Association Between Hospital-level Obstetric Quality Indicators and Maternal and Neonatal Morbidity

Abstract

Importance-In an effort to improve the quality of care, several obstetric-specific quality measures are now monitored and publically reported. The extent to which these measures are associated with maternal and neonatal morbidity is not known.Objective-To examine whether 2 Joint Commission obstetric quality indicators are associated with maternal and neonatal morbidity.Design, Setting, and Participants-Population-based observational study using linked 2010 New York City discharge and birth certificate datasets. All delivery hospitalizations were identified and two perinatal quality measures were calculated. Published algorithms were used to identify severe maternal morbidity (delivery associated with a life threatening complication or performance of a life-saving procedure) and morbidity in non-anomalous term newborns (births The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.Author Contributions: Dr. Egorova had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.• Study concept and design: Howell, Zeitlin, Hebert, Balbierz, and Egorova associated with complications such as birth trauma, hypoxia, and prolonged length of stay). Mixed-effects logistic regression models were used to examine the association between maternal morbidity, neonatal morbidity, and hospital-level quality measures while risk-adjusting for patient sociodemographic and clinical characteristics. Exposure-TwoJoint Commission perinatal quality measures: 1) elective (non-medically indicated) deliveries at >= 37 and < 39 weeks of gestation and 2) cesarean delivery performed in low-risk mothers.Main Outcomes and Measures-Individual and hospital level maternal and neonatal morbidity. Although great progress has been made in reducing obstetric complications, they persist. Severe maternal complications include renal failure and eclampsia or the need for lifesaving interventions such as prolonged mechanical ventilation or transfusions. 1,2 Neonatal complications may occur in low-risk term infants and include hypoxia and shock. 3 Severe maternal morbidity occurs in about 60,000 women (1.6 per 100 deliveries) annually in the US and 1 in 10 term infants experience neonatal complications. 3,4 Variation in complication rates between hospitals exists and suggests that the quality of obstetric care can be improved. 5 Over a third of maternal deaths and severe morbidities, and a significant proportion of neonatal mortality and morbidity may be preventable by changes in patient, clinician, and system factors. 4,[6][7][8][9] As part of its core measure set, the Joint Commission now recommends two perinatal quality measures that address important aspects of obstetric care during childbirth: 1) elective deliveries performed prior to 39 weeks of gestation and 2) cesarean deliveries performed in low-risk nulliparous women. 10 The elective delivery measure, which includes non-medi...

Severe maternal morbidity during delivery hospitalisation in a large international administrative database, 2008–2013: a retrospective cohort

“…Compared with overall SMM rates per country, our rates were higher, most likely reflecting the higher risk patient populations. 6,[27][28][29] Our results are valuable in suggesting possible ways to reduce SMM in the future. We demonstrated that co-morbid medical conditions in our cohort are higher in the USA than England and Australia.…”

Adverse outcomes of childbirth in high-risk maternity hospitals

“…The assessment of AEs from the global point of view through the tracking of indicators in medical records can signal complications or damage that are mostly preventable in childbirth care, but represent great repercussions on the health of women and the newborn. [18][19][20][21] Maternal and neonatal mortality are considered sentinel events and indirect indicators of living conditions and health in a country. 22 As indicators of final outcome, there is a tendency of decreasing growth, but, despite being infrequent, maternal death presents with a high predictive value for the occurrence of damage during care.…”

“…23 The return to the operating room or delivery room represented low specificity, due to the relationship with the reason that led to the return, which could be due to damage within care or specific needs associated with women's clinical conditions. 18,19 Uterine rupture during labor, as an adverse result, is related to the speed, effectiveness and safety of care for women; despite being infrequent, it is associated with high morbidity and mortality, in addition to causing permanent damage to the woman's reproductive life. [21][22][23][24] In the medical records analyzed, uterine rupture was present in 0.4% of the sample, which represented 2 % of adverse results found, an indicator similar to that reported by other authors 24 and acting as a key indicator of poorly conducted hemorrhagic complications.…”

Variation in hospital caesarean section rates and obstetric outcomes among nulliparae at term: a population-based cohort study

“…In contrast, in developed countries, recent high and current variations in CS rates have not been shown to be associated with improvements in maternal or neonatal physical outcomes. [5][6][7][8][9] Internationally, nulliparous women with singleton term cephalic births constitute 35-43% of the overall CS rate. 10 CS rates among these women are deemed potentially modifiable such that the CS rate in this group of women is one of the core maternity quality indicators in the USA.…”