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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 99 Research Studies Displayed
Klawetter S, Glaze K, Sward A
Warm Connections: integration of infant mental health services into WIC.
Warm Connections is an innovative integrated behavioral health program delivered in the Special Supplemental Nutrition Program for Women, Infants, and Children and rooted in an infant and early childhood mental health framework. This exploratory study describes Warm Connections and provides evaluation results from its pilot implementation. Findings suggest Warm Connections may reduce distress and increase parenting efficacy among low-income mothers and support further research of this program's feasibility.
Citation: Klawetter S, Glaze K, Sward A . Warm Connections: integration of infant mental health services into WIC. Community Ment Health J 2021 Aug;57(6):1130-41. doi: 10.1007/s10597-020-00744-y..
Keywords: Newborns/Infants, Maternal Care, Behavioral Health, Patient-Centered Healthcare, Low-Income, Vulnerable Populations
Burris HH, Passarella M, Handley SC
Black-white disparities in maternal in-hospital mortality according to teaching and black-serving hospital status.
This study’s objective was to determine whether black-white disparities in maternal in-hospital mortality during delivery vary across hospital types (black-serving vs non-black and teaching vs non-teaching) and whether overall maternal mortality differs across hospital types. The authors performed a population-based, retrospective cohort study of 5,679,044 deliveries among black (14.2%) and white patients (85.8%) in 3 states (California, Missouri, and Pennsylvania) from 1995 to 2009. Examination of black-white disparities found that after risk adjustment, black patients had significantly greater risk of death and that the disparity was similar within each of the hospital types. At teaching hospitals, mortality was similar in black-serving and nonblack-serving hospitals. Among non-teaching hospitals, mortality was significantly higher in black-serving vs nonblack-serving hospitals. Over half (53%) of black patients delivered in nonteaching black-serving hospitals compared with just 19% of white patients.
Citation: Burris HH, Passarella M, Handley SC . Black-white disparities in maternal in-hospital mortality according to teaching and black-serving hospital status. Am J Obstet Gynecol 2021 Jul;225(1):83.e1-83.e9. doi: 10.1016/j.ajog.2021.01.004..
Keywords: Maternal Care, Pregnancy, Mortality, Women, Racial / Ethnic Minorities, Disparities, Hospitals
Lange EMS, Toledo P
Peripartum racial/ethnic disparities.
Addressing disparities has been a focus of the US Department of Health and Human Services Healthy People initiative for decades, with the most recent Healthy People 2020 establishing a need for health equity in the United States. In this article, the investigators presented an overview of peripartum racial/ethnic disparities and address potential structural solutions to improve maternal health equity.
Citation: Lange EMS, Toledo P . Peripartum racial/ethnic disparities. Int Anesthesiol Clin 2021 Jul 1;59(3):1-7. doi: 10.1097/aia.0000000000000326..
Keywords: Maternal Care, Pregnancy, Disparities, Racial / Ethnic Minorities, Women
Iroz CB, Dahl CM, Cassimatis IR
Prophylactic anticoagulation for preterm premature rupture of membranes: a decision analysis.
The objective of this study was to determine the optimal modality for venous thromboembolism prophylaxis during hospitalization for preterm premature rupture of membranes using a decision analysis model. The investigators concluded that their results did not support the routine use of prophylactic anticoagulation in women admitted to the hospital for preterm premature rupture of membranes.
Citation: Iroz CB, Dahl CM, Cassimatis IR . Prophylactic anticoagulation for preterm premature rupture of membranes: a decision analysis. Am J Obstet Gynecol MFM 2021 May;3(3):100311. doi: 10.1016/j.ajogmf.2021.100311..
Keywords: Blood Clots, Blood Thinners, Prevention, Decision Making, Pregnancy, Maternal Care, Inpatient Care, Women, Medication
Haidari E, Main EK, Cui X
Maternal and neonatal health care worker well-being and patient safety climate amid the COVID-19 pandemic.
The purpose of this study was to assess the perspectives of maternal and neonatal healthcare workers (HCWs) on well-being and patient safety amid the COVID-19 pandemic. Using HCW surveys, findings showed that 66% of respondents reported symptoms of burnout and 73% felt that burnout among their co-workers had significantly increased. Compared to physicians, nurses reported higher rates of unprofessional behavior and difficulty focusing on work. The authors concluded that three months into the COVID-19 pandemic, HCW well-being was substantially compromised, with negative ramifications for patient safety.
Citation: Haidari E, Main EK, Cui X . Maternal and neonatal health care worker well-being and patient safety climate amid the COVID-19 pandemic. J Perinatol 2021 May;41(5):961-69. doi: 10.1038/s41372-021-01014-9..
Keywords: COVID-19, Burnout, Patient Safety, Provider: Nurse, Provider: Health Personnel, Maternal Care
Moniz MH, Bonawitz K, Wetmore MK
Implementing immediate postpartum contraception: a comparative case study at 11 hospitals.
Researchers examined how organizational context and implementation strategies drive successful implementation of immediate postpartum long-acting reversible contraception services, with a goal of informing the design of future implementation interventions. Semi-structured interviews were conducted with clinicians, nurses, residents, pharmacy and revenue cycle staff, and hospital administrators. They found that implementation efforts in maternity settings may be more successful if they select strategies to optimize local conditions for success. They recommended future research to evaluate whether these strategies effectively optimize local conditions for successful implementation in a variety of settings.
AHRQ-funded; HS025465; HS023784.
Citation: Moniz MH, Bonawitz K, Wetmore MK . Implementing immediate postpartum contraception: a comparative case study at 11 hospitals. Implement Sci Commun 2021 Apr 12;2(1):42. doi: 10.1186/s43058-021-00136-7..
Keywords: Contraception, Maternal Care, Women, Hospitals, Implementation
Joshi NS, Padua K, Sherman J
A feasibility study of a novel delayed cord clamping cart.
This study evaluated the feasibility of a delayed cord clamping cart (DCCC) in low-risk neonates born via Cesarean section (CS). The DCCC was utilized for 1 min of delaying umbilical cord clamping (DCC) in all neonates. Findings support the concept that utilizing a DCCC can facilitate DCC with an intact umbilical cord.
Citation: Joshi NS, Padua K, Sherman J . A feasibility study of a novel delayed cord clamping cart. Children 2021 Apr 29;8(5). doi: 10.3390/children8050357..
Keywords: Newborns/Infants, Maternal Care
Peahl AF, Powell A, Berlin H
Patient and provider perspectives of a new prenatal care model introduced in response to the coronavirus disease 2019 pandemic.
The authors evaluated institutional-level adoption and patient and provider experiences with a coronavirus disease 2019 prenatal care model. They found that reduced visit schedules and virtual visits were rapidly integrated into real-world care, with positive experiences for many patients and providers. They recommended future research to understand the health outcomes and care experience associated with alternative approaches to prenatal care delivery across more diverse patient populations outside of the coronavirus disease 2019 pandemic to inform broader health policy decisions.
Citation: Peahl AF, Powell A, Berlin H . Patient and provider perspectives of a new prenatal care model introduced in response to the coronavirus disease 2019 pandemic. Am J Obstet Gynecol 2021 Apr;224(4):384.e1-84.e11. doi: 10.1016/j.ajog.2020.10.008..
Keywords: Maternal Care, Pregnancy, Patient-Centered Healthcare, Telehealth, Health Information Technology (HIT), Healthcare Delivery, COVID-19
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.
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
Bossick AS, Brown J, Hanna A
Impact of state-level reproductive health legislation on access to and use of reproductive health services and reproductive health outcomes: a systematic scoping review in the Affordable Care Act era.
This literature review looked at the association between state-level reproductive laws and reproductive health outcomes related to services such as family planning, maternity care, abortion, and prenatal care use. A PubMed search was conducted for studies published between March 10, 2010 and August 31, 2019 and focused on research conducted after the implementation of the Affordable Care Act. Search results returned 1,529 articles with only 56 meeting the inclusion criteria for review. After further review, only 8 were selected for inclusion. Two included all 50 states and Washington, DC; one included Oregon and Washington; and the remaining 5 studies included single states (Texas, Arizona, Ohio, and Utah). Half of the studies focused solely on restrictive abortion legislation. Restricting access to family planning and abortion services were associated with negative outcomes. Expanding maternity care through Medicaid reform and autonomous midwifery laws were associated with positive outcomes for maternal and newborn health.
Citation: Bossick AS, Brown J, Hanna A . Impact of state-level reproductive health legislation on access to and use of reproductive health services and reproductive health outcomes: a systematic scoping review in the Affordable Care Act era. Womens Health Issues 2021 Mar-Apr;31(2):114-21. doi: 10.1016/j.whi.2020.11.005..
Keywords: Women, Policy, Maternal Care, Pregnancy
Herrick CJ, Keller MR, Trolard AM
Factors associated with postpartum diabetes screening in women with gestational diabetes and Medicaid during pregnancy.
This study’s goal was to understand the factors associated with the receipt of postpartum diabetes screening for women with gestational diabetes in a state without Medicaid expansion. Findings showed that prenatal certified diabetes education and access to public transportation were associated with increased screening, the total number of prenatal visits, the use of diabetes medication during pregnancy, and a pregnancy-specific comorbidity index that incorporated age.
Citation: Herrick CJ, Keller MR, Trolard AM . Factors associated with postpartum diabetes screening in women with gestational diabetes and Medicaid during pregnancy. Am J Prev Med 2021 Feb;60(2):222-31. doi: 10.1016/j.amepre.2020.08.028..
Keywords: Diabetes, Screening, Maternal Care, Pregnancy, Women, Medicaid, Access to Care
Safon CB, Heeren TC, Kerr SM
Disparities in breastfeeding among U.S. Black mothers: identification of mechanisms.
Disparities in U.S. breastfeeding rates persist among Black mothers according to birth country and between Black and White mothers, necessitating further investigation of modifiable mediating factors to inform interventions. This study sought to examine the extent that social, maternal, infant factors and Theory of Planned Behavior (TPB) domains (attitudes, perceived control, and subjective norms) mediated the association of maternal race/birth country and breastfeeding continuation.
Citation: Safon CB, Heeren TC, Kerr SM . Disparities in breastfeeding among U.S. Black mothers: identification of mechanisms. Breastfeed Med 2021 Feb;16(2):140-49. doi: 10.1089/bfm.2020.0310..
Keywords: Breast Feeding, Racial / Ethnic Minorities, Disparities, Maternal Care, Women
Saldanha IJ, Cao W, Bhuma MR
Management of primary headaches during pregnancy, postpartum, and breastfeeding: a systematic review.
Primary headaches (migraine, tension headache, cluster headache, and other trigeminal autonomic cephalgias) are common in pregnancy and postpartum. It is unclear how to best and most safely manage them. In this study, the investigators conducted a systematic review (SR) of interventions to prevent or treat primary headaches in women who are pregnant, attempting to become pregnant, postpartum, or breastfeeding.
Citation: Saldanha IJ, Cao W, Bhuma MR . Management of primary headaches during pregnancy, postpartum, and breastfeeding: a systematic review. Headache 2021 Jan;61(1):11-43. doi: 10.1111/head.14041..
Keywords: Pregnancy, Maternal Care, Care Management, Women, Evidence-Based Practice
Geissler K, Ranchoff BL, Cooper MI
Association of insurance status with provision of recommended services during comprehensive postpartum visits.
Investigators examined rates of recommended services during the comprehensive postpartum visits and differences by insurance type. Data was taken from annual National Ambulatory Medical Care Surveys. Their findings suggested that receipt of recommended services during comprehensive postpartum visits was less than 50% for most services and was similar across insurance types. These findings underscored the importance of efforts to reconceptualize postpartum care to ensure that women have access to a range of supports to manage their health during this sensitive period.
Citation: Geissler K, Ranchoff BL, Cooper MI . Association of insurance status with provision of recommended services during comprehensive postpartum visits. JAMA Netw Open 2020 Nov 2;3(11):e2025095. doi: 10.1001/jamanetworkopen.2020.25095..
Keywords: Maternal Care, Pregnancy, Women, Health Insurance, Access to Care, Healthcare Utilization
Biel F, Darney B, Caughey A
Medical indications for primary cesarean delivery in women with and without disabilities.
The purpose of this study was to examine the associations between maternal disability status and type, mode of delivery, and medical indications for cesarean delivery in California deliveries. Findings showed that women with disabilities were less likely to labor, and these unlabored cesarean deliveries were less likely to have a medical indication for cesarean, compared to women without disabilities.
Citation: Biel F, Darney B, Caughey A . Medical indications for primary cesarean delivery in women with and without disabilities. J Matern Fetal Neonatal Med 2020 Oct;33(20):3391-98. doi: 10.1080/14767058.2019.1572740..
Keywords: Labor and Delivery, Pregnancy, Disabilities, Women, Maternal Care
Simpson KR, Lyndon A, Spetz J
Missed nursing care during labor and birth and exclusive breast milk feeding during hospitalization for childbirth.
The purpose of this study was to determine associations between missed nursing care and nurse staffing during labor and birth, and exclusive breast milk feeding at hospital discharge. Exclusive breast milk feeding is a national quality indicator of inpatient maternity care. Nurses have substantial responsibility for direct support of infant feeding during the childbirth hospitalization. The investigators indicate that the results support exclusive breast milk feeding as a nurse-sensitive quality indicator.
Citation: Simpson KR, Lyndon A, Spetz J . Missed nursing care during labor and birth and exclusive breast milk feeding during hospitalization for childbirth. MCN Am J Matern Child Nurs 2020 Sep/Oct;45(5):280-88. doi: 10.1097/nmc.0000000000000644..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Breast Feeding, Inpatient Care, Nursing, Women
Bonawitz K, Wetmore M, Heisler M
Champions in context: which attributes matter for change efforts in healthcare?
The authors sought to identify and describe champion attributes influencing outcomes of healthcare change efforts. Using postpartum contraceptive care as a case study, they found that effective champions appear to leverage six key attributes to facilitate healthcare change efforts. They concluded that prospective evaluations of the interactions among champion attributes, context, and outcomes may further elucidate how champions exert their effects.
Citation: Bonawitz K, Wetmore M, Heisler M . Champions in context: which attributes matter for change efforts in healthcare? Implement Sci 2020 Aug 6;15(1):62. doi: 10.1186/s13012-020-01024-9..
Keywords: Implementation, Contraception, Women, Maternal Care
Malhamé I, Mehta N, Raker CA
Identifying cardiovascular severe maternal morbidity in epidemiologic studies.
This study’s goal was to identify cases of cardiovascular severe maternal morbidity (CSMM) for use in epidemiologic studies. CSMM has become the leading cause of maternal mortality. The authors analyzed delivery hospitalizations at an obstetric teaching hospital from 2007 to 2017. A subset of indicators developed by the CDC based on ICD codes were utilized to form the composite variable for CSMM. Two expert clinicians manually reviewed all qualifying events using a standardized tool to determine if they were true CSMM events. They also estimated the number of CSMM cases among delivery hospitalizations without qualifying ICD codes by manually reviewing all severe preeclampsia cases and a random sample of 1000 hospitalizations without severe preeclampsia. Among 91,355 delivery admissions, they captured 113 potential CSMM cases. Of those 65 (57.5%) were true CSMM cases. Indicators for acute myocardial infarction, cardiac arrest, and cardioversion had 100% true-positive rates. An additional 70 CSMM cases in the 2102 admissions with severe preeclampsia were found.
Citation: Malhamé I, Mehta N, Raker CA . Identifying cardiovascular severe maternal morbidity in epidemiologic studies. Paediatr Perinat Epidemiol 2020 Jul;34(4):452-59. doi: 10.1111/ppe.12571..
Keywords: Cardiovascular Conditions, Pregnancy, Women, Maternal Care, Labor and Delivery
Dombrowski M, Illuzzi JL, Reddy UM
Trial of labor after two prior cesarean deliveries: patient and hospital characteristics and birth outcomes.
This study’s goal was to examine utilization, success rate, and maternal and neonatal outcomes of trial of labor among women with two prior cesarean deliveries. Linked hospital discharge and birth certificate data were used for a retrospective analyses of a cohort of women in California with nonanomalous, term, singleton live births, two prior cesarean deliveries, and no clear contraindications for trial of labor. Findings showed that, among women with two prior cesarean deliveries, trial of labor was rarely attempted and was successful in 39.4% of attempts. Trial of labor in this population was associated with a modest increase in severe neonatal morbidity.
Citation: Dombrowski M, Illuzzi JL, Reddy UM . Trial of labor after two prior cesarean deliveries: patient and hospital characteristics and birth outcomes. Obstet Gynecol 2020 Jul;136(1):109-17. doi: 10.1097/aog.0000000000003845.
Keywords: Labor and Delivery, Pregnancy, Women, Maternal Care, Outcomes
Rosenbloom JI, Stwalley D, Lindley KJ
Latency of preterm hypertensive disorders of pregnancy and subsequent cardiovascular complications.
The objective of this retrospective cohort study was to test the hypothesis that increasing latency from diagnosis to delivery in patients with preterm hypertensive disorders of pregnancy is associated with an increased maternal risk of cardiovascular admission after delivery. The investigators found that prolonging expectant management of preterm hypertensive disorders of pregnancy was associated with an increased risk of maternal cardiovascular disease after delivery.
Citation: Rosenbloom JI, Stwalley D, Lindley KJ . Latency of preterm hypertensive disorders of pregnancy and subsequent cardiovascular complications. Pregnancy Hypertens 2020 Jul;21:139-44. doi: 10.1016/j.preghy.2020.05.015..
Keywords: Hypertension, Pregnancy, Cardiovascular Conditions, Women, Maternal Care, Risk
Papaleontiou M, Haymart MR
Papaleontiou M, Haymart MR. Thyroid nodules and cancer during pregnancy, post-partum and preconception planning: addressing the uncertainties and challenges.
This article describes the challenges of treating thyroid nodules and thyroid cancer during pregnancy, in the postpartum period, and during preconception planning. The benefits and risk of treatment are discussed based on current knowledge and controversies surrounding management during pregnancy.
Citation: Papaleontiou M, Haymart MR . Papaleontiou M, Haymart MR. Thyroid nodules and cancer during pregnancy, post-partum and preconception planning: addressing the uncertainties and challenges. Best Pract Res Clin Endocrinol Metab 2020 Jul;34(4):101363. doi: 10.1016/j.beem.2019.101363..
Keywords: Cancer, Pregnancy, Maternal Care, Women
Kunz SN, Phibbs CS, Profit J
The changing landscape of perinatal regionalization.
This article discusses the need for consistent perinatal regionalization policies across regions and between countries to reduce neonatal morbidity and mortality. Regionalization emphasizes matching patient needs with the capabilities of the hospital in which care is provided. The need to account for geographic and other regional differences when determining the feasibility of regionalization for a specific regions is emphasized.
Citation: Kunz SN, Phibbs CS, Profit J . The changing landscape of perinatal regionalization. Semin Perinatol 2020 Jun;44(4):151241. doi: 10.1016/j.semperi.2020.151241..
Keywords: Pregnancy, Maternal Care, Women, Policy, Hospitals
Friedman Peahl A, Heisler M, Essenmacher LK
A comparison of international prenatal care guidelines for low-risk women to inform high-value care.
The authors compared U.S. to international prenatal care consensus guidelines for low-risk women to inform care delivery reforms. They found that U.S. and peer-country guidelines recommended similar prenatal education and psychosocial services for low-risk women; however, peer countries generally recommended fewer visits, longer intervals between visits, and less reliance on obstetrician-gynecologists for routine, low-risk prenatal care. They recommended that further investigation evaluate associations between recommended care and actual practice, as well as the effects of different components of prenatal care and delivery models on maternal-infant outcomes, patient-centeredness, and health care expenditures in the U.S.
Citation: Friedman Peahl A, Heisler M, Essenmacher LK . A comparison of international prenatal care guidelines for low-risk women to inform high-value care. Am J Obstet Gynecol 2020 May;222(5):505-07. doi: 10.1016/j.ajog.2020.01.021..
Keywords: Maternal Care, Pregnancy, Women, Value, Guidelines, Evidence-Based Practice, 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.
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