Establishing a National Maternal Morbidity Outcome Indicator in England: A Population-Based Study Using Routine Hospital Data

Abstract

IntroductionAs maternal deaths become rarer, monitoring near-miss or severe maternal morbidity becomes important as a tool to measure changes in care quality. Many calls have been made to use routinely available hospital administration data to monitor the quality of maternity care. We investigated 1) the feasibility of developing an English Maternal Morbidity Outcome Indicator (EMMOI) by reproducing an Australian indicator using routinely available hospital data, 2) the impact of modifications to the indicator to address potential data quality issues, 3) the reliability of the indicator.MethodsWe used data from 6,389,066 women giving birth in England from April 2003 to March 2013 available in the Hospital Episode Statistics (HES) database of the Health and Social care Information centre (HSCIC). A composite indicator, EMMOI, was generated from the diagnoses and procedure codes. Rates of individual morbid events included in the EMMOI were compared with the rates in the UK reported by population-based studies.ResultsEMMOI included 26 morbid events (17 diagnosis and 9 procedures). Selection of the individual morbid events was guided by the Australian indicator and published literature for conditions associated with maternal morbidity and mortality in the UK, but was mainly driven by the quality of the routine hospital data. Comparing the rates of individual morbid events of the indicator with figures from population-based studies showed that the possibility of false positive and false negative cases cannot be ruled out.ConclusionWhile routine English hospital data can be used to generate a composite indicator to monitor trends in maternal morbidity during childbirth, the quality and reliability of this monitoring indicator depends on the quality of the hospital data, which is currently inadequate.

Trends in sociodemographic and health care factors in Portuguese and non‐Portuguese mothers giving birth in Portugal, 1995‐2014

“…Therefore, more studies are needed to identify composite risk factors of these adverse pregnancy outcomes, as well as the process of collecting these indicators . As a complement to the birth registry‐based perinatal surveillance, routine hospital administration data can be used to generate a composite indicator to monitor trends in maternal morbidity during pregnancy and childbirth, particularly for quality of maternity care …”

A step‐wise approach to developing indicators to compare the performance of maternity units using hospital administrative data

“…In this situation, composite indicators may be appropriate. For example, a composite maternal morbidity indicator has been proposed using Australian routine hospital data …”

“…Another example of evaluating the technical specification of an indicator is a recent study that explored whether a composite maternal morbidity indicator developed using Australian routine data could be derived from HES data . This study found that the quality of the relevant HES data meant that 11 conditions that were included in the Australian indicator would have to be excluded from the English indicator.…”

Mental health near miss indicators in maternity care: a missed opportunity? A commentary

“…Most notably, in 2011 the World Health Organization (WHO) published a near miss framework, predominantly using organ dysfunction indicators . The WHO framework has been used globally as an approach to monitoring obstetric near misses and improving care, but it has been subject to criticism for being complex to implement, particularly in low and middle income counties …”

“…In the UK, two further approaches to monitoring severe maternal morbidity or near miss events have been nationally applied. The English Maternal Morbidity Outcome Indicator (EMMOI) was adapted from an Australian tool and has recently been validated in routine hospital data in England . More recently, the Royal College of Obstetricians and Gynaecologists (RCOG), in partnership with the Royal College of Midwives, the Royal College of Paediatrics and Child Health and the London School of Hygiene and Tropical Medicine, have been commissioned by the Healthcare Quality Improvement Partnership to undertake a new National Maternity and Perinatal Audit, and are developing a national monitoring system including severe morbidity in maternity care…”