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
51 to 75 of 149 Research Studies DisplayedSafon 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
Song H, Bergman A, Chen AT
Disruptions in preventive care: mammograms during the COVID-19 pandemic.
The objective of this study was to measure the extent to which the provision of mammograms was impacted by the COVID-19 pandemic and surrounding guidelines. The data source for the study were de-identified summary data derived from medical claims and eligibility files were provided by Independence Blue Cross for women receiving mammograms. The investigators concluded that the provision of mammograms has been significantly disrupted due to the COVID-19 pandemic.
AHRQ-funded; HS026116.
Citation: Song H, Bergman A, Chen AT .
Disruptions in preventive care: mammograms during the COVID-19 pandemic.
Health Serv Res 2021 Feb;56(1):95-101. doi: 10.1111/1475-6773.13596..
Keywords: COVID-19, Screening, Cancer: Breast Cancer, Cancer, Women, Prevention
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
Baskin AS, Wang T, Mott NM
Gaps in online breast cancer treatment information for older women.
This study’s goal was to assess the availability of web-based educational materials targeting older women facing early-stage breast cancer treatment. Routine use of sentinel lymph node biopsy (SLNB) and adjuvant radiotherapy offers no overall survival benefit and may not be perceived as desirable by older women. National guidelines allow omission of these treatments for older women. The authors systematically reviewed the top 25 hospital websites ranked as “Best Hospitals for Cancer” by U.S. News & World Report, as well as the websites of four prominent national cancer organizations. Only one national organization and no hospital websites included the recommendation to avoid routine SLNB. Only 2 hospitals and 2 national organizations included information for patients older than 70 years suggesting possible omission of adjuvant radiotherapy.
AHRQ-funded; HS026030.
Citation: Baskin AS, Wang T, Mott NM .
Gaps in online breast cancer treatment information for older women.
Ann Surg Oncol 2021 Feb;28(2):950-57. doi: 10.1245/s10434-020-08961-1..
Keywords: Elderly, Education: Patient and Caregiver, Health Information Technology (HIT), Cancer: Breast Cancer, Cancer, Women
Mott N, Wang T, Miller J
Medical maximizing-minimizing preferences in relation to low-value services for older women with hormone receptor-positive breast cancer: a qualitative study.
In this qualitative study, researchers conducted 30 semi-structured interviews with women age 70 or older without a previous diagnosis of breast cancer in order to elicit perspectives on breast cancer treatment in relation to their medical maximizing-minimizing preferences, as determined by the single-item maximizer-minimizer elicitation question (MM1). They found that medical maximizing-minimizing preferences in older women corresponded with preferences for breast cancer treatment options that guidelines identify as potentially unnecessary.
AHRQ-funded; HS026030.
Citation: Mott N, Wang T, Miller J .
Medical maximizing-minimizing preferences in relation to low-value services for older women with hormone receptor-positive breast cancer: a qualitative study.
Ann Surg Oncol 2021 Feb;28(2):941-49. doi: 10.1245/s10434-020-08924-6..
Keywords: Elderly, Women, Cancer: Breast Cancer, Cancer
Wang T, Baskin A, Miller J
Trends in breast cancer treatment de-implementation in older patients with hormone receptor-positive breast cancer: a mixed methods study.
Guidelines allow for the omission of sentinel lymph node biopsy (SLNB) and post-lumpectomy radiotherapy in women >/= 70 years of age with hormone receptor-positive (HR +) breast cancer. Despite this, national data suggest these procedures have not been widely de-implemented. The objectives of this study were to evaluate trends in SLNB and post-lumpectomy radiotherapy utilization in patients who were eligible for omission and evaluate patient preferences as a target for de-implementation of low-value care.
AHRQ-funded; HS026030.
Citation: Wang T, Baskin A, Miller J .
Trends in breast cancer treatment de-implementation in older patients with hormone receptor-positive breast cancer: a mixed methods study.
Ann Surg Oncol 2021 Feb;28(2):902-13. doi: 10.1245/s10434-020-08823-w..
Keywords: Elderly, Cancer: Breast Cancer, Cancer, Healthcare Utilization, Practice Patterns, Women
Berger BO, Wolfson C, Reid LD
AHRQ Author: Reid LD
Adverse birth outcomes among women of advanced maternal age with and without health conditions in Maryland.
This study examined the association between advanced maternal age (AMA) and adverse birth outcomes among women with and without preexisting and pregnancy-related health conditions. Data for singleton births from the population-based Maryland Pregnancy Risk Assessment Monitoring System 2004-2015 were used to compare women aged 20-34 years and 35 years and older. Findings indicated that AMA is associated with adverse birth outcomes among women with and without health conditions compared with younger women with similar health status. Recommendations included improved screening and management of health conditions during pregnancy for older women, regardless of parity.
AHRQ-authored.
Citation: Berger BO, Wolfson C, Reid LD .
Adverse birth outcomes among women of advanced maternal age with and without health conditions in Maryland.
Womens Health Issues 2021 Jan-Feb;31(1):40-48. doi: 10.1016/j.whi.2020.08.008..
Keywords: Pregnancy, Newborns/Infants, Outcomes, Women, Risk
Rodriguez SA, Higashi RT, Betts AC
Anal cancer and anal cancer screening knowledge, attitudes, and perceived risk among women living with HIV.
The aims of this study were (1) to describe anal cancer knowledge, perceived risk, screening barriers, and acceptability of sample self-collection among women living with HIV (WLWH) at an integrated safety-net system and (2) to describe differences in demographic and psychosocial variables among a subsample of WLWH with a history of abnormal cervical cytology results versus those with normal results. The investigators concluded that this study highlighted a gap in knowledge and awareness among WLWH regarding their heightened risk for anal cancer.
AHRQ-funded; HS022418.
Citation: Rodriguez SA, Higashi RT, Betts AC .
Anal cancer and anal cancer screening knowledge, attitudes, and perceived risk among women living with HIV.
J Low Genit Tract Dis 2021 Jan;25(1):43-47. doi: 10.1097/lgt.0000000000000578..
Keywords: Cancer, Screening, Human Immunodeficiency Virus (HIV), Risk, Women
Rodriguez PJ, Roberts DA, Meisner J
Cost-effectiveness of dual maternal HIV and syphilis testing strategies in high and low HIV prevalence countries: a modelling study.
Dual HIV and syphilis testing might help to prevent mother-to-child transmission (MTCT) of HIV and syphilis through increased case detection and treatment. In this study, the investigators aimed to model and assess the cost-effectiveness of dual testing during antenatal care in four countries with varying HIV and syphilis prevalence. The authors concluded that incorporating dual rapid diagnostic tests in antenatal care could be cost-saving across countries with varying HIV prevalence.
AHRQ-funded; HS013853.
Citation: Rodriguez PJ, Roberts DA, Meisner J .
Cost-effectiveness of dual maternal HIV and syphilis testing strategies in high and low HIV prevalence countries: a modelling study.
Lancet Glob Health 2021 Jan;9(1):e61-e71. doi: 10.1016/s2214-109x(20)30395-8..
Keywords: Human Immunodeficiency Virus (HIV), Infectious Diseases, Prevention, Pregnancy, Women, Diagnostic Safety and Quality, Healthcare Costs
Reese TJ, Schlechter CR, Potter LN
Evaluation of revised US Preventive Services Task Force lung cancer screening guideline among women and racial/ethnic minority populations.
The purpose of this study was to determine the changes associated with the revised USPSTF guideline for lung cancer screening eligibility among female, Black, and Hispanic populations using a large nationwide survey. The investigators concluded that the revised USPSTF guideline may likely increase lung cancer screening rates for female, Black, and Hispanic populations. However, despite these potential improvements, lung cancer screening inequities may persist without tailored eligibility criteria.
AHRQ-funded; HS026198.
Citation: Reese TJ, Schlechter CR, Potter LN .
Evaluation of revised US Preventive Services Task Force lung cancer screening guideline among women and racial/ethnic minority populations.
JAMA Netw Open 2021 Jan;4(1):e2033769. doi: 10.1001/jamanetworkopen.2020.33769..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Lung Cancer, Cancer, Screening, Racial and Ethnic Minorities, Women, Guidelines, Evidence-Based Practice
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
Hatch B, Hoopes M, Darney BG
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Researchers assessed whether ACA implementation and Medicaid expansion were followed by greater receipt of recommended preventive services among women and girls in a large network of community health centers. Data was collected from electronic health records in 14 states. The researchers found that among female patients at community health centers, receipt of recommended preventive care improved after ACA implementation in both Medicaid expansion and non-expansion states, although the overall rates remained low. They recommended continued support to overcome barriers to preventive care in this population.
AHRQ-funded; HS025155.
Citation: Hatch B, Hoopes M, Darney BG .
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Womens Health Issues 2021 Jan-Feb;31(1):9-16. doi: 10.1016/j.whi.2020.08.011..
Keywords: Cancer, Medicaid, Health Insurance, Uninsured, Access to Care, Policy, Cancer: Cervical Cancer, Prevention, Women, Healthcare Utilization
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
Ali MM, McClellan C, West KD
AHRQ Author: McClellan C
Medical marijuana laws, marijuana use, and opioid-related outcomes among women in the United States.
This study examined whether state medical marijuana laws (MMLs) was associated with lower levels of opioid-related outcomes. Data was drawn from the 2002-2014 National Survey on Drug Use and Health to compare opioid misuse in states with and without MMLs among all women, pregnant women, and parenting women. It also invested the impact of MMLs on marijuana use and marijuana use disorder. There was found to be no association of MMLs with opioid misuse, opioid misuse initiation, or opioid use disorder among all women, pregnant women and parenting women. However there was a positive correlation with marijuana use and marijuana use disorder among all women and women with children. MMLs were also associated with an increase in the frequency of opioid misuse in pregnant women and a decrease in the frequency of opioid misuse for parenting women.
AHRQ-authored.
Citation: Ali MM, McClellan C, West KD .
Medical marijuana laws, marijuana use, and opioid-related outcomes among women in the United States.
Womens Health Issues 2021 Jan-Feb;31(1):24-30. doi: 10.1016/j.whi.2020.09.003..
Keywords: Women, Opioids, Substance Abuse, Medication, Policy, Practice Patterns
Xu X, Lin H, Wright JD
Association between power morcellation and mortality in women with unexpected uterine cancer undergoing hysterectomy or myomectomy.
Despite concerns that power morcellation may adversely affect prognosis of patients with occult uterine cancer, empirical evidence has been limited and inconclusive. In this study, the investigators aimed to determine whether uncontained power morcellation at the time of hysterectomy or myomectomy was associated with increased mortality risk in women with occult uterine cancer.
AHRQ-funded; HS024702.
Citation: Xu X, Lin H, Wright JD .
Association between power morcellation and mortality in women with unexpected uterine cancer undergoing hysterectomy or myomectomy.
J Clin Oncol 2019 Dec 10;37(35):3412-24. doi: 10.1200/jco.19.00562..
Keywords: Cancer, Mortality, Women, Surgery, Risk, Adverse Events
Tilden EL, Phillippi JC, Ahlberg M
Describing latent phase duration and associated characteristics among 1281 low-risk women in spontaneous labor.
Recent research suggests that latent phase of labor may terminate at 6 rather than 4 centimeters of cervical dilation. The objectives of this study were to: (a) characterize duration of the latent phase of labor among term, low-risk, United States women in spontaneous labor using the women's self-identified onset; and (b) quantify associations between demographic and maternal/newborn health characteristics and the duration of the latent phase.
AHRQ-funded; HS024733.
Citation: Tilden EL, Phillippi JC, Ahlberg M .
Describing latent phase duration and associated characteristics among 1281 low-risk women in spontaneous labor.
Birth 2019 Dec;46(4):592-601. doi: 10.1111/birt.12428..
Keywords: Labor and Delivery, Pregnancy, Women
Fitzsimmons-Craft EE, Eichen DM, Kass AE
Reciprocal longitudinal relations between weight/shape concern and comorbid pathology among women at very high risk for eating disorder onset.
This study examined short-term reciprocal longitudinal relations between weight/shape concern and comorbid symptoms and behaviors over the course of 24 months using cross-lagged panel models. Subjects were women 18-25 years old at high risk for onset of an eating disorder (ED), randomized to an online ED preventive intervention or waitlist control. Results supported focusing intervention on reducing weight/shape concern over reducing comorbid constructs for efficient short-term change.
AHRQ-funded; HS00078.
Citation: Fitzsimmons-Craft EE, Eichen DM, Kass AE .
Reciprocal longitudinal relations between weight/shape concern and comorbid pathology among women at very high risk for eating disorder onset.
Eat Weight Disord 2019 Dec;24(6):1189-98. doi: 10.1007/s40519-017-0469-7..
Keywords: Obesity, Obesity: Weight Management, Women, Risk, Behavioral Health, Young Adults
Neal JL, Carlson NS, Phillippi JC
Midwifery presence in United States medical centers and labor care and birth outcomes among low-risk nulliparous women: a Consortium on Safe Labor study.
This study compared labor care and birth outcomes between medical centers with interprofessional care (midwives and physicians) versus noninterprofessional care (physicians only). A retrospective cohort study was conducted using Consortium on Safe labor data from low-risk nulliparous women who birthed in interprofessional (7393) or noninterprofessional (6982). Women at interprofessional medical centers were 74% less likely to undergo labor induction and 75% less likely to have oxytocin augmentation. In addition, the cesarean rate was 12% lower.
AHRQ-funded; HS024733.
Citation: Neal JL, Carlson NS, Phillippi JC .
Midwifery presence in United States medical centers and labor care and birth outcomes among low-risk nulliparous women: a Consortium on Safe Labor study.
Birth 2019 Nov 11;46(3):475-86. doi: 10.1111/birt.12407..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Women, Outcomes
Grant MC, Gibbons MM, Ko CY
Evidence review conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for gynecologic surgery.
This paper is an evidence review of enhanced recovery after surgery (ERAS) protocols for gynecologic surgery that will be used as part of AHRQ’s Safety Program for Improving Surgical Care and Recovery. This initiative was developed in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality. The authors conducted a literature review of the various anesthesia components which may influence outcomes and facilitate recovery after gynecological surgery. They included interventions for preoperative, intraoperative, and postoperative phases of care and then summarized the best available evidence for ERAS for gynecological surgery. The best evidence was summarized for recommendations to be used in the initiative.
Citation: Grant MC, Gibbons MM, Ko CY .
Evidence review conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for gynecologic surgery.
AHRQ-funded; 233201500020I..
Keywords: Patient Safety, Surgery, Quality Improvement, Quality of Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Women
Mills J, Day B
AHRQ Author: Mills J
Interventions to prevent perinatal depression.
This case study relates to interventions to prevent perinatal depression. It includes a case description as well as follow up questions and answers.
AHRQ-authored.
Citation: Mills J, Day B .
Interventions to prevent perinatal depression.
Am Fam Physician 2019 Sep 15;100(6):365-66..
Keywords: U.S. Preventive Services Task Force (USPSTF), Pregnancy, Depression, Behavioral Health, Prevention, Women, Case Study
Kissler K, Thumm EB, Smith DC
Perinatal telehealth: meeting patients where they are.
This qualitative study’s objective was to describe perinatal patients' and providers' experiences with telehealth during and after the acute phase of the COVID-19 pandemic to inform future utilization of telehealth to drive the delivery of high-quality, accessible, and equitable perinatal care to diverse communities. The study included a purposive sample of 14 patients and 17 providers who received or provided perinatal care via telehealth in either a certified nurse-midwifery practice or the nurse-family partnership care model between March 2020 and April 2022. The authors conducted 2 rounds of semistructured interviews with a focus on understanding social and geographic context. Six themes were identified: (1) unexpected advantages of telehealth, (2) patient empowerment, (3) providers' fear of adverse outcomes, (4) concern for equitable care, (5) strategies to enhance the telehealth experience, and (6) strategies to address access to perinatal telehealth. Patients mentioned that they appreciated the increased ease and reduced cost of accessing visits led to fewer missed appointments.
AHRQ-funded; HS028085.
Citation: Kissler K, Thumm EB, Smith DC .
Perinatal telehealth: meeting patients where they are.
J Midwifery Womens Health 2024 Jan-Feb; 69(1):9-16. doi: 10.1111/jmwh.13560..
Keywords: Telehealth, Maternal Care, Health Information Technology (HIT), Women
Lewkowitz AK, Rosenbloom JI, Keller M
Association between stillbirth >/=23 weeks gestation and acute psychiatric illness within 1 year of delivery.
This study analyzed whether women experiencing a stillbirth had a higher risk of psychiatric morbidity and/or substance misuse within 1 year of delivery compared to women having a live birth. Higher risk was found for both using data from the Florida State Inpatient and State Emergency Department databases from 2005-2014. Women with an ICD-9 classification of stillbirth at or greater than 23 weeks gestation were included. Emergency department encounters or admissions with a diagnosis code of a psychiatric disorder were used.
AHRQ-funded; HS019455.
Citation: Lewkowitz AK, Rosenbloom JI, Keller M .
Association between stillbirth >/=23 weeks gestation and acute psychiatric illness within 1 year of delivery.
Am J Obstet Gynecol 2019 Nov;221(5):491.e1-91.e22. doi: 10.1016/j.ajog.2019.06.027..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Pregnancy, Behavioral Health, Women, Labor and Delivery
Lewkowitz AK, Rosenbloom JI, Lopez JD
Association between stillbirth at 23 weeks of gestation or greater and severe maternal morbidity.
Researchers conducted this retrospective cohort study to estimate whether stillbirth at 23 weeks of gestation or more is associated with increased risk of severe maternal morbidity compared with live birth, when stratified by maternal comorbidities. Data from HCUP’s Florida State Inpatient Database was used. The researchers found that, although severe maternal morbidity is overall uncommon, delivering a stillborn fetus at 23 weeks of gestation or greater is associated with increased likelihood of severe maternal morbidity, particularly among women with comorbidities. They conclude that health care providers must be vigilant about severe maternal morbidity during stillbirth delivery.
AHRQ-funded; HS019455.
Citation: Lewkowitz AK, Rosenbloom JI, Lopez JD .
Association between stillbirth at 23 weeks of gestation or greater and severe maternal morbidity.
Obstet Gynecol 2019 Nov;134(5):964-73. doi: 10.1097/aog.0000000000003528..
Keywords: Healthcare Cost and Utilization Project (HCUP), Pregnancy, Maternal Care, Women, Adverse Events
Moniz MH, Soliman AB, Kolenic GE
Cost sharing and utilization of postpartum intrauterine devices and contraceptive implants among commercially insured women.
Investigators evaluated the association between out-of-pocket costs and long-acting reversible contraceptive (LARC) insertion among commercially insured postpartum women. Using the Clinformatics Data Mart, they found that cost sharing for postpartum LARC is associated with use, suggesting that out-of-pocket costs may impede LARC access for some commercially insured postpartum women. They concluded that reducing out-of-pocket costs for the most effective forms of contraception may increase use.
AHRQ-funded; HS025465; HS023784.
Citation: Moniz MH, Soliman AB, Kolenic GE .
Cost sharing and utilization of postpartum intrauterine devices and contraceptive implants among commercially insured women.
Womens Health Issues 2019 Nov - Dec;29(6):465-70. doi: 10.1016/j.whi.2019.07.006..
Keywords: Women, Health Insurance, Healthcare Costs, Access to Care
Li J, Pesko MF, Unruh MA
Effect of the Medicaid primary care rate increase on prenatal care utilization among Medicaid-insured women.
The purpose of this study was to evaluate the effect of the 2013-2014 ACA Medicaid Primary Care Rate Increase on Medicaid-insured women's prenatal care utilization, overall and by race and ethnicity. The investigators concluded that the Medicaid "fee bump" improved prenatal care utilization for non-Hispanic Black and White women. They suggest that policymakers may consider reinstating higher Medicaid reimbursements to improve access to care for disadvantaged populations.
AHRQ-funded; HS024357.
Citation: Li J, Pesko MF, Unruh MA .
Effect of the Medicaid primary care rate increase on prenatal care utilization among Medicaid-insured women.
Matern Child Health J 2019 Nov;23(11):1564-72. doi: 10.1007/s10995-019-02804-6..
Keywords: Medicaid, Primary Care, Maternal Care, Pregnancy, Women, Healthcare Utilization, Racial and Ethnic Minorities, Disparities