Monitoring childbirth morbidity using hospital discharge data: further development and application of a composite measure

Korst, Lisa M.; Fridman, Moshe; Lu, Michael C.; Mitchell, Connie; Lawton, Elizabeth; Griffin, F.; Gregory, Kimberly D.

doi:10.1016/j.ajog.2014.03.011

Cited by 30 publications

(48 citation statements)

References 31 publications

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“…Our estimate for severe maternal morbidity is higher than the recent national estimate of 1.6% that was derived using similar methods, 4 but is consistent with data from New York City showing significantly higher than average maternal mortality rates, 43 and the rates of neonatal morbidity at term are consistent with previous findings. 3 Further, without medical chart review we were unable to address the recent Joint Commission recommendation to exclude women with specific types of previous uterine surgery (e.g. classical cesarean delivery and myomectomy) from the measure on elective delivery before 39 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Conclusion and Relevance-rates For The Quality Indicators Ementioning

confidence: 99%

“…3,15,16 The list includes ICD-9 code-based categories that capture indicators of death or neonatal complications (e.g., birth trauma, disseminated intravascular coagulation, neonatal intensive care unit (NICU) procedures, renal failure, respiratory conditions, necrotizing enterocolitis, …”

Section: Identifying Neonatal Morbidity At Termmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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

Howell

Zeitlin

Hebert

et al. 2015

Obstetric Anesthesia Digest

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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...

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Section: Discussionmentioning

confidence: 99%

Section: Conclusion and Relevance-rates For The Quality Indicators Ementioning

confidence: 99%

Section: Identifying Neonatal Morbidity At Termmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

Howell

Zeitlin

Hebert

et al. 2015

Obstetric Anesthesia Digest

View full text Add to dashboard Cite

show abstract

“…Furthermore, rates of severe maternal morbidity appear to vary widely across hospitals. 11 This year, in an effort to promote benchmarking and improvement, a call was made for the facility-based identification and reporting of women with severe maternal morbidity. 12,13 This call was further supported in February 2015 by the publication of a consensus-based statement from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine that proposed the development of standards for maternal risk-appropriate care.…”

mentioning

confidence: 99%

Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate care

Korst

Feldman

Bollman³

et al. 2015

American Journal of Obstetrics and Gynecology

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

Howell

Zeitlin

Hebert

et al. 2014

JAMA

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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 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 Two Joint 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. Results Severe maternal morbidity occurred among 2.4% of 115,742 deliveries and neonatal morbidity occurred among 7.8% of 103,416 non-anomalous term newborns. Rates for elective deliveries performed before 39 weeks of gestation ranged from: 15.5 to 41.9 per 100 deliveries among 41 hospitals. There were 11.7 to 39.3 cesareans per 100 deliveries performed in low-risk mothers. Overall maternal morbidity ranged from 0.9 to 5.7 mothers with complications per 100 deliveries and 3.1 to 21.3 neonates with complications per 100 deliveries. The maternal quality indicators elective delivery before 39 weeks of gestation and cesarean delivery performed in low-risk mothers were not associated with severe maternal complications (RR, 1.00; 95% CI: 0.98–1.02 and RR, 0.99, 95% CI: 0.96–1.01, respectively) or neonatal morbidity (RR, 0.99; 95% CI: 0.97–1.01 and RR, 1.01, 95% CI: 0.99–1.03, respectively). Conclusions and Relevance Rates for the quality indicators elective delivery before 39 weeks of gestation and cesarean delivery performed in low risk mothers varied widely in New York City hospitals as did maternal and neonatal complications rates. However, there were no correlations between the quality indicator rates and maternal and neonatal morbidity. Current quality indicators may not be sufficiently comprehensive for guiding quality improvement in obstetric care.

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Monitoring childbirth morbidity using hospital discharge data: further development and application of a composite measure

Cited by 30 publications

References 31 publications

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

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

Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate care

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

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