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 149 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
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
Mills J, Mohnot S
AHRQ Author: Mills J
Screening for gestational diabetes.
This “Putting Prevention into Practice: An Evidence Based Approach” paper is a case study with questions and answers related to a patient with gestational diabetes.
AHRQ-authored.
Citation: Mills J, Mohnot S .
Screening for gestational diabetes.
Am Fam Physician 2021 Dec 1;104(6):641-42..
Keywords: U.S. Preventive Services Task Force (USPSTF), Diabetes, Pregnancy, Screening, Prevention, Women, Evidence-Based Practice, Guidelines, Case Study
Tobin JN, Cassells A, Weiss E
Integrating cancer screening and mental health services in primary care: protocol and baseline results of a patient-centered outcomes intervention study.
AHRQ-funded; HS021667.
Citation: Tobin JN, Cassells A, Weiss E .
Integrating cancer screening and mental health services in primary care: protocol and baseline results of a patient-centered outcomes intervention study.
J Health Care Poor Underserved 2021;32(4):1907-34. doi: 10.1353/hpu.2021.0173..
Keywords: Patient-Centered Healthcare, Cancer, Behavioral Health, Primary Care, Depression, Women, Screening
Holcomb J, Ferguson G, Roth I
Adoption of an evidence-based intervention for mammography screening adherence in safety net clinics.
This paper describes an evidence-based intervention that was created to reduce mammography appointment no-show rates in underserved women at safety net clinics. An academic-community partnership was used to implement four strategies to improve the adoption and scale-up of the interventions with Federally Qualified Health Centers and charity care clinics. The interventions implemented were: (1) an outreach email blast targeting the community partner member clinics to increase program awareness, (2) an adoption video encouraging enrollment in the program, (3) an outreach webinar educating the community partner member clinics about the program, encouraging enrollment and outlining adoption steps, and (4) an adoption survey adapted from Consolidated Framework for Implementation Research constructs from the Cancer Prevention and Control Research Network for cancer control interventions with Federally Qualified Health Centers.
AHRQ-funded; HS023255.
Citation: Holcomb J, Ferguson G, Roth I .
Adoption of an evidence-based intervention for mammography screening adherence in safety net clinics.
Front Public Health 2021 Nov 4;9:748361. doi: 10.3389/fpubh.2021.748361..
Keywords: Evidence-Based Practice, Imaging, Screening, Women, Community-Based Practice
Alagoz O, Lowry KP, Kurian AW
Impact of the COVID-19 pandemic on breast cancer mortality in the US: estimates from collaborative simulation modeling.
This study’s objective was to project the impact of COVID-19 on future breast cancer mortality between 2020 and 2030. Three established Cancer Intervention and Surveillance Modeling Network breast cancer models were used to model reductions in mammography screening use, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first 6 months of the pandemic with return to prepandemic patterns after that time. The models project by 2030 950 cumulative excess breast cancers deaths related to reduced screening, 1314 deaths associated with delayed diagnosis of symptomatic cases, and 151 deaths associated with reduced chemotherapy use in women with hormone positive, early-stage cancer.
AHRQ-funded; HS018366.
Citation: Alagoz O, Lowry KP, Kurian AW .
Impact of the COVID-19 pandemic on breast cancer mortality in the US: estimates from collaborative simulation modeling.
J Natl Cancer Inst 2021 Nov 2;113(11):1484-94. doi: 10.1093/jnci/djab097..
Keywords: COVID-19, Cancer: Breast Cancer, Cancer, Mortality, Women
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
Bowles EJA, O'Neill SC, Li T
Effect of a randomized trial of a web-based intervention on patient-provider communication about breast density.
This study evaluated a personalized web-based intervention between women and their providers designed to improve breast cancer risk communication. This randomized trial included women aged 40-69 years with 504 women in the control group and 492 women who used the intervention website. The website included information about breast density, personalized breast cancer risk, chemoprevention, and magnetic resonance imaging. Participants self-reported their communication about density with providers at 6 weeks and 12 months. Women in the intervention arm were 2.39 times more likely to report density communication at 6 weeks than the control arm. This effect persisted at 12 months. At 6 weeks the effect was only significant among women who reported versus those who did not report any previous density discussions. A quarter of women in each arm did not have a density conversation at any point during the study.
AHRQ-funded; HS022982.
Citation: Bowles EJA, O'Neill SC, Li T .
Effect of a randomized trial of a web-based intervention on patient-provider communication about breast density.
J Womens Health 2021 Nov;30(11):1529-37. doi: 10.1089/jwh.2021.0053.
AHRQ-funded; HS022982..
AHRQ-funded; HS022982..
Keywords: Communication, Women, Cancer: Breast Cancer, Cancer, Health Information Technology (HIT)
Horner-Johnson W, Klein KA, Campbell J
Experiences of women with disabilities in accessing and receiving contraceptive care.
This study explored the experiences of women with different types of disability when they attempted to obtain contraceptive care. Four semistructured focus groups were created to sample 17 women with different types of disabilities: physical, intellectual and developmental, blind or low vision, and deaf or hard of hearing. Three main themes were identified in challenges to obtaining high-quality contraceptive care: Accessibility and Accommodations, Clinician Attitudes, and Health Insurance. Different challenges occurred with different types of disabilities such as inaccessible clinic rooms and examination tables, and inaccessible clinic forms and information. Processes and infrastructure of contraceptive care are based on an assumption of an able-bodied norm.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Klein KA, Campbell J .
Experiences of women with disabilities in accessing and receiving contraceptive care.
J Obstet Gynecol Neonatal Nurs 2021 Nov;50(6):732-41. doi: 10.1016/j.jogn.2021.07.005..
Keywords: Access to Care, Disabilities, Vulnerable Populations, Women, Sexual Health
India-Aldana S, Rundle AG, Zeleniuch-Jacquotte A
Neighborhood walkability and mortality in a prospective cohort of women.
The purpose of this study was to evaluate neighborhood walkability in relation to the risk of death for women. Participants were recruited in New York City from 1985 to 1991 and tracked for an average of 27 years. Researchers also conducted survival analyses using Cox proportional hazards models to assess association between neighborhood walkability and the risk of death from any cause. Results indicated that residence neighborhoods with higher walkability scores was associated with a lower mortality rate. No association was found between neighborhood walkability and risk of death from cardiometabolic diseases, but exploratory analyses suggested that outdoor walking and average BMI mediated the association between neighborhood walkability and mortality.
AHRQ-funded; HS026120.
Citation: India-Aldana S, Rundle AG, Zeleniuch-Jacquotte A .
Neighborhood walkability and mortality in a prospective cohort of women.
Epidemiology 2021 Nov 1; 32(6):763-72. doi: 10.1097/ede.0000000000001406..
Keywords: Women, Mortality
Kuijer A, Dominici LS, Rosenberg SM
Arm morbidity after local therapy for young breast cancer patients.
This study assessed patient-reported arm morbidity in the Young Women's Breast Cancer Study (YWS). Participants were over 1300 women with breast cancer diagnosed at age 40 or younger and who were enrolled in the YWS. Findings showed that high rates of self-reported arm morbidity in young breast cancer survivors were reported, particularly in patients receiving axillary lymph node dissection and post-mastectomy radiation therapy. Recommendations included attention to the risks and benefits of differing local therapy strategies for axillary lymph node dissection and post-mastectomy radiation therapy patients.
AHRQ-funded; HS023680.
Citation: Kuijer A, Dominici LS, Rosenberg SM .
Arm morbidity after local therapy for young breast cancer patients.
Ann Surg Oncol 2021 Oct;28(11):6071-82. doi: 10.1245/s10434-021-09947-3..
Keywords: Cancer: Breast Cancer, Cancer, Women, Surgery
Dominici L, Hu J, Zheng Y
Association of local therapy with quality-of-life outcomes in young women with breast cancer.
Researchers examined the association of surgery with longer-term satisfaction and quality of life (QOL) in young breast cancer survivors. Participants were women 40 years or older who enrolled in the Young Women's Breast Cancer Study. The results suggested that local therapy in young breast cancer survivors is persistently associated with poorer scores in multiple QOL domains, particularly among those treated with mastectomy and radiotherapy, irrespective of breast reconstruction. Socioeconomic stressors also appear to play a role.
AHRQ-funded; HS023680.
Citation: Dominici L, Hu J, Zheng Y .
Association of local therapy with quality-of-life outcomes in young women with breast cancer.
JAMA Surg 2021 Oct;156(10):e213758. 2021. doi: 10.1001/jamasurg.2021.3758..
Keywords: Cancer: Breast Cancer, Cancer, Quality of Life, Women, Surgery
Taylor K, Compton S, Kolenic GE
Financial hardship among pregnant and postpartum women in the United States, 2013 to 2018.
Financial hardship affects health care access and health outcomes among peripartum women. The objective of this study was to evaluate the prevalence of financial hardship among peripartum women over time and by insurance type and income. The investigators concluded that financial hardship among peripartum women in the United States was common from 2013 to 2018, including 24% of pregnant and postpartum women reporting unmet health care need and 60% reporting health care unaffordability.
AHRQ-funded; HS023784; HS025465.
Citation: Taylor K, Compton S, Kolenic GE .
Financial hardship among pregnant and postpartum women in the United States, 2013 to 2018.
JAMA Netw Open 2021 Oct;4(10):e2132103. doi: 10.1001/jamanetworkopen.2021.32103..
Keywords: Pregnancy, Healthcare Costs, Women, Access to Care
Butler AM, Durkin MJ, Keller MR
Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection.
This study compared treatment outcomes for various antibiotics in premenopausal women with uncomplicated urinary tract infections (UTIs). The authors compared treatment with fluoroquinolones (first-line), trimethoprim-sulfamethoxazole (TMP/SMX) (first-line), nitrofurantoin (first-line), narrow-spectrum β-lactams (non-first-line), and amoxicillin/ampicillin (non-recommended). Over 1.1 million patient outcomes were analyzed. The risk of treatment failure differed by the antibiotic type, with higher risk associated with TMP/SMX versus nitrofurantoin, and lower or similar risk associated with broad- versus narrow-spectrum β-lactams.
AHRQ-funded; HS019455.
Citation: Butler AM, Durkin MJ, Keller MR .
Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection.
Pharmacoepidemiol Drug Saf 2021 Oct;30(10):1360-70. doi: 10.1002/pds.5237..
Keywords: Antibiotics, Medication, Urinary Tract Infection (UTI), Women
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
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
Sella T, Poorvu PD, Ruddy KJ
Impact of fertility concerns on endocrine therapy decisions in young breast cancer survivors.
The diagnosis and treatment of breast cancer can have profound effects on a young woman's family planning and fertility, particularly among women with hormone receptor-positive breast cancer. In this paper the authors discuss the Young Women's Breast Cancer Study, a multicenter cohort of women aged 40 years or younger and newly diagnosed with breast cancer from 2006 to 2016. The investigators concluded that concern about fertility was a contributor to adjuvant ET decisions among a substantial proportion of young breast cancer survivors.
AHRQ-funded; HS023680.
Citation: Sella T, Poorvu PD, Ruddy KJ .
Impact of fertility concerns on endocrine therapy decisions in young breast cancer survivors.
Cancer 2021 Aug 15;127(16):2888-94. doi: 10.1002/cncr.33596..
Keywords: Cancer: Breast Cancer, Cancer, Women, Pregnancy, Decision Making
Pillay J, Donovan L, Guitard S
Screening for gestational diabetes: updated evidence report and systematic review for the US Preventive Services Task Force.
The objective of this study was to update the 2012 review on screening for gestational diabetes to inform the US Preventive Services Task Force. The investigators concluded that direct evidence on screening vs no screening remained limited. One- vs 2-step screening was not significantly associated with improved health outcomes. At or after 24 weeks of gestation, treatment of gestational diabetes was significantly associated with improved health outcomes.
Citation: Pillay J, Donovan L, Guitard S .
Screening for gestational diabetes: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2021 Aug 10;326(6):539-62. doi: 10.1001/jama.2021.10404..
Keywords: U.S. Preventive Services Task Force (USPSTF), Diabetes, Pregnancy, Screening, Evidence-Based Practice, Women, Prevention, Guidelines
Calabrese SK, Lane SB, Caldwell A
Electronic dissemination of a web-based video promotes PrEP contemplation and conversation among US women engaged in care at Planned Parenthood.
This study evaluated the acceptability and impact of a web-based PrEP educational video among women (n = 126) by comparing two Planned Parenthood centers: one using a Web Video and the other using standard education tools. Most women reported the video helped them understand better what PrEP is (92%), how it works (93%), and how to take PrEP (92%). One month post-intervention, more women in the Web Video group reported a high level of comfort discussing PrEP with a provider (82% vs 48%) and commonly thinking about PrEP (36.% vs. 4%).
AHRQ-funded; HS022242.
Citation: Calabrese SK, Lane SB, Caldwell A .
Electronic dissemination of a web-based video promotes PrEP contemplation and conversation among US women engaged in care at Planned Parenthood.
AIDS Behav 2021 Aug;25(8):2483-500. doi: 10.1007/s10461-021-03210-2..
Keywords: Human Immunodeficiency Virus (HIV), Sexual Health, Education: Patient and Caregiver, Health Promotion, Prevention, Health Information Technology (HIT), Communication, Women
Wolgemuth T, Stransky OM, Chodoff A
Exploring the preferences of women regarding sexual and reproductive health care in the context of rheumatology: a qualitative study.
The objective of this study was to explore the sexual and reproductive health (SRH) care and counseling needs of young women with rheumatic diseases in the context of their rheumatology care. The investigators concluded that patients strongly desired rheumatologists to play an active role in their SRH, by initiating family planning conversations, providing SRH education in the context of their diseases and disease-modifying antirheumatic drugs (DMARDs), and directly coordinating SRH care with OB/GYNs.
AHRQ-funded; HS022989.
Citation: Wolgemuth T, Stransky OM, Chodoff A .
Exploring the preferences of women regarding sexual and reproductive health care in the context of rheumatology: a qualitative study.
Arthritis Care Res 2021 Aug;73(8):1194-200. doi: 10.1002/acr.24249..
Keywords: Sexual Health, Women
Ling VB, Levi EE, Harrington AR
The cost of improving care: a multisite economic analysis of hospital resource use for implementing recommended postpartum contraception programmes.
Researchers evaluated the cost of implementing immediate postpartum contraceptive services at four academic centers and one private hospital in the US. Using mixed-methods cost analysis, they found that pre-implementation activities required more resources than execution activities, and sites that used lower-cost employees observed lower costs per hour for implementation activities. Further, implementation activities and costs were associated with local contextual factors, including stakeholder acceptance, integration of employees, and infrastructure readiness for the change effort.
AHRQ-funded; HS025465; HS023784.
Citation: Ling VB, Levi EE, Harrington AR .
The cost of improving care: a multisite economic analysis of hospital resource use for implementing recommended postpartum contraception programmes.
BMJ Qual Saf 2021 Aug;30(8):658-67. doi: 10.1136/bmjqs-2020-011111..
Keywords: Healthcare Costs, Sexual Health, Women, Quality Improvement, Quality of Care
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
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