National Healthcare Quality and Disparities Report
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- Access to Care (2)
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- Behavioral Health (2)
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- Blood Thinners (1)
- Breast Feeding (1)
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- (-) Maternal Care (20)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 20 of 20 Research Studies DisplayedSteenland 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
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.
AHRQ-funded; HS018661.
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 and 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.
AHRQ-funded; HS025267.
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 and Ethnic Minorities, Women
Chua KP, Fendrick AM, Conti RM
Prevalence and magnitude of potential surprise bills for childbirth.
This research letter describes a cross-sectional study that examined surprise bills that are received for childbirths and newborn hospitalizations, and whether new legislation to protect families from surprise bills would have a benefit. The authors analyzed 2019 data from Optum’s deidentified Clinformatics Data Mart and identified families with an in-network delivery in 2019 that could be linked to 1 or more in-network newborn hospitalization that was covered by the same family plan. The analysis included 95,384 families, and of those 17,949 (18.8%) had 1 or more potential surprise bill for the delivery, newborn hospitalization(s), or both. The median total liability for potential surprise bills was $744 for 6417 families, with total liability exceeding $2000. Among 32,203, and 63,181 deliveries with and without 1 or more cesarean delivery, 6594 (20.5%) and 5597 (8.9%) had 1 or more potential surprise bill, with a median liability of $1825 respectively. For 5970 and 90,991 newborn hospitalizations with or without 1 or more neonatal intensive care claim, 15.5% and 8.9% had 1 or more potential surprise bill, with a median liability of $1282 and $262 respectively. While this study was limited by lack of information whether these families actually received surprise bills, the findings suggest that federal protections against surprise bills could benefit many families.
AHRQ-funded; HS025465.
Citation: Chua KP, Fendrick AM, Conti RM .
Prevalence and magnitude of potential surprise bills for childbirth.
JAMA Health Forum 2021 Jul; 2(7):e211460. doi: 10.1001/jamahealthforum.2021.1460..
Keywords: Healthcare Costs, Maternal Care, Newborns/Infants, Hospitalization
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.
AHRQ-funded; HS027837.
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
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.
AHRQ-funded; HS000084.
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, Shared Decision Making, Pregnancy, Maternal Care, Inpatient Care, Women, Medication
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: Maternal Care, Women, Hospitals, Implementation, Sexual Health
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.
AHRQ-funded; HS023506.
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.
AHRQ-funded; HS025465.
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.
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
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.
AHRQ-funded; HS013853.
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
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.
AHRQ-funded; HS022242.
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 and Ethnic Minorities, Disparities, Maternal Care, Women
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.
AHRQ-funded; HS019455.
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
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.
AHRQ-funded; 290201500002I.
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