National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Events (3)
- Centers for Education and Research on Therapeutics (CERTs) (1)
- Clinician-Patient Communication (1)
- Communication (2)
- Decision Making (2)
- Disabilities (3)
- Disparities (1)
- Education: Patient and Caregiver (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Delivery (1)
- Health Insurance (2)
- Health Services Research (HSR) (2)
- Hospital Discharge (1)
- Hospitals (1)
- Influenza (1)
- (-) Labor and Delivery (22)
- Maternal Care (1)
- Medicaid (2)
- Medical Errors (1)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medical Liability (1)
- Medication (1)
- Mortality (1)
- Newborns/Infants (2)
- Outcomes (2)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (3)
- Patient Experience (1)
- Patient Safety (1)
- Policy (2)
- Pregnancy (17)
- Public Health (1)
- Quality Improvement (1)
- Quality Indicators (QIs) (1)
- Racial and Ethnic Minorities (2)
- Research Methodologies (1)
- Social Determinants of Health (2)
- Urban Health (1)
- Vaccination (1)
- Women (7)
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 22 of 22 Research Studies DisplayedAttanasio LB, Hardeman RR, Kozhimannil KB
Prenatal attitudes toward vaginal delivery and actual delivery mode: variation by race/ethnicity and socioeconomic status.
This study examined whether women's prenatal attitudes toward vaginal delivery differed by race/ethnicity or socioeconomic status, and whether attitudes were differently related to delivery mode depending on race/ethnicity or socioeconomic status. The study concluded that there are racial/ethnic differences in chances of cesarean delivery, and these differences are not explained by birth attitudes. Findings also suggested that white and high-socioeconomic status women may be more able to realize their preferences in childbirth.
AHRQ-funded; HS024215.
Citation: Attanasio LB, Hardeman RR, Kozhimannil KB .
Prenatal attitudes toward vaginal delivery and actual delivery mode: variation by race/ethnicity and socioeconomic status.
Birth 2017 Dec;44(4):306-14. doi: 10.1111/birt.12305..
Keywords: Health Services Research (HSR), Labor and Delivery, Pregnancy, Racial and Ethnic Minorities, Social Determinants of Health
Markowitz S, Adams EK, Lewitt MJ
Competitive effects of scope of practice restrictions: public health or public harm?
This paper examined the case of scope of practice (SOP) restrictions for certified nurse midwives and evaluated the effects of changes in states' SOP laws on markets for CNMs and on maternal and infant outcomes. The authors found that SOP laws are neither helpful nor harmful in regards to health outcomes but states that have no SOP-based barriers have lower rates of induced labor and Cesarean section births.
AHRQ-funded; HS024530.
Citation: Markowitz S, Adams EK, Lewitt MJ .
Competitive effects of scope of practice restrictions: public health or public harm?
J Health Econ 2017 Sep;55:201-18. doi: 10.1016/j.jhealeco.2017.07.004..
Keywords: Health Services Research (HSR), Labor and Delivery, Pregnancy, Public Health, Policy
Lapcharoensap W, Lee HC
Tackling quality improvement in the delivery room.
Implementation of standardized practices in the delivery room fosters a safe environment to ensure that newborn infants are cared for optimally. This article discusses how the delivery room is a unique environment and presents examples on how to approach delivery room quality improvement (QI). Key areas of potential focus for teams pursuing delivery QI include thermal regulation, optimizing respiratory support, and facilitating team communication.
AHRQ-funded; HS023506.
Citation: Lapcharoensap W, Lee HC .
Tackling quality improvement in the delivery room.
Clin Perinatol 2017 Sep;44(3):663-81. doi: 10.1016/j.clp.2017.05.003.
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Keywords: Communication, Labor and Delivery, Newborns/Infants, Quality Improvement, Patient Safety
Metz TD, Gonzalez C, Allshouse AA
Influence of patient-level factors on mode of delivery among operative vaginal delivery candidates in modern practice.
This study aimed to evaluate which patient-level factors influence mode of delivery among candidates for operative vaginal delivery. Odds of forceps versus vacuum were higher with induction, nulliparity, epidural, maternal indication, older maternal age, and longer second stage. Odds of cesarean versus operative vaginal delivery were higher with maternal indication, a perinatologist, longer second stage, older gestational age and longer labor.
AHRQ-funded; HS022143.
Citation: Metz TD, Gonzalez C, Allshouse AA .
Influence of patient-level factors on mode of delivery among operative vaginal delivery candidates in modern practice.
Am J Perinatol 2017 Aug;34(10):974-81. doi: 10.1055/s-0037-1601441.
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Keywords: Adverse Events, Healthcare Delivery, Labor and Delivery, Pregnancy, Women
Jensen EA, Lorch SA
Association between off-peak hour birth and neonatal morbidity and mortality among very low birth weight infants.
This study assessed the independent association between overnight or "off-peak" hour delivery and 3 neonatal morbidities strongly associated with childhood neurocognitive impairment. It found that very low birth weight infants born between midnight and 7:00 a.m. are at increased risk for severe intraventricular hemorrhage and death or major neonatal morbidity.
AHRQ-funded; HS015696.
Citation: Jensen EA, Lorch SA .
Association between off-peak hour birth and neonatal morbidity and mortality among very low birth weight infants.
J Pediatr 2017 Jul;186:41-48.e4. doi: 10.1016/j.jpeds.2017.02.007.
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Keywords: Labor and Delivery, Mortality, Newborns/Infants, Adverse Events
Horner-Johnson W, Kulkarni-Rajasekhara S, Darney BG
Live birth, miscarriage, and abortion among U.S. women with and without disabilities.
Researchers compared proportions of live birth, miscarriage, and abortion among women with basic action difficulties, women with complex activity limitations, and women without disabilities in a nationally representative sample. They found few differences between women with and without disabilities, and good likelihood of live birth among women with disabilities experiencing pregnancy.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Kulkarni-Rajasekhara S, Darney BG .
Live birth, miscarriage, and abortion among U.S. women with and without disabilities.
Disabil Health J 2017 Jul;10(3):382-86. doi: 10.1016/j.dhjo.2017.02.006.
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Keywords: Disabilities, Labor and Delivery, Medical Expenditure Panel Survey (MEPS), Pregnancy
Masinter LM, Dina B, Kjerulff K
Short interpregnancy intervals: results from the first baby study.
Short interpregnancy interval (SIPI), defined as 18 months or fewer between delivery and subsequent conception, has become an independent marker of maternal and child health. The authors of this study performed a secondary analysis of 18 months of data from The First Baby Study, a prospective cohort of women followed from pregnancy through 3 years after their first birth.
AHRQ-funded; HS000078.
Citation: Masinter LM, Dina B, Kjerulff K .
Short interpregnancy intervals: results from the first baby study.
Womens Health Issues 2017 Jul - Aug;27(4):426-33. doi: 10.1016/j.whi.2017.02.011..
Keywords: Pregnancy, Labor and Delivery, Women
Horner-Johnson W, Biel FM, Darney BG
Time trends in births and cesarean deliveries among women with disabilities.
This study assessed time trends in births by any mode and in primary cesarean deliveries among women with physical, sensory, or intellectual/developmental disabilities. Among all women giving birth, the proportion with a disability increased from 0.27 percent in 2000 to 0.80 percent in 2010. Women with disabilities had significantly elevated odds of primary cesarean delivery in each year, but the magnitude of the odds ratio decreased over time.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Biel FM, Darney BG .
Time trends in births and cesarean deliveries among women with disabilities.
Disabil Health J 2017 Jul;10(3):376-81. doi: 10.1016/j.dhjo.2017.02.009.
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Keywords: Disabilities, Labor and Delivery, Pregnancy
Attanasio LB, Kozhimannil KB, Srinivas SK
Concordance between women's self-reported reasons for cesarean delivery and hospital discharge records.
Researchers compared women's self-reported reasons for cesarean with their hospital discharge records and examined correlates of variability in agreement between sources. Ninety-one percent of women reported a reason for their cesarean that was present in the discharge data. Positive predictive value (PPV), the probability that women's self-reported reasons for cesarean varied by reason for cesarean, with high PPV for dystocia, macrosomia, and cephalopelvic disproportion (91.1 percent), and lower PPV for malposition (81.7 percent).
AHRQ-funded; HS024215.
Citation: Attanasio LB, Kozhimannil KB, Srinivas SK .
Concordance between women's self-reported reasons for cesarean delivery and hospital discharge records.
Womens Health Issues 2017 May - Jun;27(3):329-35. doi: 10.1016/j.whi.2016.12.006.
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Keywords: Hospital Discharge, Labor and Delivery, Pregnancy, Women
Sjaarda LA, Radin RG, Silver RM
AHRQ Author: Mitchell E
Preconception low-dose aspirin restores diminished pregnancy and live birth rates in women with low grade inflammation: a secondary analysis of a randomized trial.
This study investigated the effect of preconception-initiated low dose aspirin (LDA) on pregnancy rate, pregnancy loss, live birth rate, and inflammation during pregnancy. It concluded that in women attempting conception with elevated high sensitivity C-reactive protein (hsCRP) and prior pregnancy loss, LDA may increase clinical pregnancy and live birth rates to those of women without inflammation and reduce hsCRP elevation during pregnancy.
AHRQ-authored.
Citation: Sjaarda LA, Radin RG, Silver RM .
Preconception low-dose aspirin restores diminished pregnancy and live birth rates in women with low grade inflammation: a secondary analysis of a randomized trial.
J Clin Endocrinol Metab 2017 May;102(5):1495-504. doi: 10.1210/jc.2016-2917.
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Keywords: Pregnancy, Medication, Outcomes, Labor and Delivery
Darney BG, Biel FM, Quigley BP
Primary cesarean delivery patterns among women with physical, sensory, or intellectual disabilities.
This study sought to determine whether physical, sensory, or intellectual and developmental disabilities are independently associated with primary cesarean delivery. It found that women across disability subgroups have higher odds of cesarean delivery, and there is heterogeneity by disability type.
AHRQ-funded; HS022981.
Citation: Darney BG, Biel FM, Quigley BP .
Primary cesarean delivery patterns among women with physical, sensory, or intellectual disabilities.
Womens Health Issues 2017 May - Jun;27(3):336-44. doi: 10.1016/j.whi.2016.12.007.
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Keywords: Disabilities, Labor and Delivery, Patient-Centered Outcomes Research, Pregnancy, Women
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
Lorch SA, Martin AE, Ranade R
Lessons for providers and hospitals from Philadelphia's obstetric services closures and consolidations, 1997-2012.
The researchers examined the experience of Philadelphia County, Pennsylvania, where thirteen of nineteen hospital obstetric units closed between 1997 and 2012, and they conducted interviews at eleven hospitals whose obstetric units remained open. Interviewees reported sharp surges in delivery volume and an increase in the proportion of patients with public insurance or no insurance. The authors concluded that their study supports the need for policy makers to anticipate reductions in supply and monitor patient outcomes.
AHRQ-funded; HS018661.
Citation: Lorch SA, Martin AE, Ranade R .
Lessons for providers and hospitals from Philadelphia's obstetric services closures and consolidations, 1997-2012.
Health Aff 2014 Dec;33(12):2162-9. doi: 10.1377/hlthaff.2014.0136.
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Keywords: Labor and Delivery, Pregnancy, Hospitals
Henke RM, Wier LM, Marder WD
AHRQ Author: Friedman BS, Wong HS
Geographic variation in cesarean delivery in the United States by payer.
This study aimed (1) to determine whether the geographic variation in cesarean delivery rate is consistent for private insurance and Medicaid, and (2) to identify the patient, population, and market factors associated with cesarean rate and determine if these factors vary by payer. It concluded that factors associated with geographic variation in cesarean delivery, a frequent and high-resource inpatient procedure, vary somewhat by payer.
AHRQ-authored; AHRQ-funded; 290200600009C.
Citation: Henke RM, Wier LM, Marder WD .
Geographic variation in cesarean delivery in the United States by payer.
BMC Pregnancy Childbirth 2014 Nov 19;14:387. doi: 10.1186/s12884-014-0387-x.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Health Insurance, Labor and Delivery, Medicaid, Pregnancy
Ahrens KA, Louik C, Kerr S
Seasonal influenza vaccination during pregnancy and the risks of preterm delivery and small for gestational age birth.
The researchers examined the associations between seasonal influenza vaccination during pregnancy and the risks of PTD and SGA among a multiyear retrospective cohort of pregnancies. With the exception of pre-term delivery (PTD) associated with the 2009–10 seasonal vaccine, they found no meaningful increases in PTD or small for gestational age risks associated with seasonal trivalent influenza vaccination during pregnancy.
AHRQ-funded; HS018463.
Citation: Ahrens KA, Louik C, Kerr S .
Seasonal influenza vaccination during pregnancy and the risks of preterm delivery and small for gestational age birth.
Paediatr Perinat Epidemiol 2014 Nov;28(6):498-509. doi: 10.1111/ppe.12152..
Keywords: Influenza, Vaccination, Pregnancy, Labor and Delivery
Dublin S, Johnson KE, Walker RL
Trends in elective labor induction for six United States health plans, 2001-2007.
The authors sought to describe trends in labor induction, including elective induction, from 2001 to 2007 for six U.S. health plans and to examine the validity of induction measures derived from birth certificate and health plan data. They found that induction prevalence rose from 28% in 2001 to 32% in 2005, then declined to 29% in 2007, with the trend being similar for subgroups by parity and gestational age. Elective induction prevalence varied considerably across plans.
AHRQ-funded; HS016955.
Citation: Dublin S, Johnson KE, Walker RL .
Trends in elective labor induction for six United States health plans, 2001-2007.
J Womens Health 2014 Nov;23(11):904-11. doi: 10.1089/jwh.2014.4779.
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Keywords: Centers for Education and Research on Therapeutics (CERTs), Health Insurance, Labor and Delivery, Pregnancy, Women
Eden KB, Perrin NA, Vesco KK
A randomized comparative trial of two decision tools for pregnant women with prior cesareans.
The authors evaluated tools to help pregnant women with prior cesareans make informed decisions about having trials of labor. They found that women in both groups felt more informed, were more clear about their birth priorities, felt more supported, and overall reported less conflict after receiving either intervention.
AHRQ-funded; HS011338; HS013959.
Citation: Eden KB, Perrin NA, Vesco KK .
A randomized comparative trial of two decision tools for pregnant women with prior cesareans.
J Obstet Gynecol Neonatal Nurs 2014 Sep-Oct;43(5):568-79. doi: 10.1111/1552-6909.12485.
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Keywords: Education: Patient and Caregiver, Decision Making, Labor and Delivery, Patient-Centered Outcomes Research
Sentell T, Chang A, Cheng Y
Maternal quality and safety outcomes for Asians and Pacific Islanders in Hawaii: an observational study from five years of statewide data.
The authors investigated maternal quality and safety outcomes across heterogeneous Asian and Pacific Islanders subgroups in the United States. They found significant variation for Asian and Pacific Islander subgroups across maternal quality and safety outcomes.
AHRQ-funded; HS019990; HS021903.
Citation: Sentell T, Chang A, Cheng Y .
Maternal quality and safety outcomes for Asians and Pacific Islanders in Hawaii: an observational study from five years of statewide data.
BMC Pregnancy Childbirth 2014 Aug 30;14:298. doi: 10.1186/1471-2393-14-298.
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Keywords: Disparities, Labor and Delivery, Patient-Centered Outcomes Research, Quality Indicators (QIs), Racial and Ethnic Minorities
Darney BG, Caughey AB
Elective induction of labor symposium: nomenclature, research methodological issues, and outcomes.
This article focuses on key method issues in studies of elective induction of labor. The authors first identify methodological concerns with the existing literature and discuss each in return. They then review existing evidence about the relationship between elective induction and cesarean delivery.
AHRQ-funded; HS017582
Citation: Darney BG, Caughey AB .
Elective induction of labor symposium: nomenclature, research methodological issues, and outcomes.
Clin Obstet Gynecol. 2014 Jun;57(2):343-62. doi: 10.1097/GRF.0000000000000029..
Keywords: Research Methodologies, Outcomes, Labor and Delivery, Women
Moore JE, Low LK, Titler MG
AHRQ Author: Moore JE
Moving toward patient-centered care: women's decisions, perceptions, and experiences of the induction of labor process.
The researchers identified factors that influence inductions from the perspective of women. They found that lack of informed decision making was cited as a barrier to optimal care; additional themes emerged from the preinduction and postinduction interviews.
AHRQ-authored.
Citation: Moore JE, Low LK, Titler MG .
Moving toward patient-centered care: women's decisions, perceptions, and experiences of the induction of labor process.
Birth 2014 Jun;41(2):138-46. doi: 10.1111/birt.12080.
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Keywords: Decision Making, Labor and Delivery, Patient-Centered Healthcare, Patient Experience, Pregnancy
Hendrich A, McCoy CK, Gale J
Ascension health's demonstration of full disclosure protocol for unexpected events during labor and delivery shows promise.
This article presents a case study concerning challenges, including physician resistance, to the establishment of a common full disclosure protocol at five labor and delivery demonstration sites. Twenty-seven months after implementation, the rate of full disclosure had increased by 221 percent. Practitioners saw a number of factors as key catalysts for change including consistent and ongoing leadership by local practitioners and hospitals.
AHRQ-funded; HS019608.
Citation: Hendrich A, McCoy CK, Gale J .
Ascension health's demonstration of full disclosure protocol for unexpected events during labor and delivery shows promise.
Health Aff 2014 Jan;33(1):39-45. doi: 10.1377/hlthaff.2013.1009..
Keywords: Adverse Events, Clinician-Patient Communication, Communication, Labor and Delivery, Medical Errors, Medical Liability, Policy, Pregnancy, Women