Newly Published
Perioperative Medicine  |   May 2019
Measuring Childbirth Outcomes Using Administrative and Birth Certificate Data
Author Notes
  • From the Departments of Anesthesiology and Perioperative Medicine (L.G.G., E.F., M.A.K., S.G.P., R.N.W., J.F., M.S.G.), Public Health Sciences (L.G.G.), Obstetrics and Gynecology (J.C.G., R.N.W.), and Pediatrics, (T.P.S.), University of Rochester School of Medicine, Rochester, New York; RAND Health, RAND, Boston, Massachusetts (L.G.G., A.W.D.); Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.H.); and American College of Obstetricians and Gynecologists, Washington, D.C. (S.H.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication May 3, 2018. Accepted for publication March 22, 2019.
    Submitted for publication May 3, 2018. Accepted for publication March 22, 2019.×
  • Address correspondence to Dr. Glance: University of Rochester Medical Center, 601 Elmwood Avenue, Box 604, Rochester, New York 14642. Laurent_Glance@urmc.rochester.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Obstetric Anesthesia / Pediatric Anesthesia / Quality Improvement
Perioperative Medicine   |   May 2019
Measuring Childbirth Outcomes Using Administrative and Birth Certificate Data
Anesthesiology Newly Published on May 14, 2019. doi:10.1097/ALN.0000000000002759
Anesthesiology Newly Published on May 14, 2019. doi:10.1097/ALN.0000000000002759
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Maternal complications during and after childbirth demonstrate wide variation across hospitals

  • National reporting systems do not integrate maternal and newborn outcomes when defining hospital obstetric care quality

What This Article Tells Us That Is New:

  • Administrative data can be used to calculate hospital-level risk-adjusted maternal, newborn, and composite maternal-newborn performance

  • Maternal and newborn hospital performance were poorly correlated, suggesting that composite performance measures must also report underlying maternal and newborn performance separately

Background: The number of pregnancy-related deaths and severe maternal complications continues to rise in the United States, and the quality of obstetrical care across U.S. hospitals is uneven. Providing hospitals with performance feedback may help reduce the rates of severe complications in mothers and their newborns. The aim of this study was to develop a risk-adjusted composite measure of severe maternal morbidity and severe newborn morbidity based on administrative and birth certificate data.

Methods: This study was conducted using linked administrative data and birth certificate data from California. Hierarchical logistic regression prediction models for severe maternal morbidity and severe newborn morbidity were developed using 2011 data and validated using 2012 data. The composite metric was calculated using the geometric mean of the risk-standardized rates of severe maternal morbidity and severe newborn morbidity.

Results: The study was based on 883,121 obstetric deliveries in 2011 and 2012. The rates of severe maternal morbidity and severe newborn morbidity were 1.53% and 3.67%, respectively. Both the severe maternal morbidity model and the severe newborn models exhibited acceptable levels of discrimination and calibration. Hospital risk-adjusted rates of severe maternal morbidity were poorly correlated with hospital rates of severe newborn morbidity (intraclass correlation coefficient, 0.016). Hospital rankings based on the composite measure exhibited moderate levels of agreement with hospital rankings based either on the maternal measure or the newborn measure (κ statistic 0.49 and 0.60, respectively.) However, 10% of hospitals classified as average using the composite measure had below-average maternal outcomes, and 20% of hospitals classified as average using the composite measure had below-average newborn outcomes.

Conclusions: Maternal and newborn outcomes should be jointly reported because hospital rates of maternal morbidity and newborn morbidity are poorly correlated. This can be done using a childbirth composite measure alongside separate measures of maternal and newborn outcomes.