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
1 to 25 of 36 Research Studies DisplayedDarney BG, Fuentes-Rivera E, Saavedra-Avendaño B
Contraceptive receipt among first-trimester abortion clients and postpartum women in urban Mexico.
The objective of this retrospective cohort study was to compare uptake of contraception prior to discharge between abortion clients in Mexico City's public abortion program and postpartum women from urban settings. Data were taken from clinical records of abortion clients in Mexico City and from a population-based survey of urban women on their adoption of contraception immediately postpartum. The results showed that women who received abortions in Mexico City's public abortion program were more likely to receive a reversible modern contraceptive method before leaving the facility than urban postpartum women. The authors concluded that women should be offered the full range of contraceptive methods after any obstetric event to help prevent unintended pregnancies and avoid short interpregnancy intervals.
AHRQ-funded; HS022981.
Citation: Darney BG, Fuentes-Rivera E, Saavedra-Avendaño B .
Contraceptive receipt among first-trimester abortion clients and postpartum women in urban Mexico.
Int Perspect Sex Reprod Health 2020 Dec 14; 46(Suppl 1):35-43. doi: 10.1363/46e0720..
Keywords: Sexual Health, Women, Maternal Care
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.
AHRQ-funded; HS025515.
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.
AHRQ-funded; HS022981.
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.
AHRQ-funded; HS025715.
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.
AHRQ-funded; HS025465.
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, Sexual Health, 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.
AHRQ-funded; HS025013.
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
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.
AHRQ-funded; HS019455.
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: Blood Pressure, Pregnancy, Cardiovascular Conditions, Women, Maternal Care, Risk
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.
AHRQ-funded; HS024512.
Citation: 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
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.
AHRQ-funded; HS023801.
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.
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Keywords: Labor and Delivery, Pregnancy, Women, Maternal Care, Outcomes
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.
AHRQ-funded; HS025749.
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.
AHRQ-funded; HS025465.
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, Guidelines, Evidence-Based Practice, Healthcare Delivery
Peahl 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
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
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
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