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 18 of 18 Research Studies DisplayedWilliams D, Stout MJ, Rosenbloom JI
Preeclampsia predicts risk of hospitalization for heart failure with preserved ejection fraction.
Preeclampsia is associated with increased risk of future heart failure (HF), but the relationship between preeclampsia and HF subtypes are not well-established. The objective of this analysis was to identify the risk of HF with preserved ejection fraction (HFpEF) following a delivery complicated by preeclampsia/eclampsia. The investigators concluded that preeclampsia/eclampsia was an independent risk factor for future hospitalizations for HFpEF.
AHRQ-funded; HS019455.
Citation: Williams D, Stout MJ, Rosenbloom JI .
Preeclampsia predicts risk of hospitalization for heart failure with preserved ejection fraction.
J Am Coll Cardiol 2021 Dec 7;78(23):2281-90. doi: 10.1016/j.jacc.2021.09.1360..
Keywords: Healthcare Cost and Utilization Project (HCUP), Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Risk, Labor and Delivery, Pregnancy, Women
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
Zochowski MK, Kolenic GE, Zivin K
Trends in primary cesarean section rates among women with and without perinatal mood and anxiety disorders.
Reducing the rate of cesarean sections among women considered at low risk for delivery by that method is a goal of Healthy People 2030. Prior research suggests that perinatal mood and anxiety disorders increase the risk for cesarean section, but data are limited. This cross-sectional study of commercially insured women examined the relationship between perinatal depression and anxiety disorders and primary (first-time) cesarean section rates, using administrative claims data for US in-hospital deliveries from the period 2008-17.
AHRQ-funded; HS027640.
Citation: Zochowski MK, Kolenic GE, Zivin K .
Trends in primary cesarean section rates among women with and without perinatal mood and anxiety disorders.
Health Aff 2021 Oct;40(10):1585-91. doi: 10.1377/hlthaff.2021.00780..
Keywords: Labor and Delivery, Pregnancy, Women, Anxiety
Schwartz GL, Leifheit KM, Berkman LF
Health selection into eviction: adverse birth outcomes and children's risk of eviction through age 5 years.
Adverse birth outcomes put children at increased risk of poor future health. They also put families under sudden socioeconomic and psychological strain, which has poorly understood consequences. In this study, the investigators tested whether infants experiencing an adverse birth outcome-low birthweight or prematurity, as well as lengthy hospital stays-were more likely to be evicted in early childhood, through age 5 years.
AHRQ-funded; HS000046.
Citation: Schwartz GL, Leifheit KM, Berkman LF .
Health selection into eviction: adverse birth outcomes and children's risk of eviction through age 5 years.
Am J Epidemiol 2021 Jul;190(7):1260-69. doi: 10.1093/aje/kwab007..
Keywords: Children/Adolescents, Newborns/Infants, Labor and Delivery, Pregnancy
Chua KP, Fendrick AM, Conti RM
Out-of-pocket spending for deliveries and newborn hospitalizations among the privately insured.
The authors estimated national data on out-of-pocket spending across the childbirth episode, including both deliveries and newborn hospitalizations, using national commercial claims data. They found that, during 2016–2019, privately insured families paid $3000 out-of-pocket for maternal and newborn hospitalizations, with out-of-pocket spending exceeding $5000 for 1 in 6 families. They recommended that clinicians counsel privately insured families concerning their childbirth benefits.
Citation: Chua KP, Fendrick AM, Conti RM .
Out-of-pocket spending for deliveries and newborn hospitalizations among the privately insured.
Pediatrics 2021 Jul;148(1):e2021050552. doi: 10.1542/peds.2021-050552..
Keywords: Newborns/Infants, Labor and Delivery, Pregnancy, Healthcare Costs
Calthorpe LM, Baer RJ, Chambers BD
The association between preterm birth and postpartum mental healthcare utilization among California birthing people.
This study’s objective was to determine whether preterm birth is associated with postpartum inpatient and emergency mental healthcare utilization. The study sample was taken from a database of live-born neonates delivered in California, 2011-2017, and included all births to singleton infants between the gestational ages of 20 and 44 weeks. The findings indicate found that preterm birth is an independent risk factor for postpartum mental healthcare utilization. These findings suggest that screening for and providing mental health resources to birthing people after delivery are crucial, particularly among people giving birth to preterm infants, regardless of mental health history.
AHRQ-funded; HS026383.
Citation: Calthorpe LM, Baer RJ, Chambers BD .
The association between preterm birth and postpartum mental healthcare utilization among California birthing people.
Am J Obstet Gynecol MFM 2021 Jul;3(4):100380. doi: 10.1016/j.ajogmf.2021.100380..
Keywords: Behavioral Health, Pregnancy, Women, Labor and Delivery, Risk
Wilson BL, Butler RJ
Identifying optimal labor and delivery nurse staffing: the case of cesarean births and nursing hours.
Numerous studies have identified a relationship between nurse staffing and adverse patient outcomes in medical / surgical patient populations. However, little is known about the impact of labor and delivery (L&D) nurse staffing and adverse birth outcomes, such as unintended cesarean delivery, in low-risk term-gestation women. In this study the investigators examined nurse staffing patterns on the likelihood of cesarean sections (C-sections) among low- risk, full gestation births and provided a testing framework to distinguish optimal from ineffective levels of nurse staffing.
AHRQ-funded; HS024607.
Citation: Wilson BL, Butler RJ .
Identifying optimal labor and delivery nurse staffing: the case of cesarean births and nursing hours.
Nurs Outlook 2021 Jan-Feb;69(1):84-95. doi: 10.1016/j.outlook.2020.07.003..
Keywords: Provider: Nurse, Provider, Workforce, Labor and Delivery, Pregnancy, Quality of Care, Risk, Women
Attanasio LB, Hardeman RR, Kozhimannil KB
Prenatal attitudes toward vaginal delivery and actual delivery mode: variation by race/ethnicity and socioeconomic status.
This study examined whether women's prenatal attitudes toward vaginal delivery differed by race/ethnicity or socioeconomic status, and whether attitudes were differently related to delivery mode depending on race/ethnicity or socioeconomic status. The study concluded that there are racial/ethnic differences in chances of cesarean delivery, and these differences are not explained by birth attitudes. Findings also suggested that white and high-socioeconomic status women may be more able to realize their preferences in childbirth.
AHRQ-funded; HS024215.
Citation: Attanasio LB, Hardeman RR, Kozhimannil KB .
Prenatal attitudes toward vaginal delivery and actual delivery mode: variation by race/ethnicity and socioeconomic status.
Birth 2017 Dec;44(4):306-14. doi: 10.1111/birt.12305..
Keywords: Health Services Research (HSR), Labor and Delivery, Pregnancy, Racial and Ethnic Minorities, Social Determinants of Health
Markowitz S, Adams EK, Lewitt MJ
Competitive effects of scope of practice restrictions: public health or public harm?
This paper examined the case of scope of practice (SOP) restrictions for certified nurse midwives and evaluated the effects of changes in states' SOP laws on markets for CNMs and on maternal and infant outcomes. The authors found that SOP laws are neither helpful nor harmful in regards to health outcomes but states that have no SOP-based barriers have lower rates of induced labor and Cesarean section births.
AHRQ-funded; HS024530.
Citation: Markowitz S, Adams EK, Lewitt MJ .
Competitive effects of scope of practice restrictions: public health or public harm?
J Health Econ 2017 Sep;55:201-18. doi: 10.1016/j.jhealeco.2017.07.004..
Keywords: Health Services Research (HSR), Labor and Delivery, Pregnancy, Public Health, Policy
Lapcharoensap W, Lee HC
Tackling quality improvement in the delivery room.
Implementation of standardized practices in the delivery room fosters a safe environment to ensure that newborn infants are cared for optimally. This article discusses how the delivery room is a unique environment and presents examples on how to approach delivery room quality improvement (QI). Key areas of potential focus for teams pursuing delivery QI include thermal regulation, optimizing respiratory support, and facilitating team communication.
AHRQ-funded; HS023506.
Citation: Lapcharoensap W, Lee HC .
Tackling quality improvement in the delivery room.
Clin Perinatol 2017 Sep;44(3):663-81. doi: 10.1016/j.clp.2017.05.003.
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Keywords: Communication, Labor and Delivery, Newborns/Infants, Quality Improvement, Patient Safety
Metz TD, Gonzalez C, Allshouse AA
Influence of patient-level factors on mode of delivery among operative vaginal delivery candidates in modern practice.
This study aimed to evaluate which patient-level factors influence mode of delivery among candidates for operative vaginal delivery. Odds of forceps versus vacuum were higher with induction, nulliparity, epidural, maternal indication, older maternal age, and longer second stage. Odds of cesarean versus operative vaginal delivery were higher with maternal indication, a perinatologist, longer second stage, older gestational age and longer labor.
AHRQ-funded; HS022143.
Citation: Metz TD, Gonzalez C, Allshouse AA .
Influence of patient-level factors on mode of delivery among operative vaginal delivery candidates in modern practice.
Am J Perinatol 2017 Aug;34(10):974-81. doi: 10.1055/s-0037-1601441.
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Keywords: Adverse Events, Healthcare Delivery, Labor and Delivery, Pregnancy, Women
Jensen EA, Lorch SA
Association between off-peak hour birth and neonatal morbidity and mortality among very low birth weight infants.
This study assessed the independent association between overnight or "off-peak" hour delivery and 3 neonatal morbidities strongly associated with childhood neurocognitive impairment. It found that very low birth weight infants born between midnight and 7:00 a.m. are at increased risk for severe intraventricular hemorrhage and death or major neonatal morbidity.
AHRQ-funded; HS015696.
Citation: Jensen EA, Lorch SA .
Association between off-peak hour birth and neonatal morbidity and mortality among very low birth weight infants.
J Pediatr 2017 Jul;186:41-48.e4. doi: 10.1016/j.jpeds.2017.02.007.
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Keywords: Labor and Delivery, Mortality, Newborns/Infants, Adverse Events
Horner-Johnson W, Kulkarni-Rajasekhara S, Darney BG
Live birth, miscarriage, and abortion among U.S. women with and without disabilities.
Researchers compared proportions of live birth, miscarriage, and abortion among women with basic action difficulties, women with complex activity limitations, and women without disabilities in a nationally representative sample. They found few differences between women with and without disabilities, and good likelihood of live birth among women with disabilities experiencing pregnancy.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Kulkarni-Rajasekhara S, Darney BG .
Live birth, miscarriage, and abortion among U.S. women with and without disabilities.
Disabil Health J 2017 Jul;10(3):382-86. doi: 10.1016/j.dhjo.2017.02.006.
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Keywords: Disabilities, Labor and Delivery, Medical Expenditure Panel Survey (MEPS), Pregnancy
Masinter LM, Dina B, Kjerulff K
Short interpregnancy intervals: results from the first baby study.
Short interpregnancy interval (SIPI), defined as 18 months or fewer between delivery and subsequent conception, has become an independent marker of maternal and child health. The authors of this study performed a secondary analysis of 18 months of data from The First Baby Study, a prospective cohort of women followed from pregnancy through 3 years after their first birth.
AHRQ-funded; HS000078.
Citation: Masinter LM, Dina B, Kjerulff K .
Short interpregnancy intervals: results from the first baby study.
Womens Health Issues 2017 Jul - Aug;27(4):426-33. doi: 10.1016/j.whi.2017.02.011..
Keywords: Pregnancy, Labor and Delivery, Women
Horner-Johnson W, Biel FM, Darney BG
Time trends in births and cesarean deliveries among women with disabilities.
This study assessed time trends in births by any mode and in primary cesarean deliveries among women with physical, sensory, or intellectual/developmental disabilities. Among all women giving birth, the proportion with a disability increased from 0.27 percent in 2000 to 0.80 percent in 2010. Women with disabilities had significantly elevated odds of primary cesarean delivery in each year, but the magnitude of the odds ratio decreased over time.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Biel FM, Darney BG .
Time trends in births and cesarean deliveries among women with disabilities.
Disabil Health J 2017 Jul;10(3):376-81. doi: 10.1016/j.dhjo.2017.02.009.
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Keywords: Disabilities, Labor and Delivery, Pregnancy
Attanasio LB, Kozhimannil KB, Srinivas SK
Concordance between women's self-reported reasons for cesarean delivery and hospital discharge records.
Researchers compared women's self-reported reasons for cesarean with their hospital discharge records and examined correlates of variability in agreement between sources. Ninety-one percent of women reported a reason for their cesarean that was present in the discharge data. Positive predictive value (PPV), the probability that women's self-reported reasons for cesarean varied by reason for cesarean, with high PPV for dystocia, macrosomia, and cephalopelvic disproportion (91.1 percent), and lower PPV for malposition (81.7 percent).
AHRQ-funded; HS024215.
Citation: Attanasio LB, Kozhimannil KB, Srinivas SK .
Concordance between women's self-reported reasons for cesarean delivery and hospital discharge records.
Womens Health Issues 2017 May - Jun;27(3):329-35. doi: 10.1016/j.whi.2016.12.006.
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Keywords: Hospital Discharge, Labor and Delivery, Pregnancy, Women
Sjaarda LA, Radin RG, Silver RM
AHRQ Author: Mitchell E
Preconception low-dose aspirin restores diminished pregnancy and live birth rates in women with low grade inflammation: a secondary analysis of a randomized trial.
This study investigated the effect of preconception-initiated low dose aspirin (LDA) on pregnancy rate, pregnancy loss, live birth rate, and inflammation during pregnancy. It concluded that in women attempting conception with elevated high sensitivity C-reactive protein (hsCRP) and prior pregnancy loss, LDA may increase clinical pregnancy and live birth rates to those of women without inflammation and reduce hsCRP elevation during pregnancy.
AHRQ-authored.
Citation: Sjaarda LA, Radin RG, Silver RM .
Preconception low-dose aspirin restores diminished pregnancy and live birth rates in women with low grade inflammation: a secondary analysis of a randomized trial.
J Clin Endocrinol Metab 2017 May;102(5):1495-504. doi: 10.1210/jc.2016-2917.
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Keywords: Pregnancy, Medication, Outcomes, Labor and Delivery
Darney BG, Biel FM, Quigley BP
Primary cesarean delivery patterns among women with physical, sensory, or intellectual disabilities.
This study sought to determine whether physical, sensory, or intellectual and developmental disabilities are independently associated with primary cesarean delivery. It found that women across disability subgroups have higher odds of cesarean delivery, and there is heterogeneity by disability type.
AHRQ-funded; HS022981.
Citation: Darney BG, Biel FM, Quigley BP .
Primary cesarean delivery patterns among women with physical, sensory, or intellectual disabilities.
Womens Health Issues 2017 May - Jun;27(3):336-44. doi: 10.1016/j.whi.2016.12.007.
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Keywords: Disabilities, Labor and Delivery, Patient-Centered Outcomes Research, Pregnancy, Women