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The Next Generation of Research
On September 18-19, 2000, the U.S. Department of Health and Human Services (HHS) convened a conference on the next generation of research in maternal health. It focused on issues related to the content, quality, and use of maternal health services.
Participants urged HHS agencies to enhance the maternal health research infrastructure by developing improved data standards and systems.
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In September 2000, the U.S. Department of
Health and Human Services (HHS) convened
a conference to discuss the next generation of
research in maternal health care, with a focus on
issues related to the content, quality, and use of
maternal health care services.
The Office of the
Assistant Secretary for Health and the Agency
for Healthcare Research and Quality (AHRQ) were joined
in this effort by the Health Resources and
Services Administration (HRSA), the National Institute
for Child Health and Human Development (NICHD), and
the Centers for Disease Control and Prevention.
The Centers for Medicare & Medicaid Services (CMS)
The conference participants urged the HHS
agencies to take steps to enhance the maternal
health research infrastructure through
development of improved data standards and
systems. They also called for increased public
investment in a more rigorous assessment of
programs and practices to improve maternal
health and birth outcomes and eliminate racial
and ethnic disparities in maternal health
outcomes. Major recommendations arising from
the conference follow.
Content of Maternal Health Care
Systematically review the science related to
prenatal care interventions to identify and
study those that have not been proven to be
effective and need further study.
Shift the current focus on prenatal care to
encompass a continuum of care starting at
preconception and spanning the spectrum of
women's experiences with reproductive health
services. Move beyond the focus on low
birthweight issues to study maternal,
perinatal, infant, and child mortality and
Quality of Maternal Health Care
- Develop and validate new methods for
measurement of quality in maternal health
care to consider optimal outcomes, impact on
subsequent pregnancies, and less conventional
outcomes such as decreased morbidity and
- Initiate a systematic evaluation of proposed
quality indicators or practice guidelines based
on the specific outcomes expected. Create
mechanisms and tools that promote
adherence to and use of standards.
Disparities in Access, Use, and
Delivery of Services
- Expand research to explore the impact of
prenatal care on diverse populations as
defined by medial, demographic, cultural,
and socioeconomic characteristics, with
analyses to assess each factor independently as
it affects perinatal outcomes.
- Develop methods to identify and assess the
reasons for variations or pockets of adverse
outcomes among women receiving maternal
health care services. Evaluate targeted
interventions to improve health outcomes.
- Examine racial and ethnic disparities in the
advice, content, or quality of care provided by
health professionals and study ways to
enhance cultural sensitivity.
- Test models that address multifaceted
problems and the social determinants of
maternal health, including domestic violence
and substance abuse.
- Examine what influences women's health
knowledge and behaviors, assess the impact of
social marketing strategies, and identify the
types of care preferred by different groups of
Data and Information Needs
Invest in research and demonstration efforts
to develop improved data systems to monitor
care and study the impact of maternal health
services on outcomes of care. Improve vital
records systems, expand use of electronic
recordkeeping, and standardize data elements,
definitions, and measures.
Initiate a perinatal study to gather obstetric
and pediatric information from selected
hospitals across the country. Use managed
care and Medicaid data in States that link
mother-child health records to assess the
usefulness of quality indicators.
Develop prenatal care guidelines for high-risk
and vulnerable populations, and
systematically validate practice guidelines for
internists, family practitioners, and
Translating Research into Practice
Develop stronger interagency communication
and cooperation, and work with the private
sector to develop improved designs for
studies, analyses, and applications.
Promote the concept of a virtual knowledge
base in maternal health, and coordinate and
update best practices by linking information
from the American College of Obstetricians and Gynecologists (ACOG), AHRQ, HRSA, and CMS.
Develop a mechanism for training the next
generation of health services researchers on
maternal health clinical services.
Lastly, the participants recommended that
AHRQ, HRSA, CDC and other agencies
continue to meet annually with private-sector
providers and organizations to exchange
information on developments in the field,
coordinate research plans, and collaborate on
addressing future needs.
Current as of June 2002