National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (22)
- Adverse Drug Events (ADE) (3)
- Adverse Events (9)
- Alcohol Use (1)
- Ambulatory Care and Surgery (2)
- Antibiotics (2)
- Antimicrobial Stewardship (1)
- Anxiety (1)
- Asthma (1)
- Behavioral Health (10)
- Blood Clots (1)
- Blood Pressure (8)
- Blood Thinners (1)
- Breast Feeding (4)
- Burnout (1)
- Cancer (1)
- Cardiovascular Conditions (5)
- Care Coordination (2)
- Caregiving (2)
- Care Management (6)
- Case Study (3)
- Children/Adolescents (9)
- Chronic Conditions (4)
- Clinician-Patient Communication (3)
- Communication (6)
- Community-Based Practice (2)
- Comparative Effectiveness (4)
- Comprehensive Unit-based Safety Program (CUSP) (1)
- COVID-19 (5)
- Cultural Competence (5)
- Data (1)
- Decision Making (1)
- Depression (4)
- Diabetes (7)
- Diagnostic Safety and Quality (2)
- Disabilities (3)
- Disparities (12)
- Domestic Violence (2)
- Education: Continuing Medical Education (1)
- Education: Patient and Caregiver (4)
- Electronic Health Records (EHRs) (2)
- Emergency Department (2)
- Evidence-Based Practice (17)
- Guidelines (6)
- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Cost and Utilization Project (HCUP) (12)
- Healthcare Costs (5)
- Healthcare Delivery (8)
- Healthcare Utilization (6)
- Health Information Technology (HIT) (10)
- Health Insurance (12)
- Health Promotion (4)
- Health Services Research (HSR) (3)
- Heart Disease and Health (1)
- Hepatitis (1)
- Hospital Discharge (3)
- Hospitalization (4)
- Hospital Readmissions (1)
- Hospitals (13)
- Implementation (3)
- Injuries and Wounds (1)
- Inpatient Care (2)
- Intensive Care Unit (ICU) (1)
- Labor and Delivery (33)
- Lifestyle Changes (1)
- Low-Income (4)
- (-) Maternal Care (182)
- Medicaid (20)
- Medical Errors (1)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medication (8)
- Medication: Safety (2)
- Mortality (6)
- Newborns/Infants (22)
- Nursing (3)
- Nutrition (4)
- Obesity (1)
- Obesity: Weight Management (2)
- Outcomes (15)
- Patient-Centered Healthcare (5)
- Patient-Centered Outcomes Research (8)
- Patient Adherence/Compliance (3)
- Patient and Family Engagement (2)
- Patient Experience (3)
- Patient Safety (11)
- Payment (1)
- Policy (10)
- Practice Patterns (1)
- Pregnancy (107)
- Prevention (10)
- Primary Care (3)
- Provider (2)
- Provider: Health Personnel (1)
- Provider: Nurse (4)
- Public Health (1)
- Public Reporting (1)
- Quality Improvement (6)
- Quality Measures (2)
- Quality of Care (8)
- Racial and Ethnic Minorities (18)
- Research Methodologies (3)
- Respiratory Conditions (1)
- Risk (8)
- Rural/Inner-City Residents (2)
- Rural Health (1)
- Screening (9)
- Sexual Health (12)
- Simulation (2)
- Sleep Problems (2)
- Social Determinants of Health (9)
- Social Media (1)
- Stroke (1)
- Surgery (2)
- Surveys on Patient Safety Culture (1)
- Teams (2)
- TeamSTEPPS (1)
- Telehealth (7)
- Tobacco Use (1)
- Training (3)
- U.S. Preventive Services Task Force (USPSTF) (9)
- Uninsured (1)
- Urban Health (2)
- Urinary Tract Infection (UTI) (1)
- Vulnerable Populations (2)
- Web-Based (1)
- Women (140)
- Workforce (1)
- Young Adults (2)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
51 to 75 of 182 Research Studies DisplayedSnyder BM, Patterson MF, Gebretsadik T
Association between asthma status and prenatal antibiotic prescription fills among women in a Medicaid population.
The objective of this study was to assess the relationship between maternal asthma and outpatient prenatal antibiotic prescription fills to inform antibiotic stewardship. With data from the Tennessee Medicaid Program, findings showed that women with asthma had an increased risk of filling at least one prenatal antibiotic prescription and had an increased number of fills during pregnancy compared to women without asthma. These findings highlight that pregnant women with asthma disproportionately fill more antibiotic prescriptions during pregnancy.
AHRQ-funded; HS018454.
Citation: Snyder BM, Patterson MF, Gebretsadik T .
Association between asthma status and prenatal antibiotic prescription fills among women in a Medicaid population.
J Asthma 2022 Oct;59(10):2100-07. doi: 10.1080/02770903.2021.1993247..
Keywords: Asthma, Respiratory Conditions, Pregnancy, Antibiotics, Antimicrobial Stewardship, Medication, Maternal Care, Women, Chronic Conditions
Venkataramani M, Ogunwole SM, Caulfield LE
Maternal, infant, and child health outcomes associated with the Special Supplemental Nutrition Program for Women, Infants, and Children: a systematic review.
The purpose of this study was to determine whether WIC participation was associated with improved maternal, neonatal-birth, and infant-child health outcomes or differences in outcomes by subgroups and WIC enrollment duration. Findings showed moderate strength of evidence (SOE) that maternal WIC participation during pregnancy is likely associated with lower risk for preterm birth, low birthweight infants, and infant mortality; low SOE that maternal WIC participation may be associated with a lower likelihood of inadequate gestational weight gain, as well as increased well-child visits and childhood immunizations; and low SOE that child WIC participation may be associated with increased childhood immunizations. Further, findings showed low SOE for differences in some outcomes by race and ethnicity but insufficient evidence for differences by WIC enrollment duration.
AHRQ-funded; 75Q80120D00003.
Citation: Venkataramani M, Ogunwole SM, Caulfield LE .
Maternal, infant, and child health outcomes associated with the Special Supplemental Nutrition Program for Women, Infants, and Children: a systematic review.
pediatric pediatrics food.
Keywords: Newborns/Infants, Children/Adolescents, Women, Maternal Care, Outcomes, Nutrition
Eliason EL, A Spishak-Thomas, Steenland MW
Association of the Affordable Care Act Medicaid expansions with postpartum contraceptive use and early postpartum pregnancy.
The purpose of this study was to assess the relationship of the Affordable Care Act (ACA) Medicaid expansion with postpartum contraception use and pregnancy. The researchers found that Medicaid expansion was associated with a 7.0 percentage point increase in postpartum use of the contraceptive implant and intrauterine device LARC, a 3.1 percentage point decrease in short-acting contraception, and a 3.9 percentage point decrease in non-prescription contraceptive use overall. Increases in LARC use were concentrated among non-Hispanic, White, and Black respondents. Medicaid expansion was associated with a decrease in early postpartum pregnancy only among non-Hispanic Black respondents. The researchers concluded that the ACA Medicaid expansion improved postpartum contraceptive access and led to shifts from methods with a lower upfront out-of-pocket cost for people without insurance towards methods with the higher upfront out-of-pocket cost for people without insurance. These changes suggest that Medicaid expansions increased access to the full range of contraceptive methods.
AHRQ-funded; HS027464; HS000011
Citation: Eliason EL, A Spishak-Thomas, Steenland MW .
Association of the Affordable Care Act Medicaid expansions with postpartum contraceptive use and early postpartum pregnancy.
Contraception 2022 Sep;113:42-48. doi: 10.1016/j.contraception.2022.02.012..
Keywords: Sexual Health, Pregnancy, Maternal Care, Women, Medicaid, Access to Care, Policy
Thompson I, Bryant AG, Stuebe AM
Centering the patient in postpartum contraceptive counseling.
This article discusses the timing of postpartum contraceptive counseling and the fact that many health care providers believe prevention of future pregnancies is a priority in the postpartum period and that the inpatient postpartum stay is an ideal time to discuss contraception. However, this belief is not necessarily shared by the birthing parent, and they might be unready to discuss contraceptives, especially for people whose reproduction has been marginalized. The authors state that health care providers must acknowledge this harmful and racist history to change counseling practices actively and thoughtfully to best meet patient needs while simultaneously respecting patient autonomy.
AHRQ-funded; HS027260.
Citation: Thompson I, Bryant AG, Stuebe AM .
Centering the patient in postpartum contraceptive counseling.
Clin Obstet Gynecol 2022 Sep 1;65(3):588-93. doi: 10.1097/grf.0000000000000725..
Keywords: Maternal Care, Pregnancy, Women, Sexual Health
Horner-Johnson W, Garg B, Darney BG BG
Severe maternal morbidity and other perinatal complications among women with physical, sensory, or intellectual and developmental disabilities.
The authors assessed differences in severe maternal morbidity (SMM) and other perinatal complications by presence and type of disability in a retrospective cohort study of California births from 2000-2012. They found that SMM and other perinatal complications were more common among women with disabilities than among women without disabilities.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Garg B, Darney BG BG .
Severe maternal morbidity and other perinatal complications among women with physical, sensory, or intellectual and developmental disabilities.
Paediatr Perinat Epidemiol 2022 Sep;36(5):759-68. doi: 10.1111/ppe.12873..
Keywords: Maternal Care, Disabilities, Adverse Events, Pregnancy, Women
Hirai AH, Owens PL, Reid LD
AHRQ Author: Owens PL, Reid LD
Associations between state-level severe maternal morbidity and other perinatal indicators.
This study used the HCUP State Inpatient Databases (HCUP-SID) to determine the correlation between state-level severe maternal morbidity (SMM) rates and perinatal indicators. HCUP-SID was analyzed from 2017 to 2019 using revised code sets for 20 indicators excluding blood transfusions. Perinatal indicators used included prepregnancy hypertension, prepregnancy diabetes, prepregnancy obesity, low-risk cesarean delivery, preterm birth, infant mortality, and maternal mortality. HCUP-SID data for 10,542,942 maternal deliveries and 11,394,752 live births from the National Vital Statistics System (NVSS) were aggregated for state-level analysis. SMM rates were significantly correlated with 2 of the 7 perinatal indicators: prepregnancy hypertension and low-risk cesarean deliveries. All other perinatal indicators were significantly associated with at least 4 of 7 other indicators, and most correlations were higher in magnitude. Maternity mortality rates were highest in the southeast.
AHRQ-authored.
Citation: Hirai AH, Owens PL, Reid LD .
Associations between state-level severe maternal morbidity and other perinatal indicators.
JAMA Netw Open 2022 Jul;5(7):e2224621. doi: 10.1001/jamanetworkopen.2022.24621..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Pregnancy, Women, Labor and Delivery, Hospitalization
Ellison J, Wang C, Yarrington C
Insurance and geographic variations in non-invasive prenatal testing.
The purpose of this study was to estimate the population-level rate of non-invasive prenatal testing (NIPT) uptake in Massachusetts and identify disparities based on patient zip-code and insurance type. The researchers identified pregnant patients aged 35 years or older at their delivery between 7/1/2015 to 12/31/2015 who were eligible for NIPT use, to assess the role of area‐level sociodemographic characteristics and NIPT uptake. The study reported that considerable geographic variation was discovered. Patients living in zip‐codes within and surrounding the Boston metropolitan area were more likely to receive NIPT, as were those living in Eastern MA. The observed NIPT rate (per 1000 pregnant individuals aged 35 and over) was 48.7 for Medicaid enrollees and 272.1 for commercial enrollees; 123.0 and 223.2 for patients living in a zip‐code with a high versus low proportion of Black/Hispanic residents; and 107.7 and 218.4 for those in a zip‐code with a high versus low proportion of low‐income residents. The researchers reported that birthing people covered by Medicaid were over five times less likely to receive NIPT than their counterparts with commercial coverage. Lower NIPT rates in zip‐codes with a high proportion of low‐income or Black/Hispanic residents also suggests that geographic variations in uptake may reflect racial/ethnic and income disparities independent of insurance coverage. The researchers concluded that the study findings emphasize the presence of substantial disparities in NIPT uptake based on insurance and zip-code of residence, and that further research is needed to identify barriers and facilitators to uptake and to evaluate interventions to address inequities in NIPT use.
AHRQ-funded; HS000011.
Citation: Ellison J, Wang C, Yarrington C .
Insurance and geographic variations in non-invasive prenatal testing.
Prenat Diagn 2022 Jul;42(8):1004-07. doi: 10.1002/pd.6155..
Keywords: Pregnancy, Maternal Care, Women, Health Insurance, Screening
Admon LK, Ford ND, Ko JY
Trends and distribution of in-hospital mortality among pregnant and postpartum individuals by pregnancy period.
The purpose of this study was to examine long-term trends in inpatient death rates among pregnant and postpartum individuals and proportion of deaths by pregnancy period (antenatal, delivery, and postpartum). The researchers examined patterns of inpatient mortality during pregnancy-associated hospitalizations utilizing data from the National Inpatient Sample for 1994 to 2015 and 2017 to 2019. The study found that between 1994 and 2015, among 84,181,338 hospitalizations an estimated 12,654 inpatient deaths occurred among pregnant and postpartum individuals with a mean age of 29.37. Inpatient deaths during delivery hospitalizations decreased from 10.6 deaths per 100 000 delivery hospitalizations to 4.7 deaths per 100 000 delivery hospitalizations between 1994 to 1995 and 2014 to 2015. The rate of inpatient deaths in antenatal and postpartum periods remained unchanged between 1994 to 1995 and 2014 to 2015. The researchers concluded that resources directed toward improving quality of care at obstetric delivery have been associated with decreased rates of severe morbidity and may be associated with decreased mortality, but additional efforts need to be directed toward antenatal and postpartum hospitalizations.
AHRQ-funded; HS027640.
Citation: Admon LK, Ford ND, Ko JY .
Trends and distribution of in-hospital mortality among pregnant and postpartum individuals by pregnancy period.
JAMA Netw Open 2022 Jul;5(7):e2224614. doi: 10.1001/jamanetworkopen.2022.24614..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Mortality, Pregnancy, Women, Hospitals
Hirai AH, Owens PL, Reid LD
AHRQ Author: Owens PL, Reid LD
Trends in severe maternal morbidity in the US across the transition to ICD-10-CM/PCS from 2012-2019.
This study evaluated national and state trends in severe maternal morbidity (SMM) rates from 2012 to 2019, and potential disruptions associated with the transition to International Classification of Diseases, 10th Revision, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS) in October 2015. This repeated cross-sectional analysis examined delivery hospitalizations in the HCUP’s National Inpatient Sample and State Inpatient Databases. There were almost 6 million delivery hospitalizations in the national sample representing a weighted total of 29.8 million deliveries with a mean maternal age of 28.6 years. SMM rates increased from 69.5 per 10,000 deliveries to 79.7 per 10,000 in 2019 without a significant change across the ICD-10-CM/PCS transition. OF 20 SMM indicators, rates for 10 indicators increased while 3 significantly decreased with 5 of those changes associated with the ICD-10-CM/PCS transition. Acute kidney failure had the largest increase, from 6.4 to 15.3 per 10,000 delivery hospitalizations, with no change associated with ICD transition. Disseminated intravascular coagulation had the largest decrease from 31.3 to 21.2 per 10,000, with a significant drop associated with ICD transition. State SMM rates significantly decreased for 1 state and significantly increased for 21 states from 2012 to 2019 and with varying associations with ICD transition.
AHRQ-authored.
Citation: Hirai AH, Owens PL, Reid LD .
Trends in severe maternal morbidity in the US across the transition to ICD-10-CM/PCS from 2012-2019.
JAMA Netw Open 2022 Jul;5(7):e2222966. doi: 10.1001/jamanetworkopen.2022.22966..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Pregnancy, Women, Labor and Delivery, Hospitalization
Jaynes S, Brathwaite D, Tully KP
Systematic review of the effect of technology-mediated education intervention on maternal outcomes in the first year after birth.
This systematic literature review synthesized the findings on the effect of technology-mediated education intervention in the first year after birth on maternal health outcomes and to evaluate interventions for participant perspectives and health equity. The literature search found articles published between 2010 and 2020. The authors identified 21 articles that met their inclusion criteria. Videos were the most commonly reported education intervention, followed by text messages, phone calls, and websites. Maternal health topics addressed in the included articles were mental health, weight loss, breastfeeding, general postpartum education, perineal care, and substance use. These technology-mediated interventions were shown to positively affect mental health, weight loss, and breastfeeding outcomes.
AHRQ-funded; HS027260.
Citation: Jaynes S, Brathwaite D, Tully KP .
Systematic review of the effect of technology-mediated education intervention on maternal outcomes in the first year after birth.
J Obstet Gynecol Neonatal Nurs 2022 May;51(3):278-89. doi: 10.1016/j.jogn.2022.02.005..
Keywords: Pregnancy, Women, Maternal Care, Education: Patient and Caregiver, Health Information Technology (HIT)
Hunte R, Klawetter S, Paul S
"Black nurses in the home is working": advocacy, naming, and processing racism to improve Black maternal and infant health.
The purpose of this qualitative study was to examine how Black women’s health, pregnancy and parenting are impacted by racism, and how the relationship between Black women’s health, pregnancy and parenting and racism-related stress are affected by a culturally-specific perinatal care program. The researchers conducted focus groups and utilized a Black Feminist approach to center the perspectives and lived experiences of Black women. Four themes surfaced in the analysis, including: 1) The widespread reach of structural racism, 2) Trust and healing facilitated through shared identities, 3) Racism directly impacts mental health, and 4) Advocacy at all levels is a vital service. The researchers concluded that structural racism has chronic and toxic effects on Black women’s physical and mental health, and Black perinatal care should include: culturally-specific approaches, advocacy, mental health support with specific attention to racism-related stress, and examination of implicit biases.
AHRQ-funded; HS026370.
Citation: Hunte R, Klawetter S, Paul S .
"Black nurses in the home is working": advocacy, naming, and processing racism to improve Black maternal and infant health.
Matern Child Health J 2022 Apr;26(4):933-40. doi: 10.1007/s10995-021-03283-4..
Keywords: Racial and Ethnic Minorities, Women, Maternal Care, Pregnancy, Newborns/Infants, Cultural Competence
Eliason EL, Daw JR, Steenland MW
Changes in postpartum insurance coverage in the US during the COVID-19 pandemic.
The purpose of this study was to examine changes in postpartum insurance loss or changes (churn) in Medicaid-insured pregnant people during the COVID-19 pandemic. The researchers utilized the 2019 to 2021 Current Population Survey, Annual Social and Economic Supplement
(CPS-ASEC), with an annual sample size of approximately 98,000 households. The study covered 3 time periods: prepandemic (2019), early pandemic (2020), and pandemic (2021), and included female respondents aged 18 to 44 years who were living with a child
younger than 1 year at the time. Coverage was assigned to one of three categories: private, Medicaid, or uninsured. Churn was defined as loss of insurance or changes in insurance type between current insurance and insurance in the previous year. The study found that in 2019 (before the pandemic), among postpartum respondents with Medicaid during the last year, 88.2% had consistent Medicaid, 10.3% lost coverage, and 1.6%switched to private coverage. In 2021 (during the pandemic), consistent Medicaid increased by 6.8 percentage points and Medicaid-uninsured churn decreased by 6.6 percentage points representing a 64% decline from 2019. The researchers concluded that postpartum insurance loss decreased during the pandemic, primarily associated with large increases in consistent Medicaid coverage, and that these findings suggest that the Families First Coronavirus Response Act, which prevented Medicaid disenrollment, was associated with substantial reductions in postpartum Medicaid loss.
(CPS-ASEC), with an annual sample size of approximately 98,000 households. The study covered 3 time periods: prepandemic (2019), early pandemic (2020), and pandemic (2021), and included female respondents aged 18 to 44 years who were living with a child
younger than 1 year at the time. Coverage was assigned to one of three categories: private, Medicaid, or uninsured. Churn was defined as loss of insurance or changes in insurance type between current insurance and insurance in the previous year. The study found that in 2019 (before the pandemic), among postpartum respondents with Medicaid during the last year, 88.2% had consistent Medicaid, 10.3% lost coverage, and 1.6%switched to private coverage. In 2021 (during the pandemic), consistent Medicaid increased by 6.8 percentage points and Medicaid-uninsured churn decreased by 6.6 percentage points representing a 64% decline from 2019. The researchers concluded that postpartum insurance loss decreased during the pandemic, primarily associated with large increases in consistent Medicaid coverage, and that these findings suggest that the Families First Coronavirus Response Act, which prevented Medicaid disenrollment, was associated with substantial reductions in postpartum Medicaid loss.
AHRQ-funded; HS000011; HS027464.
Citation: Eliason EL, Daw JR, Steenland MW .
Changes in postpartum insurance coverage in the US during the COVID-19 pandemic.
JAMA Health Forum 2022 Apr;3(4):e220688. doi: 10.1001/jamahealthforum.2022.0688..
Keywords: COVID-19, Health Insurance, Maternal Care, Women, Pregnancy
Moniz MH, Dalton VK, Smith RD
Feasibility and acceptability of a toolkit-based process to implement patient-centered, immediate postpartum long-acting reversible contraception services.
The objectives of this single-site study were to develop a theory-informed toolkit, to evaluate the feasibility of toolkit-based implementation of immediate postpartum long-acting reversible contraception services, and to refine the toolkit. The study was conducted at a large academic medical center. The authors concluded that the toolkit-based process was associated with high acceptability but mixed healthcare quality outcomes. They suggested that future research should test the effectiveness of the refined toolkit in a multisite, prospective trial.
AHRQ-funded; HS025465.
Citation: Moniz MH, Dalton VK, Smith RD .
Feasibility and acceptability of a toolkit-based process to implement patient-centered, immediate postpartum long-acting reversible contraception services.
Am J Obstet Gynecol 2022 Mar; 226(3):394.e1-94.e16. doi: 10.1016/j.ajog.2021.10.009..
Keywords: Maternal Care, Patient-Centered Healthcare, Women, Sexual Health
Dude AM, Schueler K, Schumm LP
Preconception care and severe maternal morbidity in the United States.
This study’s objective was to measure the association between preconception care and the odds of severe maternal morbidity among women with Medicaid using a secondary analysis of Medicaid claims using Medicaid Analytic Extract files. Findings showed that contraceptive services in the year before conception and routine exams for women with chronic disease were associated with decreased odds of severe maternal morbidity or death for Medicaid enrollees.
AHRQ-funded; HS027027.
Citation: Dude AM, Schueler K, Schumm LP .
Preconception care and severe maternal morbidity in the United States.
Am J Obstet Gynecol MFM 2022 Mar;4(2):100549. doi: 10.1016/j.ajogmf.2021.100549..
Keywords: Maternal Care, Pregnancy, Women, Labor and Delivery, Sexual Health
Reid LD, Weiss AJ, Fingar KR
AHRQ Author: Reid LD
Contributors to disparities in postpartum readmission rates between safety-net and non-safety-net hospitals: a decomposition analysis.
The authors assessed how patient, hospital, and community characteristics explain the safety-net hospital (SNH)/non-SNH disparity in postpartum readmission rates. Using HCUP data, they found that higher postpartum readmission rates at SNHs versus non-SNHs were largely due to differences in the patient mix rather than hospital factors. They recommended hospital initiatives to reduce the risk of postpartum readmissions among SNH patients. They concluded that improving factors that contribute to the disparity, including underlying health conditions and health inequities associated with race, will require enduring investments in public health.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Reid LD, Weiss AJ, Fingar KR .
Contributors to disparities in postpartum readmission rates between safety-net and non-safety-net hospitals: a decomposition analysis.
J Hosp Med 2022 Feb;17(2):77-87. doi: 10.1002/jhm.2769..
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Hospital Readmissions, Maternal Care, Women, Disparities
Lyndon A, Simpson KR, Spetz J
Psychometric properties of The Perinatal Missed Care Survey and missed care during labor and birth.
The purpose of this study was to confirm reliability and validity of the Perinatal Missed Care Survey in a large sample of nurses and hospitals, test construct validity with confirmatory factor analysis, and describe the prevalence of missed nursing care during labor and birth. The study found the survey to be a valid and reliable adaptation of the original MISSCARE instrument. This survey could potentially be used to measure nursing care quality and to assess the effectiveness of structural interventions to improve quality and safety.
AHRQ-funded; HS025715.
Citation: Lyndon A, Simpson KR, Spetz J .
Psychometric properties of The Perinatal Missed Care Survey and missed care during labor and birth.
Appl Nurs Res 2022 Feb;63:151516. doi: 10.1016/j.apnr.2021.151516..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Women
Roman LA, Raffo JE, Strutz K
The impact of a population-based system of care intervention on enhanced prenatal care and service utilization among Medicaid-insured pregnant women.
Enhanced prenatal/postnatal care home visiting programs for Medicaid-insured women have significant positive impacts on care and health outcomes. However, enhanced prenatal care participation rates are typically low, enrolling <30% of eligible women. This study investigated the impacts of a population-based systems approach on timely enhanced prenatal care participation and other healthcare utilization. The investigators concluded that a population systems approach improved selected enhanced prenatal care participation and service utilization for Medicaid-insured women in a county population, those in practices with established clinical-community linkages, and Black women.
AHRQ-funded; HS020208.
Citation: Roman LA, Raffo JE, Strutz K .
The impact of a population-based system of care intervention on enhanced prenatal care and service utilization among Medicaid-insured pregnant women.
Am J Prev Med 2022 Feb;62(2):e117-e27. doi: 10.1016/j.amepre.2021.08.012..
Keywords: Maternal Care, Pregnancy, Medicaid, Women
Gordon SH, Hoagland A, Admon LK
Extended postpartum Medicaid eligibility is associated with improved continuity of coverage in the postpartum year.
The purpose of this study was to explore whether states that adopt the American Rescue Plan Act 0f 2021 option to provide eligibility for pregnancy-related benefits for a full year after birth are likely to improve continuity of postpartum insurance coverage. The researchers utilized linked birth records, income, and all-payer claims data for Medicaid-paid births in Colorado during the period 2014-19. Continuity of coverage during one year postpartum among people eligible for low-income adult Medicaid as compared with those ineligible for Medicaid. The study found that retention of Medicaid coverage as a low-income adult was associated with 1.5 additional months of postpartum insurance enrollment and a 12-percentage-point increase in the probability of continuous insurance coverage during the first year after birth. The study concluded that states adopting the American Rescue Plan Act’s option to extend pregnancy-related benefits for a year after birth are likely to increase continuity of postpartum insurance coverage.
AHRQ-funded; HS027640.
Citation: Gordon SH, Hoagland A, Admon LK .
Extended postpartum Medicaid eligibility is associated with improved continuity of coverage in the postpartum year.
Health Aff 2022 Jan;41(1):69-78. doi: 10.1377/hlthaff.2021.00730..
Keywords: Maternal Care, Medicaid, Women, Pregnancy, Access to Care, Policy
Steenland MW, Wilson IB, Matteson KA
Association of Medicaid expansion in Arkansas with postpartum coverage, outpatient care, and racial disparities.
This study’s objective was to measure the association of Medicaid expansion in Arkansas with postpartum coverage, outpatient care, and racial disparities. A total of 60,990 childbirths were reviewed from January 1, 2014 on with a total of 72.3% paid for by Medicaid and 27.7% paid for by a commercial payer. The mean age of the birthing person was 27; with 67% White, 22% Black, and 7% Hispanic. Medicaid expansion in Arkansas was associated with a 27.8 percentage point increase in continuous insurance coverage and an increase in outpatient visits of 0.9 during the first 6 months postpartum, representing relative increases of 54.9% and 75.0%, respectively. Racial disparities in postpartum coverage decreased from 6.3 percentage points before expansion to -2.0 after. However, disparities in outpatient care after expansion persisted between Black and White individuals.
AHRQ-funded; HS027464.
Citation: Steenland MW, Wilson IB, Matteson KA .
Association of Medicaid expansion in Arkansas with postpartum coverage, outpatient care, and racial disparities.
JAMA Health Forum 2021 Dec;2(12):e214167. doi: 10.1001/jamahealthforum.2021.4167..
Keywords: Medicaid, Maternal Care, Pregnancy, Racial and Ethnic Minorities, Disparities, Policy, Women, Access to Care
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
Ernest EC, Hellar A, Varallo J
Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention.
This study evaluated the impact of a multicomponent safe surgery intervention in Tanzania to reduce surgical site infection (SSI) rates and mortality after caesarean sections (CS). The authors used the WHO Surgical Safety Checklist (SSC) to measure WHO SSC utilization, SSI rates, and CS-related perioperative mortality rates (POMRs) before and 18 months after implementation. The SSC utilization rate for CS increased from 3.7% to 95.1%, which decreased the proportion of women with SSI after CS from 14% during baseline to 1%. CS-related POMR decreased by 38.5% after implementation of safe surgery interventions as well.
AHRQ-funded; HS024235.
Citation: Ernest EC, Hellar A, Varallo J .
Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention.
BMJ Glob Health 2021 Dec;6(12). doi: 10.1136/bmjgh-2021-006788..
Keywords: Maternal Care, Pregnancy, Healthcare-Associated Infections (HAIs), Surgery, Injuries and Wounds, Adverse Events, Patient Safety
Raffo JE, Titcombe C, Henning S
Clinical-community linkages: the impact of standard care processes that engage Medicaid-eligible pregnant women in home visiting.
The purpose of this study was to describe how practice sites operationalized clinical-community linkage strategies that best suited their setting and to determine if efforts resulted in improved Maternal Infant Health Program participation and other service use. Findings showed that clinical-community linkages can significantly improve participation of Medicaid-insured women in an evidence-based home visiting program and other prenatal services.
AHRQ-funded; HS020208.
Citation: Raffo JE, Titcombe C, Henning S .
Clinical-community linkages: the impact of standard care processes that engage Medicaid-eligible pregnant women in home visiting.
Womens Health Issues 2021 Nov-Dec;31(6):532-39. doi: 10.1016/j.whi.2021.06.006..
Keywords: Pregnancy, Maternal Care, Women, Medicaid, Community-Based Practice
Viswanathan M, Cook Middleton J, Stuebe AM
Maternal, fetal, and child outcomes of mental health treatments in women: a meta‐analysis of pharmacotherapy
The authors systematically reviewed evidence on pharmacotherapy for perinatal mental health disorders. The investigators concluded that evidence from few studies supported the use of pharmacotherapy for perinatal mental health disorders. Although many studies reported on adverse events, they could not rule out underlying disease severity as the cause of the association between exposures and adverse events.
AHRQ-funded; 290201500011I.
Citation: Viswanathan M, Cook Middleton J, Stuebe AM .
Maternal, fetal, and child outcomes of mental health treatments in women: a meta‐analysis of pharmacotherapy
Psych Res Clin Pract 2021 Sep;3(3):123-40. doi: 10.1176/appi.prcp.20210001..
Keywords: Behavioral Health, Women, Maternal Care, Pregnancy, Medication, Evidence-Based Practice
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.
AHRQ-funded; HS026370.
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
Kern-Goldberger AR, Kneifati-Hayek J, Fernandes Y
Wrong-patient orders in obstetrics.
The objective of this observational study was to compare rates of wrong-patient orders among patients on obstetric units compared with reproductive-aged women admitted to medical-surgical units. The investigators concluded that order errors occurred more frequently on obstetric units compared with medical-surgical units.
AHRQ-funded; HS024538; HS026121.
Citation: Kern-Goldberger AR, Kneifati-Hayek J, Fernandes Y .
Wrong-patient orders in obstetrics.
Obstet Gynecol 2021 Aug 1;138(2):229-35. doi: 10.1097/aog.0000000000004474..
Keywords: Medical Errors, Maternal Care, Pregnancy, Women, Adverse Events, Patient Safety