarean birth, and adverse birth outcomes when using the different active labor diagnostic guidelines. Active labor diagnostic guidelines were applied retrospectively to cervical examination data. The authors conclude that many parous women with spontaneous labor onset are admitted to the hospital before active labor, and these women are more likely to receive oxytocin augmentation during labor and to have a cesarean birth. Implications for practice are discussed.
AHRQ-funded; HS024733.
Citation: Neal JL, Lowe NK, Phillippi JC .
Likelihood of cesarean birth among parous women after applying leading active labor diagnostic guidelines.
Midwifery 2018 Dec;67:64-69. doi: 10.1016/j.midw.2018.09.007..
Keywords: Shared Decision Making, Guidelines, Hospitalization, Labor and Delivery, Pregnancy, Women
Nelson DB, Moniz MH, Davis MM
Population-level factors associated with maternal mortality in the United States, 1997-2012.
This study analyzed state-level maternal mortality for the years 1997-2012 using multilevel mixed-effects regression grouped by state, using publicly available data. The study concluded that, in addition to better case ascertainment of maternal deaths, adverse changes in chronic diseases, insufficient healthcare access, and social determinants of health represent identifiable risks for maternal mortality that merit prompt attention in population-directed interventions and health policies.
AHRQ-funded; HS025465.
Citation: Nelson DB, Moniz MH, Davis MM .
Population-level factors associated with maternal mortality in the United States, 1997-2012.
BMC Public Health 2018 Aug 13;18(1):1007. doi: 10.1186/s12889-018-5935-2..
Keywords: Health Services Research (HSR), Labor and Delivery, Mortality, Pregnancy, Social Determinants of Health
Attanasio LB, Kozhimannil KB, Kjerulff KH
Factors influencing women's perceptions of shared decision making during labor and delivery: results from a large-scale cohort study of first childbirth.
The researchers examined correlates of shared decision making during labor and delivery. They found that women who were black and who did not have a college degree or private insurance were less likely to report high shared decision making, as well as women who underwent labor induction, instrumental vaginal or cesarean delivery.
AHRQ-funded; HS024215.
Citation: Attanasio LB, Kozhimannil KB, Kjerulff KH .
Factors influencing women's perceptions of shared decision making during labor and delivery: results from a large-scale cohort study of first childbirth.
Patient Educ Couns 2018 Jun;101(6):1130-36. doi: 10.1016/j.pec.2018.01.002.
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Keywords: Shared Decision Making, Disparities, Labor and Delivery, Patient-Centered Healthcare, Social Determinants of Health
Xu X, Lee HC, Lin H
Hospital variation in cost of childbirth and contributing factors: a cross-sectional study.
The purpose of this study was to examine hospital variation in cost of childbirth hospitalizations and identify factors that contribute to the variation. The study concluded that cost of childbirth hospitalizations varied widely among hospitals in California. Institutional characteristics significantly contributed to this variation. Higher-cost hospitals did not have better outcomes, suggesting potential opportunities to enhance value in care.
AHRQ-funded; HS023801.
Citation: Xu X, Lee HC, Lin H .
Hospital variation in cost of childbirth and contributing factors: a cross-sectional study.
BJOG 2018 Jun;125(7):829-39. doi: 10.1111/1471-0528.15007..
Keywords: Healthcare Costs, Health Services Research (HSR), Hospitals, Labor and Delivery, Pregnancy
White VanGompel E, Main EK, Tancredi D
Do provider birth attitudes influence cesarean delivery rate: a cross-sectional study.
The authors estimated the association between individual provider attitudes towards birth and their low-risk primary cesarean rate. Through surveys of California providers of intrapartum care in 2013, they found that provider attitudinal differences are associated with nulliparous, term, singleton, vertex cesarean rates. Those meeting the HP2020 goal hold attitudes more favorable towards vaginal birth, suggesting a modifiable target for quality improvement initiatives to decrease low risk primary cesareans.
AHRQ-funded; HS022236.
Citation: White VanGompel E, Main EK, Tancredi D .
Do provider birth attitudes influence cesarean delivery rate: a cross-sectional study.
BMC Pregnancy Childbirth 2018 May 29;18(1):184. doi: 10.1186/s12884-018-1756-7.
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Keywords: Provider: Health Personnel, Labor and Delivery, Pregnancy, Practice Patterns
Lyndon A, Malana J, Hedi LC
Thematic analysis of women's perspectives on the meaning of safety during hospital-based birth.
This study used an interdisciplinary team of five investigators to examine women’s birth experiences in the perspective of patient safety. Five investigators in the fields of nursing, medicine, product design, and journalism analyzed transcripts to see how women felt about their physical or emotional safety during birth, and to identify opportunities for improvement in care. Teams that were well-organized promoted feelings of safety as well as human connection.
AHRQ-funded; HS023506.
Citation: Lyndon A, Malana J, Hedi LC .
Thematic analysis of women's perspectives on the meaning of safety during hospital-based birth.
J Obstet Gynecol Neonatal Nurs 2018 May;47(3):324-32. doi: 10.1016/j.jogn.2018.02.008..
Keywords: Labor and Delivery, Pregnancy, Women, Patient Safety, Patient Experience
Hefele JG, Santos P, Ritter G
Risk factors for shoulder dystocia: the impact of mother's race and ethnicity.
The purpose of this observational study was to examine shoulder dystocia risk factors by race and ethnicity using a 19,236 sample of pregnant women who presented for labor and delivery. Results found that, for White non-Hispanic mothers, the strongest risk factors were delivering past 40 weeks' gestation and use of epidural anesthesia during delivery. Among Black non-Hispanic mothers, the risk factors with the greatest impact were use of epidural and having gestational diabetes and controlling the condition with insulin. Additionally, among Hispanic mothers, having Spanish as the primary language increased shoulder dystocia likelihood compared to those who did not cite it as their primary language. This study provides evidence that risk factors for a labor and delivery condition can vary significantly across racial and ethnic subgroups.
AHRQ-funded; HS019608.
Citation: Hefele JG, Santos P, Ritter G .
Risk factors for shoulder dystocia: the impact of mother's race and ethnicity.
J Racial Ethn Health Disparities 2018 Apr;5(2):333-41. doi: 10.1007/s40615-017-0374-9..
Keywords: Adverse Events, Labor and Delivery, Injuries and Wounds, Newborns/Infants, Pregnancy, Risk
McArdle J, Sorensen A, Fowler CI
Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care.
The purpose of this study using TeamSTEPPS was to assess the implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units. Results suggested that successful management of shoulder dystocia requires a rapid, standardized, and coordinated response. The Safety Program for Perinatal Care strategies to increase safety of shoulder dystocia management are scalable, replicable, and adaptable to unit needs and circumstances.
AHRQ-funded; 2902010000241.
Citation: McArdle J, Sorensen A, Fowler CI .
Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care.
J Obstet Gynecol Neonatal Nurs 2018 Mar;47(2):191-201. doi: 10.1016/j.jogn.2017.11.014.
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Keywords: Labor and Delivery, Newborns/Infants, Pregnancy, Adverse Events, TeamSTEPPS, Injuries and Wounds, Care Management, Education: Continuing Medical Education, Training, Tools & Toolkits, Patient Safety, Nursing, Communication, Quality of Care
Santos P, Hefele JG, Ritter G
Population-based risk factors for shoulder dystocia.
This retrospective observational study examined population-based risk factors for infant shoulder dystocia during labor. Five hospitals in 5 states were used and over 19,000 births evaluated between April 2011 and July 2013. An increased risk for dystocia was found for women who were prescribed insulin, indicating gestational diabetes. However this was not true of women with gestational diabetes who were not prescribed insulin. Other risk factors included being Black, Hispanic, covered by Medicaid or no insurance, infant gestational age of 41 weeks or greater, and chronic diabetes.
AHRQ-funded; HS019608.
Citation: Santos P, Hefele JG, Ritter G .
Population-based risk factors for shoulder dystocia.
J Obstet Gynecol Neonatal Nurs 2018 Jan;47(1):32-42. doi: 10.1016/j.jogn.2017.11.011..
Keywords: Labor and Delivery, Newborns/Infants, Risk, Pregnancy, Injuries and Wounds, Adverse Events
Phillippi JC, Danhausen K, Alliman J
Neonatal outcomes in the birth center setting: a systematic review.
This systematic review examined the effects of the birth center setting on neonatal mortality in economically developed countries. The criteria for inclusion included being in English, published after 1980 and in countries with similar guidelines to the American Association of Birth Centers Standards. The only measure used was neonatal mortality and results did not find any difference between using a birth center as opposed to a traditional hospital setting. The literature was not found to have many good quality studies, and further research is recommended.
AHRQ-funded; HS024733.
Citation: Phillippi JC, Danhausen K, Alliman J .
Neonatal outcomes in the birth center setting: a systematic review.
J Midwifery Womens Health 2018 Jan;63(1):68-89. doi: 10.1111/jmwh.12701..
Keywords: Evidence-Based Practice, Labor and Delivery, Mortality, Newborns/Infants, Outcomes, Pregnancy, Women
Srinivas SK, Fager C, Lorch SA
Variations in postdelivery infection and thrombosis by hospital teaching status.
The researchers examined hospital-level variation overall and by teaching status in 2 maternal outcomes, postpartum infections, and thrombosis. They found substantial variation in infection and thrombosis rates among hospitals both overall and by teaching status, suggesting that these 2 outcomes may be useful measures of inpatient obstetric quality.
AHRQ-funded; HS015696.
Citation: Srinivas SK, Fager C, Lorch SA .
Variations in postdelivery infection and thrombosis by hospital teaching status.
Am J Obstet Gynecol 2013 Dec;209(6):567.e1-7. doi: 10.1016/j.ajog.2013.08.002..
Keywords: Pregnancy, Labor and Delivery, Outcomes, Quality of Care
Bardenheier BH, Elixhauser A, Imperatore G
AHRQ Author: Elixhauser A
Variation in prevalence of gestational diabetes mellitus among hospital discharges for obstetric delivery across 23 states in the United States.
The authors examined variability in diagnosed gestational diabetes mellitus (GDM) prevalence at delivery by race/ethnicity and state. Their results suggest that GDM rates differ by state, with this variation attributable to differences in obesity at the population level, age, race/ethnicity, hospital, and insurance.
AHRQ-authored.
Citation: Bardenheier BH, Elixhauser A, Imperatore G .
Variation in prevalence of gestational diabetes mellitus among hospital discharges for obstetric delivery across 23 states in the United States.
Diabetes Care 2013 May;36(5):1209-14. doi: 10.2337/dc12-0901.
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Keywords: Diabetes, Healthcare Cost and Utilization Project (HCUP), Hospital Discharge, Labor and Delivery, Pregnancy
Bruckner TA, Rehkopf DH, Catalano RA
Income gains and very low-weight birth among low-income black mothers in California.
The researchers examined pregnant women in California in the 1990s who likely received a lump sum federal tax refund as a result of the Earned Income Tax Credit (EITC) in order to determine the effect, if any, on their infant’s birthweight. Contrary to expectation, the odds of a very low birthweight (VLBW) infant increase above expected values two months immediately following the tax disbursement.
AHRQ-funded; HS0008609.
Citation: Bruckner TA, Rehkopf DH, Catalano RA .
Income gains and very low-weight birth among low-income black mothers in California.
Biodemography Soc Biol 2013;59(2):141-56. doi: 10.1080/19485565.2013.833802..
Keywords: Newborns/Infants, Low-Income, Social Determinants of Health, Labor and Delivery