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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 9 of 9 Research Studies DisplayedDullabh P, Heaney-Huls KK, Chiao AB
Implementation and evaluation of an electronic health record-integrated app for postpartum monitoring of hypertensive disorders of pregnancy using patient-contributed data collection.
This paper describes a pilot intervention of a smartphone app for postpartum monitoring of hypertensive disorders of pregnancy (HDP) that integrates patient-contributed data into electronic health records (EHRs) to support monitoring and clinical decision-making. Results from the pilot evaluation highlighted the resources needed when implementing the app, challenges for integrating an app into the EHR, and the usability and utility of the HDP monitoring app for patient and clinician users. Key observations of the implementation team included the importance of a local clinical champion, more robust patient involvement and support for the remote patient monitoring program, an impetus for EHR developers to adopt data integration standards, and a need to expand the capabilities of the standards to support interventions using patient-contributed data.
AHRQ-funded; 233201500023I.
Citation: Dullabh P, Heaney-Huls KK, Chiao AB .
Implementation and evaluation of an electronic health record-integrated app for postpartum monitoring of hypertensive disorders of pregnancy using patient-contributed data collection.
JAMIA Open 2023 Dec; 6(4):ooad098. doi: 10.1093/jamiaopen/ooad098..
Keywords: Electronic Health Records (EHRs), Maternal Care, Blood Pressure, Telehealth, Health Information Technology (HIT), Women
Balk EM, Danilack VA, Cao W
Televisits compared with in-person visits for routine antenatal care: a systematic review.
This systematic review’s objective was to compare benefits and harms of televisits and in-person visits in people receiving routine antenatal visit care. The search was conducted in multiple databases searching for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms. Abstrackr was used for double independent screening for studies comparing televisits and in person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. The authors found two randomized controlled trials, four nonrandomized comparative studies, and one survey that compared visit types between 2004 and 2020, three of which were conducted during the COVID-19 pandemic. The studies found low-strength evidence that hybrid (televisits and in-person visits) and all in-person visits did not indicate differences in rates of neonatal intensive care unit admission of the newborn or preterm births. However, the COVID-19 pandemic confounded the association between the use of hybrid visits and preterm birth. The authors also found there is low-strength evidence that satisfaction with overall antenatal care was greater in people who were pregnant and receiving hybrid visits.
AHRQ-funded; 75Q80120D00001.
Citation: Balk EM, Danilack VA, Cao W .
Televisits compared with in-person visits for routine antenatal care: a systematic review.
Obstet Gynecol 2023 Jul 1; 142(1):19-29. doi: 10.1097/aog.0000000000005194..
Keywords: Telehealth, Health Information Technology (HIT), Maternal Care, Women
Cantor AG, Nelson HD, Pappas M
Telehealth for women's preventive services for reproductive health and intimate partner violence: a comparative effectiveness review.
This comparative effectiveness review was conducted on the effectiveness and harms of telehealth interventions for women's reproductive health and intimate partner violence (IPV) services. A literature search was conducted for randomized controlled trials (RCTs) and observational studies of telehealth strategies for women's reproductive health and IPV versus usual care for the period July 2016 to May 2022. Eight RCTs, 1 nonrandomized trial, and 7 observational studies were included (7 studies of contraceptive care and 9 of IPV services). Telehealth services demonstrated similar care as usual care for contraceptive use, sexually transmitted infections, and pregnancy (low strength of evidence [SOE]). Evidence on abortion was insufficient. Outcomes were also similar between telehealth and usual care interventions to replace or supplement IPV services and comparators for repeat IPV, depression, posttraumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors (low SOE). Telehealth barriers identified included limited internet access, digital literacy, technical challenges, and confidentiality concerns. Safety strategies increased telehealth use for IPV services. Evidence lacked on access, health equity, or harms.
AHRQ-funded; 75Q80120D00006.
Citation: Cantor AG, Nelson HD, Pappas M .
Telehealth for women's preventive services for reproductive health and intimate partner violence: a comparative effectiveness review.
J Gen Intern Med 2023 May; 38(7):1735-43. doi: 10.1007/s11606-023-08033-6..
Keywords: Telehealth, Health Information Technology (HIT), Women, Prevention, Domestic Violence, Evidence-Based Practice, Maternal Care, Sexual Health, Patient-Centered Outcomes Research, Comparative Effectiveness
Konnyu KJ, Danilack VA, Adam GP
Changes to prenatal care visit frequency and telehealth: a systematic review of qualitative evidence.
This study systematically reviewed patient, partner or family, and clinician perspectives, preferences, and experiences related to prenatal care visit schedules and televisits for routine prenatal care. This review is a subset of a larger review on both the qualitative experiences and quantitative benefits and harms of reduced prenatal care visit schedules and televisits for routine prenatal care that was produced by the Brown Evidence-based Practice Center for AHRQ. The authors synthesized barriers and facilitators to the implementation of reduced care visits or of televisits into 1 of 14 domains defined by the Theoretical Domains Framework (TDF) and a Best Fit Framework approach and summarized themes within TDF domains. They assessed their confidence in the summary statements using the GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in Evidence from Reviews of Qualitative research) tool. They found four studies that addressed the number of scheduled routine prenatal visits, and five studies that addressed televisits. These studies found that health care professionals believed fewer routine visits may be more convenient for patients and may increase clinic capacity to provide additional care for patients with high-risk pregnancies. But both patients and clinicians had concerns about potential lesser care with fewer visits, including concerns about quality of care and challenges with implementing new delivery-of-care models.
AHRQ-funded; 290201500002I.
Citation: Konnyu KJ, Danilack VA, Adam GP .
Changes to prenatal care visit frequency and telehealth: a systematic review of qualitative evidence.
Obstet Gynecol 2023 Feb;141(2):299-323. doi: 10.1097/aog.0000000000005046.
Keywords: Maternal Care, Pregnancy, Women, Telehealth, Health Information Technology (HIT)
Fareed N, Swoboda C, Singh P
Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: mixed-methods study.
The objective of this study was to develop user specifications for a tailored and integrated technology, patient application (mHealth) and provider dashboard, that provides a complete view of Medicaid-enrolled patients with type 2 diabetes (T2D) during pregnancy and to develop prototypes based on users’ needs. Participating patients and providers stated a core set of expectations for the mHealth and dashboard applications. Participants then provided feedback to improve these applications. The authors concluded that digital health tools could transform health care among Medicaid-enrolled patients with T2D during pregnancy, with the goal of managing their blood glucose levels. Refining the stated needs and preferences of patients and providers to develop applications holds potential for tackling complicated health care issues.
AHRQ-funded; HS028822.
Citation: Fareed N, Swoboda C, Singh P .
Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: mixed-methods study.
Digit Health 2023 Jan-Dec; 9:20552076221144181. doi: 10.1177/20552076221144181..
Keywords: Patient-Centered Healthcare, Telehealth, Diabetes, Pregnancy, Chronic Conditions, Women, Health Information Technology (HIT)
Peahl AF, Smith RD, Moniz MN
Prenatal care redesign: creating flexible maternity care models through virtual care.
Each year, over 98% of the almost 4 million pregnant patients in the United States receive prenatal care-a crucial preventive service to improve outcomes for moms and babies. In this paper, the authors outline their experience rapidly transitioning prenatal care to a new model with 4 in-person visits, 1 ultrasound visit, and 4 virtual visits (the 4-1-4 prenatal plan). They then explore how lessons from this implementation can inform patient-centered prenatal care redesign during and beyond the COVID-19 pandemic.
AHRQ-funded; HS025465.
Citation: Peahl AF, Smith RD, Moniz MN .
Prenatal care redesign: creating flexible maternity care models through virtual care.
Am J Obstet Gynecol 2020 Sep;223(3):389.e1-89.e10. doi: 10.1016/j.ajog.2020.05.029..
Keywords: Maternal Care, Telehealth, Health Information Technology (HIT), Pregnancy, Women, Healthcare Delivery, Patient-Centered Healthcare
Kissler K, Thumm EB, Smith DC
Perinatal telehealth: meeting patients where they are.
This qualitative study’s objective was to describe perinatal patients' and providers' experiences with telehealth during and after the acute phase of the COVID-19 pandemic to inform future utilization of telehealth to drive the delivery of high-quality, accessible, and equitable perinatal care to diverse communities. The study included a purposive sample of 14 patients and 17 providers who received or provided perinatal care via telehealth in either a certified nurse-midwifery practice or the nurse-family partnership care model between March 2020 and April 2022. The authors conducted 2 rounds of semistructured interviews with a focus on understanding social and geographic context. Six themes were identified: (1) unexpected advantages of telehealth, (2) patient empowerment, (3) providers' fear of adverse outcomes, (4) concern for equitable care, (5) strategies to enhance the telehealth experience, and (6) strategies to address access to perinatal telehealth. Patients mentioned that they appreciated the increased ease and reduced cost of accessing visits led to fewer missed appointments.
AHRQ-funded; HS028085.
Citation: Kissler K, Thumm EB, Smith DC .
Perinatal telehealth: meeting patients where they are.
J Midwifery Womens Health 2024 Jan-Feb; 69(1):9-16. doi: 10.1111/jmwh.13560..
Keywords: Telehealth, Maternal Care, Health Information Technology (HIT), Women
Stringer KL, Azuero A, Ott C
Feasibility and acceptability of real-time antiretroviral adherence monitoring among depressed women living with HIV in the deep south of the US.
The purpose of this study was to present feasibility and acceptability data on the use of an electronic adherence monitor (EAM) among African American women in remote areas of the Southeastern United States with HIV and co-occurring depression. EAM and self-reported antiretroviral therapy (ART) adherence was monitored among 25 participants recruited at four HIV clinics in Alabama. Intra-class correlation showed a low degree of concordance between EAM and self-reported adherence. 83% of data collected via EAM was transmitted in real-time; the remainder was delayed though technological failures or was lost entirely. The authors conclude that EAM monitoring is feasible in a rural US setting but that technological difficulties may impede the device's usefulness for just-in-time adherence interventions.
AHRQ-funded; HS013852.
Citation: Stringer KL, Azuero A, Ott C .
Feasibility and acceptability of real-time antiretroviral adherence monitoring among depressed women living with HIV in the deep south of the US.
AIDS Behav 2018 May;23(5):1306-14. doi: 10.1007/s10461-018-2322-z..
Keywords: Depression, Health Information Technology (HIT), Human Immunodeficiency Virus (HIV), Medication, Behavioral Health, Patient Adherence/Compliance, Rural Health, Telehealth, Women
Gordon M, Henderson R, Holmes JH
Participatory design of ehealth solutions for women from vulnerable populations with perinatal depression.
Using a participatory design approach, the Stress in Pregnancy: Improving Results with Interactive Technology group developed specifications for a suite of eHealth applications to improve the quality of perinatal mental health care. Three apps were developed by the group: an app to support high-risk women after discharge from hospital, a screening tool for depression, and a patient decision aid for supporting treatment choice.
AHRQ-funded; HS022441.
Citation: Gordon M, Henderson R, Holmes JH .
Participatory design of ehealth solutions for women from vulnerable populations with perinatal depression.
J Am Med Inform Assoc 2016 Jan;23(1):105-9. doi: 10.1093/jamia/ocv109.
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Keywords: Telehealth, Women, Pregnancy, Depression, Social Determinants of Health