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Topics
- Adverse Drug Events (ADE) (1)
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- Behavioral Health (1)
- Care Management (1)
- Centers for Education and Research on Therapeutics (CERTs) (1)
- Clinician-Patient Communication (1)
- Communication (3)
- Comprehensive Unit-based Safety Program (CUSP) (1)
- Cultural Competence (1)
- Decision Making (2)
- Disparities (1)
- Education: Patient and Caregiver (1)
- Electronic Health Records (EHRs) (1)
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- Guidelines (2)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Cost and Utilization Project (HCUP) (4)
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- Hospital Discharge (1)
- Hospitals (5)
- Influenza (1)
- (-) Labor and Delivery (34)
- Maternal Care (13)
- Medicaid (2)
- Medical Errors (1)
- Medical Liability (1)
- Medication (2)
- Medication: Safety (1)
- Mortality (2)
- Newborns/Infants (6)
- Nursing (1)
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- Research Methodologies (1)
- Risk (2)
- Simulation (1)
- Social Determinants of Health (1)
- Surgery (1)
- Surveys on Patient Safety Culture (1)
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- Urban Health (1)
- Vaccination (1)
- Women (20)
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 25 of 34 Research Studies DisplayedTilden EL, Phillippi JC, Ahlberg M
Describing latent phase duration and associated characteristics among 1281 low-risk women in spontaneous labor.
Recent research suggests that latent phase of labor may terminate at 6 rather than 4 centimeters of cervical dilation. The objectives of this study were to: (a) characterize duration of the latent phase of labor among term, low-risk, United States women in spontaneous labor using the women's self-identified onset; and (b) quantify associations between demographic and maternal/newborn health characteristics and the duration of the latent phase.
AHRQ-funded; HS024733.
Citation: Tilden EL, Phillippi JC, Ahlberg M .
Describing latent phase duration and associated characteristics among 1281 low-risk women in spontaneous labor.
Birth 2019 Dec;46(4):592-601. doi: 10.1111/birt.12428..
Keywords: Labor and Delivery, Pregnancy, Women
Tan M, Lipman S, Lee H
Evaluation of electronic medical records on nurses' time allocation during cesarean delivery.
The impact of the electronic medical record (EMR) on nursing workload is not well understood. The objective of this descriptive study was to measure the actual and perceived time that nurses spend on the EMR in the operating room during cesarean births. The investigators found that on average, nurses spent 40% of their intraoperative time on the EMR during cesarean births, and this time burden was distributed across the perioperative period.
AHRQ-funded; HS023506.
Citation: Tan M, Lipman S, Lee H .
Evaluation of electronic medical records on nurses' time allocation during cesarean delivery.
J Patient Saf 2019 Dec;15(4):e82-e85. doi: 10.1097/pts.0000000000000467..
Keywords: Electronic Health Records (EHRs), Labor and Delivery, Provider: Nurse, Health Information Technology (HIT), Provider, Pregnancy
Neal JL, Carlson NS, Phillippi JC
Midwifery presence in United States medical centers and labor care and birth outcomes among low-risk nulliparous women: a Consortium on Safe Labor study.
This study compared labor care and birth outcomes between medical centers with interprofessional care (midwives and physicians) versus noninterprofessional care (physicians only). A retrospective cohort study was conducted using Consortium on Safe labor data from low-risk nulliparous women who birthed in interprofessional (7393) or noninterprofessional (6982). Women at interprofessional medical centers were 74% less likely to undergo labor induction and 75% less likely to have oxytocin augmentation. In addition, the cesarean rate was 12% lower.
AHRQ-funded; HS024733.
Citation: Neal JL, Carlson NS, Phillippi JC .
Midwifery presence in United States medical centers and labor care and birth outcomes among low-risk nulliparous women: a Consortium on Safe Labor study.
Birth 2019 Nov 11;46(3):475-86. doi: 10.1111/birt.12407..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Women, Outcomes
Lewkowitz AK, Rosenbloom JI, Keller M
Association between stillbirth >/=23 weeks gestation and acute psychiatric illness within 1 year of delivery.
This study analyzed whether women experiencing a stillbirth had a higher risk of psychiatric morbidity and/or substance misuse within 1 year of delivery compared to women having a live birth. Higher risk was found for both using data from the Florida State Inpatient and State Emergency Department databases from 2005-2014. Women with an ICD-9 classification of stillbirth at or greater than 23 weeks gestation were included. Emergency department encounters or admissions with a diagnosis code of a psychiatric disorder were used.
AHRQ-funded; HS019455.
Citation: Lewkowitz AK, Rosenbloom JI, Keller M .
Association between stillbirth >/=23 weeks gestation and acute psychiatric illness within 1 year of delivery.
Am J Obstet Gynecol 2019 Nov;221(5):491.e1-91.e22. doi: 10.1016/j.ajog.2019.06.027..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Pregnancy, Behavioral Health, Women, Labor and Delivery
Carlson NS, Neal JL, Tilden EL
Influence of midwifery presence in United States centers on labor care and outcomes of low-risk parous women: a Consortium on Safe Labor study.
The authors analyzed the association between midwifery presence in maternity care teams and the birth processes and outcomes of low-risk parous women. They found that parous women have significantly higher rates of vaginal birth, including vaginal birth after cesarean, and a lower likelihood of labor induction when cared for in centers with midwives. They concluded that their findings support integrated, team-based models of perinatal care to improve maternal outcomes.
AHRQ-funded; HS024733.
Citation: Carlson NS, Neal JL, Tilden EL .
Influence of midwifery presence in United States centers on labor care and outcomes of low-risk parous women: a Consortium on Safe Labor study.
Birth 2019 Sep;46(3):487-99. doi: 10.1111/birt.12405..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Women, Outcomes
Carter EB, Cahill AG, Olsen MA
Practical considerations with 17-Hydroxyprogesterone caproate for preterm birth prevention: does timing of initiation and compliance matter?
This study examined whether early initiation and compliance with use of 17-OHPC can reduce the risk of preterm birth (PTB) risk more than later medication initiation. A retrospective cohort study was conducted using MarketScan® data. Rates of PTB were compared for women with medication initiation at 16-21 weeks versus 21-29 weeks. Women with an early 17-OHPC start were less likely to delivery preterm than those with a later start. Less compliant patients also had a higher PTB rate.
AHRQ-funded; HS019455.
Citation: Carter EB, Cahill AG, Olsen MA .
Practical considerations with 17-Hydroxyprogesterone caproate for preterm birth prevention: does timing of initiation and compliance matter?
J Perinatol 2019 Sep;39(9):1182-89. doi: 10.1038/s41372-019-0401-2..
Keywords: Pregnancy, Labor and Delivery, Women, Medication, Patient Adherence/Compliance
Brenes-Monge A, Saavedra-Avendano B, Alcalde-Rabanal J
Are overweight and obesity associated with increased risk of cesarean delivery in Mexico? A cross-sectional study from the National Survey of Health and Nutrition.
Researchers conducted a cross-sectional study to test the association between overweight and obesity and cesarean delivery in Mexico using data from the 2012 National Survey of Health and Nutrition (ENSANUT). They found that multiparous women with obesity are at higher risk of cesarean delivery in Mexico than multiparous women with normal body mass index. They recommend that efforts to reduce the cesarean deliveries rate take the obesity epidemic into account.
AHRQ-funded; HS022981.
Citation: Brenes-Monge A, Saavedra-Avendano B, Alcalde-Rabanal J .
Are overweight and obesity associated with increased risk of cesarean delivery in Mexico? A cross-sectional study from the National Survey of Health and Nutrition.
BMC Pregnancy Childbirth 2019 Jul 11;19(1):239. doi: 10.1186/s12884-019-2393-5..
Keywords: Labor and Delivery, Obesity, Pregnancy, Risk, Women
Simpson KR, Lyndon A, Spetz J
Adaptation of the MISSCARE Survey to the maternity care setting.
This paper examines the feasibility of using the Missed Nursing Care (MISSCARE) Survey to study missed nursing care during labor and delivery. This survey has not been used to examine childbirth care although it is the most common reason for hospitalization in the United States. A modified version called the Perinatal Missed Care Survey appears to be the most feasible and promising instrument to evaluate missed nursing care during labor and delivery.
AHRQ-funded; HS025715.
Citation: Simpson KR, Lyndon A, Spetz J .
Adaptation of the MISSCARE Survey to the maternity care setting.
J Obstet Gynecol Neonatal Nurs 2019 Jul;48(4):456-67. doi: 10.1016/j.jogn.2019.05.005..
Keywords: Labor and Delivery, Maternal Care, Nursing, Pregnancy, Women
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
Guglielminotti J, Landau R, Li. G
Adverse events and factors associated with potentially avoidable use of general anesthesia in cesarean deliveries.
Compared with neuraxial anesthesia, general anesthesia for cesarean delivery is associated with increased risk of maternal adverse events. Reducing avoidable general anesthetics for cesarean delivery may improve safety of obstetric anesthesia care. This study examined adverse events, trends, and factors associated with potentially avoidable general anesthetics for cesarean delivery. The investigators concluded that compared with neuraxial anesthesia, avoidable general anesthetics are associated with increased risk of adverse maternal outcomes.
AHRQ-funded; HS025787.
Citation: Guglielminotti J, Landau R, Li. G .
Adverse events and factors associated with potentially avoidable use of general anesthesia in cesarean deliveries.
Anesthesiology 2019 Jun;130(6):912-22. doi: 10.1097/aln.0000000000002629..
Keywords: Healthcare Cost and Utilization Project (HCUP), Labor and Delivery, Surgery, Pregnancy, Adverse Drug Events (ADE), Adverse Events, Women, Medication, Medication: Safety, Patient Safety, Maternal Care
Simpson KR, Lyndon A, Spetz J
Adherence to the AWHONN staffing guidelines as perceived by labor nurses.
Labor and delivery nurses were surveyed to determine if their units adhere to Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) staffing guidelines. Labor nurses in selected hospitals in California, Michigan and New Jersey were invited via email to participate in the study. Their nurse leaders facilitated the invitations. A total of 615 labor nurses from 67 hospitals participated. Most nurses did report that staffing guidelines were adhered to. The hospitals with smaller annual birth volumes (500-999 range) were significantly more like to be perceived as compliant than hospitals with 2,500 or more annual births.
AHRQ-funded; HS025715.
Citation: Simpson KR, Lyndon A, Spetz J .
Adherence to the AWHONN staffing guidelines as perceived by labor nurses.
Nurs Womens Health 2019 Jun;23(3):217-23. doi: 10.1016/j.nwh.2019.03.003..
Keywords: Care Management, Guidelines, Labor and Delivery, Maternal Care, Patient Safety, Pregnancy, Provider, Provider: Nurse, 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
Lapcharoensap W, Cong A, Sherman J
Safety and ergonomic challenges of ventilating a premature infant during delayed cord clamping.
This study discussed the reasons that delayed cord clamping (DCC) for term and preterm infants is endorsed by multiple medical organizations. It has been shown to reduce hemorrhage, lower incidence of necrotizing enterocolitis and the need for transfusions in preterm infants. The writers held a number of multidisciplinary simulation workshops of vaginal and Caesarean deliveries, with providers starting positive pressure ventilation and ending with CPAP on a preterm manikin. Videos were also reviewed and identified 5 themes of concern: sterility, equipment, mobility, space, and workflow.
AHRQ-funded; HS023506.
Citation: Lapcharoensap W, Cong A, Sherman J .
Safety and ergonomic challenges of ventilating a premature infant during delayed cord clamping.
Children 2019 Apr 13;6(4). doi: 10.3390/children6040059..
Keywords: Adverse Events, Labor and Delivery, Newborns/Infants, Patient Safety
Kahwati LC, Sorensen AV, Teixeira-Poit S
AHRQ Author: Mistry KB
Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care.
The purpose of this study was to describe the Safety Program for Perinatal Care (SPPC) implementation experience and evaluate the short-term impact on labor and delivery (L&D) unit patient safety culture, processes, and adverse events. SPPC implementation by L&D units were supported sing a program toolkit, trainings, and technical assistance. Researchers then evaluated the program using a pre-post, mixed-methods design. Changes in safety and quality were measured using the Modified Adverse Outcome Index (MAOI) and other perinatal care indicators. Findings showed that SPPC had a favorable impact on unit patient safety culture and processes, but mixed short-term impact on maternal and neonatal adverse events.
AHRQ-authored; AHRQ-funded; 2902010000241.
Citation: Kahwati LC, Sorensen AV, Teixeira-Poit S .
Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care.
Jt Comm J Qual Patient Saf 2019 Apr;45(4):231-40. doi: 10.1016/j.jcjq.2018.11.002..
Keywords: Adverse Events, Communication, Comprehensive Unit-based Safety Program (CUSP), Labor and Delivery, Maternal Care, Newborns/Infants, Outcomes, Patient Safety, Pregnancy, Simulation, Surveys on Patient Safety Culture, Teams, TeamSTEPPS, Training, Women
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
Xu X, Lee HC, Lin H
Hospital variation in utilization and success of trial of labor after a prior cesarean.
The purpose of this study was to examine hospital variation in utilization and success of trial of labor after cesarean delivery (TOLAC) and to identify associated institutional characteristics and patient outcomes. The investigators found that utilization and success rates of TOLAC varied considerably across hospitals. Strategies to promote vaginal birth should be tailored to hospital needs and characteristics (e.g., increase availability at low TOLAC rate hospitals while being more selective at high TOLAC rate hospitals, and targeted support for lower capacity hospitals).
AHRQ-funded; HS023801.
Citation: Xu X, Lee HC, Lin H .
Hospital variation in utilization and success of trial of labor after a prior cesarean.
Am J Obstet Gynecol 2019 Jan;220(1):98.e1-98.e14. doi: 10.1016/j.ajog.2018.09.034.
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Keywords: Labor and Delivery, Pregnancy, Women
Burstein PD, Zalenski DM, Edwards JL
Changing labor and delivery practice: focus on achieving practice and documentation standardization with the goal of improving neonatal outcomes.
The researchers established a multifactorial shoulder dystocia response and management protocol to promote sustainable practice change. In the first year, there was a threefold increase in shoulder dystocia reporting, which continued in years 2 and 3. In the first year, 96 percent of clinicians completed all training elements. Overall teams reached a 99 percent adoption rate of the shoulder dystocia protocol.
AHRQ-funded; HS019608.
Citation: Burstein PD, Zalenski DM, Edwards JL .
Changing labor and delivery practice: focus on achieving practice and documentation standardization with the goal of improving neonatal outcomes.
Health Serv Res 2016 Dec;51 Suppl 3:2472-86. doi: 10.1111/1475-6773.12589.
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Keywords: Labor and Delivery, Newborns/Infants, Adverse Events, Quality Improvement, Quality of Care, Patient Safety, Patient-Centered Outcomes Research, Outcomes, Guidelines, Evidence-Based Practice, Pregnancy, Teams
Sentell T, Chang A, Ahn HJ
Maternal language and adverse birth outcomes in a statewide analysis.
The study goal was to consider the relationship of maternal language to birth outcomes using Hawaii’s hospitalization data. It found that non-English speakers had approximately two times higher risk of having an obstetric trauma during a vaginal birth when other factors, including race/ethnicity, were controlled. Non-English speakers also had higher rates of potentially high-risk deliveries.
AHRQ-funded; HS019990; HS021903.
Citation: Sentell T, Chang A, Ahn HJ .
Maternal language and adverse birth outcomes in a statewide analysis.
Women Health 2016;56(3):257-80. doi: 10.1080/03630242.2015.1088114.
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Keywords: Adverse Events, Communication, Labor and Delivery, Outcomes
Bommarito KM, Gross GA, Willers DM
The effect of clinical chorioamnionitis on cesarean delivery in the United States.
This study examined the association of clinical chorioamnionitis on cesarean delivery in a national sample of hospital discharges. It found that women with clinical chorioamnionitis were more likely to have cesarean delivery than those without clinical chorioamnionitis. The risk of cesarean delivery varied significantly by hospital location, teaching status, and U.S. region.
AHRQ-funded; HS019455.
Citation: Bommarito KM, Gross GA, Willers DM .
The effect of clinical chorioamnionitis on cesarean delivery in the United States.
Health Serv Res 2016 Oct;51(5):1879-95. doi: 10.1111/1475-6773.12447.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Labor and Delivery, Pregnancy, Risk, Women
Salemi JL, Pathak EB, Salihu HM
Infant outcomes after elective early-term delivery compared with expectant management.
The purpose of the study was to compare the risk of neonatal morbidity and infant mortality between elective early-term deliveries and those expectantly managed and delivered at 39 weeks of gestation or greater. It concluded that the issues surrounding the timing and reasons for delivery initiation are complicated and each pregnancy unique. Furthermore, it cautions against a general avoidance of all elective early-term deliveries.
AHRQ-funded - HS019997.
Citation: Salemi JL, Pathak EB, Salihu HM .
Infant outcomes after elective early-term delivery compared with expectant management.
Obstet Gynecol 2016 Apr;127(4):657-66. doi: 10.1097/aog.0000000000001331.
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Keywords: Newborns/Infants, Mortality, Pregnancy, Labor and Delivery, Adverse Events
Cheng ER, Park H, Wisk LE
Examining the link between women's exposure to stressful life events prior to conception and infant and toddler health: the role of birth weight.
The authors suggested a pathway may exist among maternal exposure to stressful life events prior to conception (PSLEs), infant birth weight, and subsequent offspring health. Infant and toddler health outcomes were assessed at 9 and 24 months, including overall health status, special healthcare needs, and severe health conditions. The analysis suggested a chains-of-risk model in which women's exposure to PSLEs increased the risk for giving birth to a very low birth weight infant, adversely affecting infant and toddler health.
AHRQ-funded; HS000063; HS00083.
Citation: Cheng ER, Park H, Wisk LE .
Examining the link between women's exposure to stressful life events prior to conception and infant and toddler health: the role of birth weight.
J Epidemiol Community Health 2016 Mar;70(3):245-52. doi: 10.1136/jech-2015-205848.
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Keywords: Maternal Care, Women, Labor and Delivery, Newborns/Infants, Newborns/Infants
Parriott AM, Arah OA
Patient volumes and pre- and postdischarge postpartum infection: a retrospective cohort study.
The researchers examined the association between hospital and clinician obstetric volume and postpartum infection risk in the pre- and postdischarge periods. They found that hospital obstetric volume is positively associated with predischarge postpartum infections, whereas clinician volume may be negatively associated with those predischarge infections.
AHRQ-funded; HS000046.
Citation: Parriott AM, Arah OA .
Patient volumes and pre- and postdischarge postpartum infection: a retrospective cohort study.
Am J Infect Control 2016 Jan;44(1):30-5. doi: 10.1016/j.ajic.2015.08.018.
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Keywords: Healthcare-Associated Infections (HAIs), Hospital Discharge, Labor and Delivery, Maternal Care, Patient Safety
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