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
76 to 100 of 198 Research Studies DisplayedPeahl AF, Novara A, Heisler M
Patient preferences for prenatal and postpartum care delivery: a survey of postpartum women.
The objective of this study was to describe patients' preferences for prenatal and postpartum care delivery. The investigators concluded that current prenatal and postpartum care delivery did not match patients' preferences for visit number or between-visit contact, and patients were open to alternative models of prenatal care, including remote monitoring.
AHRQ-funded; HS025465.
Citation: Peahl AF, Novara A, Heisler M .
Patient preferences for prenatal and postpartum care delivery: a survey of postpartum women.
Obstet Gynecol 2020 May;135(5):1038-46. doi: 10.1097/aog.0000000000003731.
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Keywords: Pregnancy, Maternal Care, Women, Healthcare Delivery
Peahl AF, Gourevitch RA, Luo EM
Right-sizing prenatal care to meet patients' needs and improve maternity care value.
In this manuscript, investigators present a new conceptual model for prenatal care that incorporates both patients' medical and social needs into four phenotypes, and use human-centered design methods to describe how better matching patient needs with prenatal services can increase the use of high-value services and decrease the use of low-value services. They also address some of the key challenges to implementing right-sized prenatal care, including capturing outcomes through research and payment.
AHRQ-funded; HS000055; HS025465.
Citation: Peahl AF, Gourevitch RA, Luo EM .
Right-sizing prenatal care to meet patients' needs and improve maternity care value.
Obstet Gynecol 2020 May;135(5):1027-37. doi: 10.1097/aog.0000000000003820..
Keywords: Maternal Care, Pregnancy, Women, Quality Improvement, Quality of Care
Sherman JP, Hedli LC, Kristensen-Cabrera AI
Understanding the heterogeneity of labor and delivery units: using design thinking methodology to assess environmental factors that contribute to safety in childbirth.
There is limited research exploring the relationship between design and patient safety outcomes, especially in maternal and neonatal care. In this study, the investigators employed design thinking methodology to understand how the design of labor and delivery units impacted safety and identified spaces and systems where improvements are needed.
AHRQ-funded; HS023506.
Citation: Sherman JP, Hedli LC, Kristensen-Cabrera AI .
Understanding the heterogeneity of labor and delivery units: using design thinking methodology to assess environmental factors that contribute to safety in childbirth.
Am J Perinatol 2020 May;37(6):638-46. doi: 10.1055/s-0039-1685494..
Keywords: Labor and Delivery, Pregnancy, Patient Safety, Maternal Care, Women, Newborns/Infants
Mills J, Hulse S
AHRQ Author: Mills J
Screening for asymptomatic bacteriuria in adults.
This case study poses three questions concerning a 33-year-old woman presenting for a first prenatal visit at 8 weeks' gestation. The woman reported morning nausea and breast tenderness. A review of systems and physical examination were consistent with early pregnancy but were otherwise unremarkable.
AHRQ-authored.
Citation: Mills J, Hulse S .
Screening for asymptomatic bacteriuria in adults.
Am Fam Physician 2020 Apr 15;101(8):493-94..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Prevention, Urinary Tract Infection (UTI), Pregnancy, Maternal Care, Women, Case Study
Kahwati LC, Clark R, Berkman N
Screening for bacterial vaginosis in pregnant adolescents and women to prevent preterm delivery: updated evidence report and systematic review for the US Preventive Services Task Force.
Researchers sought to update the evidence on screening and treatment of asymptomatic bacterial vaginosis in pregnancy for the USPSTF. They found that the evidence suggests no difference in the incidence of preterm delivery and related outcomes from treatment for asymptomatic bacterial vaginosis in a general obstetric population but was inconclusive for women with a prior preterm delivery. Maternal adverse events from treatment appear to be infrequent and minor, but the evidence about harms from in utero exposure was inconclusive.
AHRQ-funded; 290201500011I.
Citation: Kahwati LC, Clark R, Berkman N .
Screening for bacterial vaginosis in pregnant adolescents and women to prevent preterm delivery: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2020 Apr 7;323(13):1293-309. doi: 10.1001/jama.2020.0233..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Evidence-Based Practice, Prevention, Women, Children/Adolescents, Pregnancy, Maternal Care, Antibiotics, Medication
Bartsch SM, Stokes-Cawley OJ, Buekens P
The potential economic value of a therapeutic Chagas disease vaccine for pregnant women to prevent congenital transmission.
Currently, there are no solutions to prevent congenital transmission of Chagas disease during pregnancy, which affects 1-40% of pregnant women in Latin America and is associated with a 5% transmission risk. In this study the investigators sought to determine the economic value of therapeutic vaccines to prevent congenital transmission. The investigators delineated the thresholds at which therapeutic vaccination of Chagas-positive pregnant women would be cost-effective and cost-saving, providing economic guidance for decision-makers to consider when developing and bringing such a vaccine to market.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Stokes-Cawley OJ, Buekens P .
The potential economic value of a therapeutic Chagas disease vaccine for pregnant women to prevent congenital transmission.
Vaccine 2020 Apr 3;38(16):3261-70. doi: 10.1016/j.vaccine.2020.02.078..
Keywords: Vaccination, Healthcare Costs, Pregnancy, Women
Darney BG, Fuentes-Rivera E, Polo G
Con la ley y sin la ley/With and without the law: utilization of abortion services and case fatality in Mexico, 2000-2016.
This study examined abortion and case-fatality rate trends in Mexico and Mexico City from 2000 to 2016. The rate nationally was 6.7 per 1000 in 2000, peaked in 2011, and plateaued in 2016. In Mexico City the utilization rate peaked in 2014 and then plateaued. Nationwide and in Mexico City (where abortion was legalized in 2007) case-fatality rates declined over time. After abortion became legal in Mexico City, the rate decreased more rapidly than in the other states of Mexico.
AHRQ-funded.
Citation: Darney BG, Fuentes-Rivera E, Polo G .
Con la ley y sin la ley/With and without the law: utilization of abortion services and case fatality in Mexico, 2000-2016.
Int J Gynaecol Obstet 2020 Mar;148(3):369-74. doi: 10.1002/ijgo.13077..
Keywords: Pregnancy, Healthcare Utilization, Women, Healthcare Delivery
Gregory EF, Upadhya KK, Cheng TL
AHRQ Author: Mistry KB
Enabling factors associated with receipt of interconception health care.
This study examined factors associated with receipt of preventive health care between pregnancies (interconception) using data from a study at four health centers in the Baltimore metropolitan area. The Anderson’s Model of Health Services Use model was used to identify data on factors up to 15 months postpartum. Factors included health history, self-rated health, demographics, predisposing factors, and enabling factors. The cohort included 376 women who were predominantly non-Hispanic Black (84%), and low income. Two enabling factors were associated with receipt of care: having a personal doctor or nurse and having non-Medicaid insurance.
AHRQ-authored
Citation: Gregory EF, Upadhya KK, Cheng TL .
Enabling factors associated with receipt of interconception health care.
Matern Child Health J 2020 Mar;24(3):275-82. doi: 10.1007/s10995-019-02850-0..
Keywords: Maternal Care, Prevention, Pregnancy, Healthcare Utilization, Women, Access to Care
Dissanayake MV, Darney BG, Caughey AB
Miscarriage occurrence and prevention efforts by disability status and type in the United States.
This study compares miscarriage rates among women by disability and type in the United States. Data from the 2011-2015 National Survey of Family Growth was used to examine outcomes in women with at least one completed pregnancy within the past 5 years. Analyses was conducted for women in six disability categories (any, hearing, vision, cognitive, physical, independent living) who had experienced miscarriage within the past 5 years. Overall, 21.83% women without disabilities and 31.63% of women with disabilities experienced a miscarriage. Women with any, cognitive, physical, and independent living had higher adjusted odds of experiencing miscarriage. A higher proportion of women with any, vision, physical, or independent living received recommendations for bedrest (65%) than women without (34%).
AHRQ-funded; HS022981; HS025155.
Citation: Dissanayake MV, Darney BG, Caughey AB .
Miscarriage occurrence and prevention efforts by disability status and type in the United States.
J Womens Health 2020 Mar;29(3):345-52. doi: 10.1089/jwh.2019.7880..
Keywords: Pregnancy, Women, Maternal Care, Disabilities
Birru Talabi M, Clowse MEB, Blalock SJ
Perspectives of adult rheumatologists regarding family planning counseling and care: a qualitative study.
This qualitative study sought to assess rheumatologists' perspectives, attitudes, and practices regarding family planning counseling and reproductive health care (FPCC). A geographically diverse sample of U.S. rheumatologists were interviewed and the transcripts of the interviews developed into a code book based on their content. Findings showed that rheumatologists feel a sense of responsibility to provide some aspects of FPCC to reproductive-age female patients. However, their own apprehensions about managing complicated pregnancies may negatively influence how they advise patients about pregnancy planning or avoidance. Future work should focus on eliminating barriers and identifying solutions that support rheumatologists' efforts to provide high-quality FPCC to patients.
AHRQ-funded; HS022989.
Citation: Birru Talabi M, Clowse MEB, Blalock SJ .
Perspectives of adult rheumatologists regarding family planning counseling and care: a qualitative study.
Arthritis Care Res 2020 Mar;72(3):452-58. doi: 10.1002/acr.23872..
Keywords: Arthritis, Pregnancy, Sexual Health, Provider: Physician, Women
Horner-Johnson W, Dissanayake M, Wu JP
Pregnancy intendedness by maternal disability status and type in the United States.
Using data from the National Survey of Family Growth, researchers studied pregnancy-intendedness among U.S. women with disabilities. They found that a higher proportion of pregnancies were unintended among women with disabilities than among women without disabilities, and that women with independent living disability had the highest proportion. They recommend further research to understand differences in unintended pregnancy by type and extent of disability, as well as the inclusion of people with disabilities in sex education and the incorporation of their routine care in discussions of reproductive planning.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Dissanayake M, Wu JP .
Pregnancy intendedness by maternal disability status and type in the United States.
Perspect Sex Reprod Health 2020 Mar;52(1):31-38. doi: 10.1363/psrh.12130..
Keywords: Pregnancy, Women, Disabilities
Glazer KB, Danilack VA, Werner EF
Elucidating the role of overweight and obesity in racial and ethnic disparities in cesarean delivery risk.
This study’s goal was to quantify the extent to which overweight and obesity explain cesarean delivery rates among women of different racial and ethnic backgrounds. Administrative records were used from New York City for 216,481 singleton, nulliparous births from 2008 to 2013. Risk ratios, risk differences, and population attributable fractions for associations between body mass index and cesarean, stratified by race and ethnicity was calculated. Black and Hispanic women had the highest cesarean rates attributable to obesity and overweight (17.4% and 14.6%) respectively.
AHRQ-funded; HS025013.
Citation: Glazer KB, Danilack VA, Werner EF .
Elucidating the role of overweight and obesity in racial and ethnic disparities in cesarean delivery risk.
Ann Epidemiol 2020 Feb;42:4-11.e4. doi: 10.1016/j.annepidem.2019.12.012.
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Keywords: Disparities, Racial and Ethnic Minorities, Pregnancy, Labor and Delivery, Risk, Obesity, Women
Guglielminotti J, Rosenberg H, Li G
Prevalence of malignant hyperthermia diagnosis in obstetric patients in the United States, 2003 to 2014.
The goal of this study was to assess the prevalence of malignant hyperthermia (MH) diagnosis and associated factors in obstetric patients. Using data from the Nationwide Inpatient Sample, results showed that the prevalence of MH-susceptibility is about 1 in 125,000 in cesarean deliveries, similar to the prevalence reported in non-obstetrical surgery inpatients. The findings of this study suggest that stocking dantrolene in maternity units is justified.
AHRQ-funded; HS025787.
Citation: Guglielminotti J, Rosenberg H, Li G .
Prevalence of malignant hyperthermia diagnosis in obstetric patients in the United States, 2003 to 2014.
BMC Anesthesiol 2020 Jan 20;20(1):19. doi: 10.1186/s12871-020-0934-0..
Keywords: Healthcare Cost and Utilization Project (HCUP), Pregnancy, Maternal Care, Women, Diagnostic Safety and Quality, Labor and Delivery
Mabry-Hernandez I, Yan LD
AHRQ Author: Mabry-Hernandez I
Screening for hepatitis B virus in pregnant women.
This case study involves a 33-year-old U.S.-born pregnant clinician presenting for a first prenatal visit. She was pregnant once, more than two years ago; at that time she screened negative for the hepatitis B virus (HBV). She reports that she received an HBV vaccination one year ago during a work-related physical examination.
AHRQ-authored.
Citation: Mabry-Hernandez I, Yan LD .
Screening for hepatitis B virus in pregnant women.
Am Fam Physician 2020 Jan 15;101(2):115-16..
Keywords: U.S. Preventive Services Task Force (USPSTF), Hepatitis, Pregnancy, Women, Maternal Care, Screening, Pregnancy, Case Study
Klawetter S, McNitt C, Hoffman JA
Perinatal depression in low-income women: a literature review and innovative screening approach.
This paper is a literature review of perinatal depression prevalence, consequences, and screening among low-income women and women of color. The Warm Connections program has an innovative perinatal depression screening protocol and was used with WIC participants. The literature showed mixed findings of perinatal prevalence among low-income women and women of color. There were lower perinatal depression rates in the Warm Connections program in studies using less specific perinatal depression screening instruments with similar samples.
AHRQ-funded; HS026370.
Citation: Klawetter S, McNitt C, Hoffman JA .
Perinatal depression in low-income women: a literature review and innovative screening approach.
Curr Psychiatry Rep 2020 Jan 7;22(1):1. doi: 10.1007/s11920-019-1126-9.
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Keywords: Depression, Pregnancy, Women, Low-Income, Social Determinants of Health, Screening, Behavioral Health, Maternal Care, Disparities, Diagnostic Safety and Quality
Gordon SH, Sommers BD, Wilson IB
Effects of Medicaid expansion on postpartum coverage and outpatient utilization.
Timely postpartum care is associated with lower maternal morbidity and mortality, yet fewer than half of Medicaid beneficiaries attend a postpartum visit. Using Medicaid claims data for 2013-2015 from Colorado, which expanded Medicaid under the Affordable Care Act, and Utah, which did not, the authors conclude that expansion may promote the stability of postpartum coverage and increase the use of postpartum outpatient care in the Medicaid program.
AHRQ-funded; HS025560.
Citation: Gordon SH, Sommers BD, Wilson IB .
Effects of Medicaid expansion on postpartum coverage and outpatient utilization.
Health Aff 2020 Jan;39(1):77-84. doi: 10.1377/hlthaff.2019.00547..
Keywords: Medicaid, Pregnancy, Women, Access to Care, Maternal Care, Ambulatory Care and Surgery, Policy, Healthcare Delivery
Rosenbloom JI, Lewkowitz AK, Lindley KJ
Expectant management of hypertensive disorders of pregnancy and future cardiovascular morbidity.
The purpose of this study was to test the hypothesis that a longer length of time between diagnosis of hypertensive disorders of pregnancy and delivery is associated with increased risk of cardiovascular morbidity in the years after delivery. The investigators concluded that prolonged expectant management of preterm hypertensive disorders of pregnancy was associated with an increased risk of maternal cardiac disease in the ensuing years.
AHRQ-funded; HS019455.
Citation: Rosenbloom JI, Lewkowitz AK, Lindley KJ .
Expectant management of hypertensive disorders of pregnancy and future cardiovascular morbidity.
Obstet Gynecol 2020 Jan;135(1):27-35. doi: 10.1097/aog.0000000000003567..
Keywords: Blood Pressure, Pregnancy, Cardiovascular Conditions, Labor and Delivery, Risk, Women
Lundsberg LS, Main EK, Lee HC
Low-interventional approaches to intrapartum care: hospital variation in practice and associated factors.
This study compared hospitals in California with low and high-interventional practices for labor and delivery. A total of 185 California hospitals completed a survey of intrapartum care, including questions on low- versus high-interventional practices. They identified 2 distinct groups of hospitals that tended to use low- or high-interventional practices. Hospitals that used low-interventional practices tended to have midwife-led or physician-midwife collaborative labor management or were in rural locations. High-interventional practice hospitals had a higher proportion of women covered by Medicaid or other safety-net programs as well as hospitals located in counties with higher liability insurance premiums. Both sets of hospitals had comparable morbidity rates but low-intervention hospitals had lower rates of cesarean birth and episiotomies. Only one-quarter of hospitals were found to use low-interventional practices.
AHRQ-funded; HS023801.
Citation: Lundsberg LS, Main EK, Lee HC .
Low-interventional approaches to intrapartum care: hospital variation in practice and associated factors.
J Midwifery Womens Health 2020 Jan;65(1):33-44. doi: 10.1111/jmwh.13017..
Keywords: Labor and Delivery, Pregnancy, Women, Maternal Care, Hospitals, Quality of Care
Moniz MH, Fendrick AM, Kolenic GE
Out-of-pocket spending for maternity care among women with employer-based insurance, 2008-15.
The Affordable Care Act (ACA) requires employer-based insurance plans to cover maternity services, but plans are allowed to impose cost sharing such as copayments and deductibles for these services. This study aimed to evaluate trends in cost sharing for maternity care among working women in employer-based plans, before and after the ACA. The investigators found that between 2008 and 2015, average out-of-pocket spending for maternity care rose among women with employer-based insurance. This increase was largely driven by increased spending among women with deductibles.
AHRQ-funded; HS025465; HS023784.
Citation: Moniz MH, Fendrick AM, Kolenic GE .
Out-of-pocket spending for maternity care among women with employer-based insurance, 2008-15.
Health Aff 2020 Jan;39(1):18-23. doi: 10.1377/hlthaff.2019.00296..
Keywords: Pregnancy, Women, Maternal Care, Health Insurance, Healthcare Costs, Policy
Carlson NS, Breman R, Neal JL
Preventing cesarean birth in women with obesity: influence of unit-level midwifery presence on use of cesarean among women in the Consortium on Safe Labor data set.
The primary goal of this study was to examine associations between midwifery unit-level presence and unplanned cesarean birth in women with different body mass index (BMI) ranges. Data from the Consortium on Safe Labor was used to analyze information on low-risk, healthy women who labored and gave birth in medical centers with or without the unit-level presence of midwives. Results indicate that the odds of unplanned cesarean birth among women who gave birth in centers with midwives were 16% lower than the odds of cesarean birth among similar women who gave birth at centers without midwives. However, women whose BMI was above 35.00 kg/m at labor admission had similar odds of cesarean birth, regardless of unit-level midwifery presence. Although integration of midwives into the caregiving environment of medical centers in the United States was associated with overall decrease in the incidence of cesarean birth, increased maternal BMI nevertheless remained positively associated with these outcomes.
AHRQ-funded; HS024733
Citation: Carlson NS, Breman R, Neal JL .
Preventing cesarean birth in women with obesity: influence of unit-level midwifery presence on use of cesarean among women in the Consortium on Safe Labor data set.
J Midwifery Womens Health 2020 Jan;65(1):22-32. doi: 10.1111/jmwh.13022..
Keywords: Labor and Delivery, Pregnancy, Obesity, Women, Prevention, Maternal Care
Tilden 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
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
Mills J, Day B
AHRQ Author: Mills J
Interventions to prevent perinatal depression.
This case study relates to interventions to prevent perinatal depression. It includes a case description as well as follow up questions and answers.
AHRQ-authored.
Citation: Mills J, Day B .
Interventions to prevent perinatal depression.
Am Fam Physician 2019 Sep 15;100(6):365-66..
Keywords: U.S. Preventive Services Task Force (USPSTF), Pregnancy, Depression, Behavioral Health, Prevention, Women, Case Study
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
Lewkowitz AK, Rosenbloom JI, Lopez JD
Association between stillbirth at 23 weeks of gestation or greater and severe maternal morbidity.
Researchers conducted this retrospective cohort study to estimate whether stillbirth at 23 weeks of gestation or more is associated with increased risk of severe maternal morbidity compared with live birth, when stratified by maternal comorbidities. Data from HCUP’s Florida State Inpatient Database was used. The researchers found that, although severe maternal morbidity is overall uncommon, delivering a stillborn fetus at 23 weeks of gestation or greater is associated with increased likelihood of severe maternal morbidity, particularly among women with comorbidities. They conclude that health care providers must be vigilant about severe maternal morbidity during stillbirth delivery.
AHRQ-funded; HS019455.
Citation: Lewkowitz AK, Rosenbloom JI, Lopez JD .
Association between stillbirth at 23 weeks of gestation or greater and severe maternal morbidity.
Obstet Gynecol 2019 Nov;134(5):964-73. doi: 10.1097/aog.0000000000003528..
Keywords: Healthcare Cost and Utilization Project (HCUP), Pregnancy, Maternal Care, Women, Adverse Events