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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 10 of 10 Research Studies Displayed
Bossick AS, Brown J, Hanna A
Impact of state-level reproductive health legislation on access to and use of reproductive health services and reproductive health outcomes: a systematic scoping review in the Affordable Care Act era.
This literature review looked at the association between state-level reproductive laws and reproductive health outcomes related to services such as family planning, maternity care, abortion, and prenatal care use. A PubMed search was conducted for studies published between March 10, 2010 and August 31, 2019 and focused on research conducted after the implementation of the Affordable Care Act. Search results returned 1,529 articles with only 56 meeting the inclusion criteria for review. After further review, only 8 were selected for inclusion. Two included all 50 states and Washington, DC; one included Oregon and Washington; and the remaining 5 studies included single states (Texas, Arizona, Ohio, and Utah). Half of the studies focused solely on restrictive abortion legislation. Restricting access to family planning and abortion services were associated with negative outcomes. Expanding maternity care through Medicaid reform and autonomous midwifery laws were associated with positive outcomes for maternal and newborn health.
Citation: Bossick AS, Brown J, Hanna A . Impact of state-level reproductive health legislation on access to and use of reproductive health services and reproductive health outcomes: a systematic scoping review in the Affordable Care Act era. Womens Health Issues 2021 Mar-Apr;31(2):114-21. doi: 10.1016/j.whi.2020.11.005..
Keywords: Women, Policy, Maternal Care, Pregnancy
Dalton VK, Moniz MH, Bailey MJ
Trends in birth rates after elimination of cost sharing for contraception by the Patient Protection and Affordable Care Act.
Researchers evaluated changes in birth rates by income level among commercially insured women before (2008-2013) and after (2014-2018) the elimination of cost sharing for contraception under the Patient Protection and Affordable Care Act (ACA). The analytic sample included over 4.5 million women enrolled in 47,721 health plans. In this cross-sectional study, the researchers found that the elimination of cost sharing for contraception under the ACA was associated with improvements in contraceptive method prescription fills and a decrease in births among commercially insured women. Women with low income had more precipitous decreases than women with higher income, suggesting that enhanced access to contraception may address well-documented income-related disparities in unintended birth rates.
AHRQ-funded; HS025465; HS023784.
Citation: Dalton VK, Moniz MH, Bailey MJ . Trends in birth rates after elimination of cost sharing for contraception by the Patient Protection and Affordable Care Act. JAMA Netw Open 2020 Nov 2;3(11):e2024398. doi: 10.1001/jamanetworkopen.2020.24398..
Keywords: Policy, Health Insurance, Women, Healthcare Costs, Pregnancy, Sexual Health
Montoya-Williams D, Passarella M, Lorch SA
The impact of paid family leave in the United States on birth outcomes and mortality in the first year of life.
The purpose of this study was to evaluate the effect of paid family leave in California on statewide rates of preterm birth, low birthweight, post-neonatal mortality, and overall infant mortality. Probabilistic methods were used to match records of live birth with maternal and newborn hospital records; only singleton births were included in the study. Rates of infant health outcomes before and after implementation of the 2004 policy in California were compared with rates in two states that had no paid family leave policy. Findings showed that implementation of paid family leave policies in California was associated with a 12-percent reduction in post-neonatal mortality after adjusting for maternal and neonatal factors.
Citation: Montoya-Williams D, Passarella M, Lorch SA . The impact of paid family leave in the United States on birth outcomes and mortality in the first year of life. Health Serv Res 2020 Oct;55(Suppl 2):807-14. doi: 10.1111/1475-6773.13288..
Keywords: Newborns/Infants, Pregnancy, Mortality, Policy, Outcomes, Labor and Delivery
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.
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
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.
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
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
Cottrell E, Darney BG, Marino M
Study protocol: a mixed-methods study of women's healthcare in the safety net after Affordable Care Act implementation - EVERYWOMAN.
In this paper, the authors describe a 5-year, mixed-methods study comparing women's contraceptive, preventive, prenatal and postpartum care before and after ACA implementation and between Medicaid expansion and non-expansion states. They conclude that the findings will be relevant to policy and practice, informing efforts that enhance the provision of timely, evidence-based reproductive care, to improve health outcomes, and to reduce disparities among women. Patient, provider and practice-level interviews will serve to contextualize their findings and to develop subsequent studies and interventions to support women's healthcare provision in community health center settings.
Citation: Cottrell E, Darney BG, Marino M . Study protocol: a mixed-methods study of women's healthcare in the safety net after Affordable Care Act implementation - EVERYWOMAN. Health Res Policy Syst 2019 Jun 11;17(1):58. doi: 10.1186/s12961-019-0445-y..
Keywords: Women, Safety Net, Access to Care, Medicaid, Policy, Prevention, Pregnancy, Maternal Care, Sexual Health
Jou J, Kozhimannil KB, Abraham JM
Paid maternity leave in the United States: associations with maternal and infant health.
Using data from Listening to Mothers III, a national survey of women ages 18-45 who gave birth in 2011-2012, the investigators conducted multivariate logistic regression to predict the likelihood of outcomes related to infant health, maternal physical and mental health, and maternal health behaviors by the use and duration of paid maternity leave. They concluded that Practice Paid maternity leave significantly predicted lower odds of maternal and infant re-hospitalization and higher odds of doing well with exercise and stress management.
Citation: Jou J, Kozhimannil KB, Abraham JM . Paid maternity leave in the United States: associations with maternal and infant health. Matern Child Health J 2018 Feb;22(2):216-25. doi: 10.1007/s10995-017-2393-x..
Keywords: Maternal Care, Newborns/Infants, Policy, Pregnancy, Women
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.
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
Hendrich A, McCoy CK, Gale J
Ascension health's demonstration of full disclosure protocol for unexpected events during labor and delivery shows promise.
This article presents a case study concerning challenges, including physician resistance, to the establishment of a common full disclosure protocol at five labor and delivery demonstration sites. Twenty-seven months after implementation, the rate of full disclosure had increased by 221 percent. Practitioners saw a number of factors as key catalysts for change including consistent and ongoing leadership by local practitioners and hospitals.
Citation: Hendrich A, McCoy CK, Gale J . Ascension health's demonstration of full disclosure protocol for unexpected events during labor and delivery shows promise. Health Aff 2014 Jan;33(1):39-45. doi: 10.1377/hlthaff.2013.1009..
Keywords: Adverse Events, Clinician-Patient Communication, Communication, Labor and Delivery, Medical Errors, Medical Liability, Policy, Pregnancy, Women