National Healthcare Quality and Disparities Report
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- Adverse Drug Events (ADE) (1)
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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 DisplayedWilliams D, Stout MJ, Rosenbloom JI
Preeclampsia predicts risk of hospitalization for heart failure with preserved ejection fraction.
Preeclampsia is associated with increased risk of future heart failure (HF), but the relationship between preeclampsia and HF subtypes are not well-established. The objective of this analysis was to identify the risk of HF with preserved ejection fraction (HFpEF) following a delivery complicated by preeclampsia/eclampsia. The investigators concluded that preeclampsia/eclampsia was an independent risk factor for future hospitalizations for HFpEF.
AHRQ-funded; HS019455.
Citation: Williams D, Stout MJ, Rosenbloom JI .
Preeclampsia predicts risk of hospitalization for heart failure with preserved ejection fraction.
J Am Coll Cardiol 2021 Dec 7;78(23):2281-90. doi: 10.1016/j.jacc.2021.09.1360..
Keywords: Healthcare Cost and Utilization Project (HCUP), Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Risk, Labor and Delivery, Pregnancy, Women
Admon LK, Dalton VK, Kolenic GE
Comparison of delivery-related, early and late postpartum severe maternal morbidity among individuals with commercial insurance in the US, 2016 to 2017.
This study analyzed data from 2016 to 2017 on delivery-related, early, and late postpartum severe maternal morbidity (SMM) among individuals with commercial insurance by race and ethnicity and perinatal mood and anxiety disorder (PMAD) status. This cross-sectional study of deidentified claims data from the Optum Clinformatics Data Mart evaluated rates of SMM during 3 pregnancy periods among individuals aged 15 to 44 years. The study sample comprised of 100,982 individuals with a mean age of 31.6 years. SMM rates were compared for pregnancies with and without complications, with blood transfusions being the number one indicator for pregnancy and postpartum periods with SMM. Rates of SMM with and without blood transfusion varied by race and ethnicity and PMAD status. Higher rates of SMM were identified among Black individuals compared with White individuals for the pregnancy, early postpartum, and late postpartum periods, respectively. Higher rates of blood transfusion were also identified in each of the 3 periods among individuals with PMADs compared to individuals without PMADs.
AHRQ-funded; HS027640.
Citation: Admon LK, Dalton VK, Kolenic GE .
Comparison of delivery-related, early and late postpartum severe maternal morbidity among individuals with commercial insurance in the US, 2016 to 2017.
JAMA Netw Open 2021 Dec;4(12):e2137716. doi: 10.1001/jamanetworkopen.2021.37716..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Pregnancy, Health Insurance, Racial and Ethnic Minorities, Anxiety
Zochowski MK, Kolenic GE, Zivin K
Trends in primary cesarean section rates among women with and without perinatal mood and anxiety disorders.
Reducing the rate of cesarean sections among women considered at low risk for delivery by that method is a goal of Healthy People 2030. Prior research suggests that perinatal mood and anxiety disorders increase the risk for cesarean section, but data are limited. This cross-sectional study of commercially insured women examined the relationship between perinatal depression and anxiety disorders and primary (first-time) cesarean section rates, using administrative claims data for US in-hospital deliveries from the period 2008-17.
AHRQ-funded; HS027640.
Citation: Zochowski MK, Kolenic GE, Zivin K .
Trends in primary cesarean section rates among women with and without perinatal mood and anxiety disorders.
Health Aff 2021 Oct;40(10):1585-91. doi: 10.1377/hlthaff.2021.00780..
Keywords: Labor and Delivery, Pregnancy, Women, Anxiety
Schwartz GL, Leifheit KM, Berkman LF
Health selection into eviction: adverse birth outcomes and children's risk of eviction through age 5 years.
Adverse birth outcomes put children at increased risk of poor future health. They also put families under sudden socioeconomic and psychological strain, which has poorly understood consequences. In this study, the investigators tested whether infants experiencing an adverse birth outcome-low birthweight or prematurity, as well as lengthy hospital stays-were more likely to be evicted in early childhood, through age 5 years.
AHRQ-funded; HS000046.
Citation: Schwartz GL, Leifheit KM, Berkman LF .
Health selection into eviction: adverse birth outcomes and children's risk of eviction through age 5 years.
Am J Epidemiol 2021 Jul;190(7):1260-69. doi: 10.1093/aje/kwab007..
Keywords: Children/Adolescents, Newborns/Infants, Labor and Delivery, Pregnancy
Chua KP, Fendrick AM, Conti RM
Out-of-pocket spending for deliveries and newborn hospitalizations among the privately insured.
The authors estimated national data on out-of-pocket spending across the childbirth episode, including both deliveries and newborn hospitalizations, using national commercial claims data. They found that, during 2016–2019, privately insured families paid $3000 out-of-pocket for maternal and newborn hospitalizations, with out-of-pocket spending exceeding $5000 for 1 in 6 families. They recommended that clinicians counsel privately insured families concerning their childbirth benefits.
Citation: Chua KP, Fendrick AM, Conti RM .
Out-of-pocket spending for deliveries and newborn hospitalizations among the privately insured.
Pediatrics 2021 Jul;148(1):e2021050552. doi: 10.1542/peds.2021-050552..
Keywords: Newborns/Infants, Labor and Delivery, Pregnancy, Healthcare Costs
Calthorpe LM, Baer RJ, Chambers BD
The association between preterm birth and postpartum mental healthcare utilization among California birthing people.
This study’s objective was to determine whether preterm birth is associated with postpartum inpatient and emergency mental healthcare utilization. The study sample was taken from a database of live-born neonates delivered in California, 2011-2017, and included all births to singleton infants between the gestational ages of 20 and 44 weeks. The findings indicate found that preterm birth is an independent risk factor for postpartum mental healthcare utilization. These findings suggest that screening for and providing mental health resources to birthing people after delivery are crucial, particularly among people giving birth to preterm infants, regardless of mental health history.
AHRQ-funded; HS026383.
Citation: Calthorpe LM, Baer RJ, Chambers BD .
The association between preterm birth and postpartum mental healthcare utilization among California birthing people.
Am J Obstet Gynecol MFM 2021 Jul;3(4):100380. doi: 10.1016/j.ajogmf.2021.100380..
Keywords: Behavioral Health, Pregnancy, Women, Labor and Delivery, Risk
Wilson BL, Butler RJ
Identifying optimal labor and delivery nurse staffing: the case of cesarean births and nursing hours.
Numerous studies have identified a relationship between nurse staffing and adverse patient outcomes in medical / surgical patient populations. However, little is known about the impact of labor and delivery (L&D) nurse staffing and adverse birth outcomes, such as unintended cesarean delivery, in low-risk term-gestation women. In this study the investigators examined nurse staffing patterns on the likelihood of cesarean sections (C-sections) among low- risk, full gestation births and provided a testing framework to distinguish optimal from ineffective levels of nurse staffing.
AHRQ-funded; HS024607.
Citation: Wilson BL, Butler RJ .
Identifying optimal labor and delivery nurse staffing: the case of cesarean births and nursing hours.
Nurs Outlook 2021 Jan-Feb;69(1):84-95. doi: 10.1016/j.outlook.2020.07.003..
Keywords: Provider: Nurse, Provider, Workforce, Labor and Delivery, Pregnancy, Quality of Care, Risk, Women
Korst LM, Feldman DS, Bollman DL
Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate care.
The researchers examined the extent to which hospitals could be classified by increasingly sophisticated maternal levels of care. They concluded that childbirth services varied widely across California hospitals, and most hospitals did not fit easily into proposed levels. Cognizance of this existing variation is critical to determining the optimal configuration of services for basic, intermediate, and regional maternal levels of care.
AHRQ-funded; HS020915.
Citation: Korst LM, Feldman DS, Bollman DL .
Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate care.
Am J Obstet Gynecol 2015 Oct;213(4):527.e1-27.e12. doi: 10.1016/j.ajog.2015.07.014..
Keywords: Labor and Delivery, Maternal Care, Hospitals, Access to Care
Feldman DS, Bollman DL, Fridman M
Do laborists improve delivery outcomes for laboring women in California community hospitals?
The researchers sought to determine the impact of the laborists staffing model on cesarean rates and maternal morbidity in California community hospitals. They were unable to demonstrate differences in cesarean and maternal childbirth complication rates in community hospitals with and without laborists.
AHRQ-funded; HS020915.
Citation: Feldman DS, Bollman DL, Fridman M .
Do laborists improve delivery outcomes for laboring women in California community hospitals?
Am J Obstet Gynecol 2015 Oct;213(4):587.e1-87.e13. doi: 10.1016/j.ajog.2015.05.051..
Keywords: Labor and Delivery, Outcomes, Patient Safety, Women
Korst LM, Feldman DS, Bollman DL
Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals.
The objective of the study was to describe the resources and activities associated with childbirth services. It concluded that childbirth services varied widely across California hospitals. Cognizance of this variation and linkage of these data to childbirth outcomes should assist in the identification of key resources and activities that optimize the hospital environment for pregnant women.
AHRQ-funded; HS020915.
Citation: Korst LM, Feldman DS, Bollman DL .
Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals.
Am J Obstet Gynecol 2015 Oct;213(4):523.e1-8. doi: 10.1016/j.ajog.2015.08.013..
Keywords: Labor and Delivery, Maternal Care, Hospitals, Access to Care
Tilden EL, Lee VR, Allen AJ
Cost-effectiveness analysis of latent versus active labor hospital admission for medically low-risk, term women.
The purpose of this study was to assess the outcomes and costs of hospital admission during the latent versus active phase of labor. It found that delaying admission until active labor would result in 672,000 fewer epidurals, 67,232 fewer cesarean deliveries, and 9.6 fewer maternal deaths in our theoretic cohort as compared to admission during latent labor.
AHRQ-funded; HS017582.
Citation: Tilden EL, Lee VR, Allen AJ .
Cost-effectiveness analysis of latent versus active labor hospital admission for medically low-risk, term women.
Birth 2015 Sep;42(3):219-26. doi: 10.1111/birt.12179..
Keywords: Labor and Delivery, Comparative Effectiveness, Healthcare Costs, Patient-Centered Outcomes Research, Hospitalization
Andrews SE, Alston MJ, Allshouse AA
Does the number of forceps deliveries performed in residency predict use in practice?
The researchers aimed to determine whether a threshold number of forceps deliveries in residency predicts use of forceps in independent practice. They concluded that, although exceeding 13 forceps deliveries made it highly likely that obstetricians would use them in practice, further study is necessary to set goals for a number of resident forceps deliveries that translate into use in practice.
AHRQ-funded; HS022143.
Citation: Andrews SE, Alston MJ, Allshouse AA .
Does the number of forceps deliveries performed in residency predict use in practice?
Am J Obstet Gynecol 2015 Jul;213(1):93.e1-4. doi: 10.1016/j.ajog.2015.03.025..
Keywords: Labor and Delivery, Patient-Centered Outcomes Research, Practice Patterns, Training, Women
Cavazos-Rehg PA, Krauss MJ, Spitznagel EL
Maternal age and risk of labor and delivery complications.
The researchers examined associations between maternal age and prevalence of maternal morbidity during complications of labor and delivery. Using HCUP data, they found that complications with the highest odds among women 11-18 years of age included preterm delivery, chorioamnionitis, endometritis, and mild preeclampsia. Pregnant women 15-19 years old had greater odds for severe preeclampsia, eclampsia, postpartum hemorrhage, poor fetal growth, and fetal distress. Pregnant women 35 and older had greater odds for preterm delivery, hypertension, superimposed preeclampsia, severe preeclampsia, and decreased risk for chorioamnionitis. Women over 40 had increased odds for mild preeclampsia, fetal distress, and poor fetal growth.
AHRQ-funded; HS019455.
Citation: Cavazos-Rehg PA, Krauss MJ, Spitznagel EL .
Maternal age and risk of labor and delivery complications.
Matern Child Health J 2015 Jun;19(6):1202-11. doi: 10.1007/s10995-014-1624-7.
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Keywords: Adverse Events, Healthcare Cost and Utilization Project (HCUP), Labor and Delivery, Pregnancy, Risk
Camelo Castillo W, Boggess K, Sturmer T
Association of adverse pregnancy outcomes with glyburide vs insulin in women with gestational diabetes.
The purpose of this study was to estimate the risks of adverse pregnancy outcomes among women receiving glyburide compared with insulin for the treatment of gestational diabetes mellitus (GDM) in a US population-based cohort. It found an association between glyburide (compared with insulin) and elevated risk of NICU admission, neonatal hypoglycemia, respiratory distress, birth injury, and large for gestational age in women with GDM.
AHRQ-funded; HS017950.
Citation: Camelo Castillo W, Boggess K, Sturmer T .
Association of adverse pregnancy outcomes with glyburide vs insulin in women with gestational diabetes.
JAMA Pediatr 2015 May;169(5):452-8. doi: 10.1001/jamapediatrics.2015.74..
Keywords: Adverse Drug Events (ADE), Adverse Events, Comparative Effectiveness, Diabetes, Labor and Delivery, Maternal Care, Medication, Newborns/Infants, Outcomes, Pregnancy, Women
Huesch M, Doctor JN
Factors associated with increased cesarean risk among African American women: evidence from California, 2010.
The researchers studied the association of maternal health in African American women in hospitals or communities with the rates of cesarean delivery of infants. They found that cesarean rates were significantly higher overall for African American women than other women (unadjusted rate 36.8 percent vs 32.7 percent), as were both elective and emergency primary cesarean rates.
AHRQ-funded; HS021868.
Citation: Huesch M, Doctor JN .
Factors associated with increased cesarean risk among African American women: evidence from California, 2010.
Am J Public Health 2015 May;105(5):956-62. doi: 10.2105/ajph.2014.302381..
Keywords: Labor and Delivery, Maternal Care, Racial and Ethnic Minorities
Metz TD, Allshouse AA, Faucett AM
Validation of a vaginal birth after cesarean delivery prediction model in women with two prior cesarean deliveries.
This study evaluated whether an existing vaginal birth after cesarean (VBAC) prediction model validated for women with one prior cesarean delivery also accurately predicts the likelihood of VBAC in women with two prior cesarean deliveries. It found that the estimates of VBAC success based on the Maternal-Fetal Medicines Units prediction model are similar to the actual rates observed among women with two prior cesarean deliveries.
AHRQ-funded; HS022143.
Citation: Metz TD, Allshouse AA, Faucett AM .
Validation of a vaginal birth after cesarean delivery prediction model in women with two prior cesarean deliveries.
Obstet Gynecol 2015 Apr;125(4):948-52. doi: 10.1097/aog.0000000000000744..
Keywords: Labor and Delivery, Pregnancy, Women
Marshall NE, Vanderhoeven J, Eden KB
Impact of simulation and team training on postpartum hemorrhage management in non-academic centers.
The researchers conducted a multi-center study to evaluate in situ simulation and team training for postpartum hemorrhage management (PPH) among experienced clinical teams in non-academic hospitals in urban and rural communities. They found that team training significantly improved response times in the management of PPH, including the recognition of PPH, time to administer first medication, performance of uterine massage and time to administer second medication.
AHRQ-funded; HS015800; HS016673.
Citation: Marshall NE, Vanderhoeven J, Eden KB .
Impact of simulation and team training on postpartum hemorrhage management in non-academic centers.
J Matern Fetal Neonatal Med 2015 Mar;28(5):495-9. doi: 10.3109/14767058.2014.923393..
Keywords: Training, Patient Safety, Labor and Delivery, Women
Santos P, Ritter GA, Hefele JL
Decreasing intrapartum malpractice: targeting the most injurious neonatal adverse events.
The researchers conducted a case study of a risk reduction labor and delivery model at 5 demonstration sites. After 27 months post implementation, reporting of unintended events increased significantly (43 vs 84 per 1000 births), while high-risk malpractice events decreased significantly (14 vs 7 per 1000 births).
AHRQ-funded; HS019608.
Citation: Santos P, Ritter GA, Hefele JL .
Decreasing intrapartum malpractice: targeting the most injurious neonatal adverse events.
J Healthc Risk Manag 2015;34(4):20-7. doi: 10.1002/jhrm.21168..
Keywords: Labor and Delivery, Patient Safety, Risk, Medical Liability, Medical Errors
Witt WP, Wisk LE, Cheng ER
Determinants of cesarean delivery in the US: a lifecourse approach.
The researchers sought to determine whether the effects of preconception stressful life events (PSLEs) on birth weight differed by neighborhood disadvantage. They found that the risk of having very low birthweight infants among women with PSLEs, women with chronic conditions, or minority women was strongest among those living in disadvantaged neighborhoods, which suggests exacerbation of risk within disadvantaged environments.
AHRQ-funded; HS000083; HS000063.
Citation: Witt WP, Wisk LE, Cheng ER .
Determinants of cesarean delivery in the US: a lifecourse approach.
Matern Child Health J 2015 Jan;19(1):84-93. doi: 10.1007/s10995-014-1498-8..
Keywords: Labor and Delivery, Maternal Care, Pregnancy, Risk, Social Determinants of Health
Kastenberg ZJ, Lee HC, Profit J
Effect of deregionalized care on mortality in very low-birth-weight infants with necrotizing enterocolitis.
The study’s aims were to describe the current trend toward deregionalization and to test the hypothesis that infants with necrotizing enterocolitis represent a particularly high-risk subgroup of the VLBW population that would benefit from early identification, increased intensity of early management, and possible targeted triage to tertiary hospitals. It found that outcomes for VLBW infants continue to be suboptimal when they are not born into high-level, high-volume centers.
AHRQ-funded; HS000028.
Citation: Kastenberg ZJ, Lee HC, Profit J .
Effect of deregionalized care on mortality in very low-birth-weight infants with necrotizing enterocolitis.
JAMA Pediatr 2015 Jan;169(1):26-32. doi: 10.1001/jamapediatrics.2014.2085..
Keywords: Newborns/Infants, Labor and Delivery, Mortality, Neonatal Intensive Care Unit (NICU), Healthcare Delivery