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 20 of 20 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
Austin 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