National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (10)
- Antibiotics (1)
- Care Management (1)
- Children/Adolescents (1)
- Communication (3)
- Comparative Effectiveness (1)
- Comprehensive Unit-based Safety Program (CUSP) (1)
- Diabetes (1)
- Education: Continuing Medical Education (1)
- Evidence-Based Practice (2)
- Guidelines (1)
- Healthcare Costs (1)
- Healthcare Delivery (2)
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- Injuries and Wounds (3)
- (-) Labor and Delivery (22)
- Low-Income (2)
- Maternal Care (5)
- Medication (2)
- Mortality (6)
- Neonatal Intensive Care Unit (NICU) (1)
- (-) Newborns/Infants (22)
- Nursing (1)
- Outcomes (7)
- Patient-Centered Outcomes Research (1)
- Patient Safety (7)
- Policy (1)
- Pregnancy (14)
- Quality Improvement (3)
- Quality of Care (4)
- Risk (3)
- Sepsis (1)
- Simulation (1)
- Social Determinants of Health (1)
- Surveys on Patient Safety Culture (1)
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- Vulnerable Populations (1)
- Women (7)
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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 22 of 22 Research Studies DisplayedFlannery DD, Mukhopadhyay S, Morales KH
Delivery characteristics and the risk of early-onset neonatal sepsis.
This retrospective cohort study identified term and preterm infants at lowest risk of culture-confirmed early-onset sepsis (EOS) using delivery characteristics and also determined antibiotic use among them. The study cohort included term and preterm infants born 2009 to 2014 with blood culture with or without cerebrospinal fluid culture obtained ≤72 hours after birth. Low EOS risk criteria included: cesarean delivery, without labor or membrane rupture before delivery, and no antepartum concern for intraamniotic infection or nonreassuring fetal status. Among 53,575 births, 7549 (14.1%) were evaluated and 41 (0.5%) of those infants had EOS. For 1121 evaluated infants there were low-risk delivery characteristics and none had EOS. Duration of antibiotics administered to infants born with and without low-risk characteristics was not different.
AHRQ-funded; HS027468.
Citation: Flannery DD, Mukhopadhyay S, Morales KH .
Delivery characteristics and the risk of early-onset neonatal sepsis.
Pediatrics 2022 Feb;149(2). doi: 10.1542/peds.2021-052900..
Keywords: Newborns/Infants, Sepsis, Risk, Labor and Delivery, Antibiotics, Medication
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
Leifheit KM, Schwartz GL, Pollack CE
Severe housing insecurity during pregnancy: association with adverse birth and infant outcomes.
This study measured the association of severe housing insecurity with adverse birth and infant outcomes. Data was analyzed from 3248 mother-infant dyads enrolled in the Fragile Families and Child Wellbeing Study. This prospective cohort study represented births in 20 large U.S. cities from 1998 to 2000. Severe housing insecurity was defined as threatened eviction or homelessness. Adverse outcomes included low birth weight and/or preterm birth, admission to a neonatal intensive care unit (NICU) or stepdown facility, extended hospitalization after delivery, and infant health and temperament. There were statistically significant associations found between severe housing insecurity during pregnancy and low birth weight and/or preterm births. Housing insecurity and infant fair or poor health and poor temperament were not found to have statistically significant associations. Population attributable fraction (PAF) estimates suggested that up to 3% of adverse birth and infant outcomes could be avoided by eliminating severe housing insecurity among low-income, pregnant women.
AHRQ-funded; HS000046.
Citation: Leifheit KM, Schwartz GL, Pollack CE .
Severe housing insecurity during pregnancy: association with adverse birth and infant outcomes.
Int J Environ Res Public Health 2020 Nov 21;17(22):8659. doi: 10.3390/ijerph17228659..
Keywords: Pregnancy, Labor and Delivery, Vulnerable Populations, Outcomes, Adverse Events, Women, Low-Income, Newborns/Infants
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.
AHRQ-funded; HS018661.
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
Herrick HM, Lorch S, Hsu JY
Impact of flow disruptions in the delivery room.
The goal of this study was to identify the impact of flow disruptions during neonatal resuscitation and to determine their association with key process and outcome measures. Delivery-room resuscitations of neonates less 32 weeks gestational age were video recorded for observation. Results showed that flow disruptions occurred frequently during neonatal resuscitation and recommendations included measuring flow disruptions as a feasible method to assess the impact of human factors in the delivery room and to identify modifiable factors and practices to improve patient care.
AHRQ-funded; HS023538; HS026491; HS026625; HS023806.
Citation: Herrick HM, Lorch S, Hsu JY .
Impact of flow disruptions in the delivery room.
Resuscitation 2020 May;150:29-35. doi: 10.1016/j.resuscitation.2020.02.037.
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Keywords: Workflow, Labor and Delivery, Newborns/Infants, Patient Safety, Healthcare Delivery, 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
Vanderlaan J, Rochat R, Williams B
Associations between hospital maternal service level and delivery outcomes.
This study explored the associations between delivery hospital self-reported level of maternal service, as defined by the American Hospital Association, and both maternal and neonatal outcomes among women at high maternal risk, as defined by the Obstetric Comorbidity Index. The investigators concluded that for the group of pregnant women in need of maternal transfer, delivery hospital self-reported level of maternal care was not associated with the odds of poor maternal or neonatal outcomes.
AHRQ-funded; HS024655.
Citation: Vanderlaan J, Rochat R, Williams B .
Associations between hospital maternal service level and delivery outcomes.
Womens Health Issues 2019 May - Jun;29(3):252-58. doi: 10.1016/j.whi.2019.02.004..
Keywords: Maternal Care, Labor and Delivery, Pregnancy, Women, Outcomes, Hospitals, Quality of Care, Newborns/Infants, Mortality
Lapcharoensap W, Cong A, Sherman J
Safety and ergonomic challenges of ventilating a premature infant during delayed cord clamping.
This study discussed the reasons that delayed cord clamping (DCC) for term and preterm infants is endorsed by multiple medical organizations. It has been shown to reduce hemorrhage, lower incidence of necrotizing enterocolitis and the need for transfusions in preterm infants. The writers held a number of multidisciplinary simulation workshops of vaginal and Caesarean deliveries, with providers starting positive pressure ventilation and ending with CPAP on a preterm manikin. Videos were also reviewed and identified 5 themes of concern: sterility, equipment, mobility, space, and workflow.
AHRQ-funded; HS023506.
Citation: Lapcharoensap W, Cong A, Sherman J .
Safety and ergonomic challenges of ventilating a premature infant during delayed cord clamping.
Children 2019 Apr 13;6(4). doi: 10.3390/children6040059..
Keywords: Adverse Events, Labor and Delivery, Newborns/Infants, Patient Safety
Kahwati LC, Sorensen AV, Teixeira-Poit S
AHRQ Author: Mistry KB
Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care.
The purpose of this study was to describe the Safety Program for Perinatal Care (SPPC) implementation experience and evaluate the short-term impact on labor and delivery (L&D) unit patient safety culture, processes, and adverse events. SPPC implementation by L&D units were supported sing a program toolkit, trainings, and technical assistance. Researchers then evaluated the program using a pre-post, mixed-methods design. Changes in safety and quality were measured using the Modified Adverse Outcome Index (MAOI) and other perinatal care indicators. Findings showed that SPPC had a favorable impact on unit patient safety culture and processes, but mixed short-term impact on maternal and neonatal adverse events.
AHRQ-authored; AHRQ-funded; 2902010000241.
Citation: Kahwati LC, Sorensen AV, Teixeira-Poit S .
Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care.
Jt Comm J Qual Patient Saf 2019 Apr;45(4):231-40. doi: 10.1016/j.jcjq.2018.11.002..
Keywords: Adverse Events, Communication, Comprehensive Unit-based Safety Program (CUSP), Labor and Delivery, Maternal Care, Newborns/Infants, Outcomes, Patient Safety, Pregnancy, Simulation, Surveys on Patient Safety Culture, Teams, TeamSTEPPS, Training, Women
Hefele JG, Santos P, Ritter G
Risk factors for shoulder dystocia: the impact of mother's race and ethnicity.
The purpose of this observational study was to examine shoulder dystocia risk factors by race and ethnicity using a 19,236 sample of pregnant women who presented for labor and delivery. Results found that, for White non-Hispanic mothers, the strongest risk factors were delivering past 40 weeks' gestation and use of epidural anesthesia during delivery. Among Black non-Hispanic mothers, the risk factors with the greatest impact were use of epidural and having gestational diabetes and controlling the condition with insulin. Additionally, among Hispanic mothers, having Spanish as the primary language increased shoulder dystocia likelihood compared to those who did not cite it as their primary language. This study provides evidence that risk factors for a labor and delivery condition can vary significantly across racial and ethnic subgroups.
AHRQ-funded; HS019608.
Citation: Hefele JG, Santos P, Ritter G .
Risk factors for shoulder dystocia: the impact of mother's race and ethnicity.
J Racial Ethn Health Disparities 2018 Apr;5(2):333-41. doi: 10.1007/s40615-017-0374-9..
Keywords: Adverse Events, Labor and Delivery, Injuries and Wounds, Newborns/Infants, Pregnancy, Risk
McArdle J, Sorensen A, Fowler CI
Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care.
The purpose of this study using TeamSTEPPS was to assess the implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units. Results suggested that successful management of shoulder dystocia requires a rapid, standardized, and coordinated response. The Safety Program for Perinatal Care strategies to increase safety of shoulder dystocia management are scalable, replicable, and adaptable to unit needs and circumstances.
AHRQ-funded; 2902010000241.
Citation: McArdle J, Sorensen A, Fowler CI .
Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care.
J Obstet Gynecol Neonatal Nurs 2018 Mar;47(2):191-201. doi: 10.1016/j.jogn.2017.11.014.
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Keywords: Labor and Delivery, Newborns/Infants, Pregnancy, Adverse Events, TeamSTEPPS, Injuries and Wounds, Care Management, Education: Continuing Medical Education, Training, Tools & Toolkits, Patient Safety, Nursing, Communication, Quality of Care
Santos P, Hefele JG, Ritter G
Population-based risk factors for shoulder dystocia.
This retrospective observational study examined population-based risk factors for infant shoulder dystocia during labor. Five hospitals in 5 states were used and over 19,000 births evaluated between April 2011 and July 2013. An increased risk for dystocia was found for women who were prescribed insulin, indicating gestational diabetes. However this was not true of women with gestational diabetes who were not prescribed insulin. Other risk factors included being Black, Hispanic, covered by Medicaid or no insurance, infant gestational age of 41 weeks or greater, and chronic diabetes.
AHRQ-funded; HS019608.
Citation: Santos P, Hefele JG, Ritter G .
Population-based risk factors for shoulder dystocia.
J Obstet Gynecol Neonatal Nurs 2018 Jan;47(1):32-42. doi: 10.1016/j.jogn.2017.11.011..
Keywords: Labor and Delivery, Newborns/Infants, Risk, Pregnancy, Injuries and Wounds, Adverse Events
Phillippi JC, Danhausen K, Alliman J
Neonatal outcomes in the birth center setting: a systematic review.
This systematic review examined the effects of the birth center setting on neonatal mortality in economically developed countries. The criteria for inclusion included being in English, published after 1980 and in countries with similar guidelines to the American Association of Birth Centers Standards. The only measure used was neonatal mortality and results did not find any difference between using a birth center as opposed to a traditional hospital setting. The literature was not found to have many good quality studies, and further research is recommended.
AHRQ-funded; HS024733.
Citation: Phillippi JC, Danhausen K, Alliman J .
Neonatal outcomes in the birth center setting: a systematic review.
J Midwifery Womens Health 2018 Jan;63(1):68-89. doi: 10.1111/jmwh.12701..
Keywords: Evidence-Based Practice, Labor and Delivery, Mortality, Newborns/Infants, Outcomes, Pregnancy, Women
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
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
Burstein PD, Zalenski DM, Edwards JL
Changing labor and delivery practice: focus on achieving practice and documentation standardization with the goal of improving neonatal outcomes.
The researchers established a multifactorial shoulder dystocia response and management protocol to promote sustainable practice change. In the first year, there was a threefold increase in shoulder dystocia reporting, which continued in years 2 and 3. In the first year, 96 percent of clinicians completed all training elements. Overall teams reached a 99 percent adoption rate of the shoulder dystocia protocol.
AHRQ-funded; HS019608.
Citation: Burstein PD, Zalenski DM, Edwards JL .
Changing labor and delivery practice: focus on achieving practice and documentation standardization with the goal of improving neonatal outcomes.
Health Serv Res 2016 Dec;51 Suppl 3:2472-86. doi: 10.1111/1475-6773.12589.
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Keywords: Labor and Delivery, Newborns/Infants, Adverse Events, Quality Improvement, Quality of Care, Patient Safety, Patient-Centered Outcomes Research, Outcomes, Guidelines, Evidence-Based Practice, Pregnancy, Teams
Salemi JL, Pathak EB, Salihu HM
Infant outcomes after elective early-term delivery compared with expectant management.
The purpose of the study was to compare the risk of neonatal morbidity and infant mortality between elective early-term deliveries and those expectantly managed and delivered at 39 weeks of gestation or greater. It concluded that the issues surrounding the timing and reasons for delivery initiation are complicated and each pregnancy unique. Furthermore, it cautions against a general avoidance of all elective early-term deliveries.
AHRQ-funded - HS019997.
Citation: Salemi JL, Pathak EB, Salihu HM .
Infant outcomes after elective early-term delivery compared with expectant management.
Obstet Gynecol 2016 Apr;127(4):657-66. doi: 10.1097/aog.0000000000001331.
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Keywords: Newborns/Infants, Mortality, Pregnancy, Labor and Delivery, Adverse Events
Cheng ER, Park H, Wisk LE
Examining the link between women's exposure to stressful life events prior to conception and infant and toddler health: the role of birth weight.
The authors suggested a pathway may exist among maternal exposure to stressful life events prior to conception (PSLEs), infant birth weight, and subsequent offspring health. Infant and toddler health outcomes were assessed at 9 and 24 months, including overall health status, special healthcare needs, and severe health conditions. The analysis suggested a chains-of-risk model in which women's exposure to PSLEs increased the risk for giving birth to a very low birth weight infant, adversely affecting infant and toddler health.
AHRQ-funded; HS000063; HS00083.
Citation: Cheng ER, Park H, Wisk LE .
Examining the link between women's exposure to stressful life events prior to conception and infant and toddler health: the role of birth weight.
J Epidemiol Community Health 2016 Mar;70(3):245-52. doi: 10.1136/jech-2015-205848.
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Keywords: Maternal Care, Women, Labor and Delivery, Newborns/Infants, Newborns/Infants
Camelo Castillo W, Boggess K, Sturmer T
Association of adverse pregnancy outcomes with glyburide vs insulin in women with gestational diabetes.
The purpose of this study was to estimate the risks of adverse pregnancy outcomes among women receiving glyburide compared with insulin for the treatment of gestational diabetes mellitus (GDM) in a US population-based cohort. It found an association between glyburide (compared with insulin) and elevated risk of NICU admission, neonatal hypoglycemia, respiratory distress, birth injury, and large for gestational age in women with GDM.
AHRQ-funded; HS017950.
Citation: Camelo Castillo W, Boggess K, Sturmer T .
Association of adverse pregnancy outcomes with glyburide vs insulin in women with gestational diabetes.
JAMA Pediatr 2015 May;169(5):452-8. doi: 10.1001/jamapediatrics.2015.74..
Keywords: Adverse Drug Events (ADE), Adverse Events, Comparative Effectiveness, Diabetes, Labor and Delivery, Maternal Care, Medication, Newborns/Infants, Outcomes, Pregnancy, Women
Kastenberg ZJ, Lee HC, Profit J
Effect of deregionalized care on mortality in very low-birth-weight infants with necrotizing enterocolitis.
The study’s aims were to describe the current trend toward deregionalization and to test the hypothesis that infants with necrotizing enterocolitis represent a particularly high-risk subgroup of the VLBW population that would benefit from early identification, increased intensity of early management, and possible targeted triage to tertiary hospitals. It found that outcomes for VLBW infants continue to be suboptimal when they are not born into high-level, high-volume centers.
AHRQ-funded; HS000028.
Citation: Kastenberg ZJ, Lee HC, Profit J .
Effect of deregionalized care on mortality in very low-birth-weight infants with necrotizing enterocolitis.
JAMA Pediatr 2015 Jan;169(1):26-32. doi: 10.1001/jamapediatrics.2014.2085..
Keywords: Newborns/Infants, Labor and Delivery, Mortality, Neonatal Intensive Care Unit (NICU), Healthcare Delivery
Bruckner TA, Rehkopf DH, Catalano RA
Income gains and very low-weight birth among low-income black mothers in California.
The researchers examined pregnant women in California in the 1990s who likely received a lump sum federal tax refund as a result of the Earned Income Tax Credit (EITC) in order to determine the effect, if any, on their infant’s birthweight. Contrary to expectation, the odds of a very low birthweight (VLBW) infant increase above expected values two months immediately following the tax disbursement.
AHRQ-funded; HS0008609.
Citation: Bruckner TA, Rehkopf DH, Catalano RA .
Income gains and very low-weight birth among low-income black mothers in California.
Biodemography Soc Biol 2013;59(2):141-56. doi: 10.1080/19485565.2013.833802..
Keywords: Newborns/Infants, Low-Income, Social Determinants of Health, Labor and Delivery