Maternity care is the number one cause for hospital admission, yet little is known about what constitutes good care or quality obstetrical services. It is widely recognized that there is a dearth of indicators being used to monitor maternal healthcare quality. Yet, there is a breadth of potential indicators available. Using administrative data, and existing theoretical frameworks, the purpose of this study is to pilot proposed indicators derived from administrative databases for monitoring maternal healthcare quality. We will do this by achieving the following two study aims: 1. Using the existing set of Agency for Healthcare Research and Quality (AHRQ) Quality Indicators-aimed predominantly at the adult non-pregnant population-we will provide a set of indicators (with appropriate case definitions) for quality improvement and tracking of pregnancy and childbirth services and outcomes. 2. Based on previous work by the study team, we will provide theoretical and empirical evidence for an additional 38 potential quality indicators specific to pregnancy and childbirth that have either been established for the adult non-pregnant population (and likely pertinent to the obstetric population), or proposed in the literature, as being specifically relevant for use in the obstetric population based on traditional Donabedian criteria. Potential indicators will be evaluated from two sources: the AHRQ Indicator Sets (Prevention Quality Indicators, Inpatient Quality Indicators, Patient Safety Quality Indicators), and a set of 38 proposed indicators that are specific to pregnancy and childbirth, and amenable to measurement using administrative data, as developed by the Maternal Quality Indicator Working Group (MQI WG), and expanded further by the current study team. Using an administrative dataset from the State of California that links mothers and newborns as a foundation for our analyses, we will evaluate the ability of these indicators to represent the quality of care of maternal healthcare services at the community or hospital level. All of these indicators will be empirically evaluated to examine whether the following requirements criteria of the Public Reporting Evaluation Framework are fulfilled: (a) Importance, (b) Scientific acceptability, (c) Usability, and (d) Feasibility. The net result would be a module of pregnancy related indicators that can be used by researchers, quality improvement experts, clinicians, and hospitals for piloting, benchmarking, and ultimately system-wide improvement in the quality of healthcare provided during pregnancy and childbirth. Our overarching goal is to develop a comprehensive set of quality indicators to monitor maternal healthcare quality using the rigorous framework and existing sets of quality indicators established by AHRQ. In addition, we will review additional candidate indicators-specific to pregnancy and childbirth-previously suggested by researchers or expert opinion leaders. Through this evaluation of potential quality indicators, we will set the stage to identify best practices needed to improve specific pregnancy and childbirth outcomes.

Public Health Relevance

This proposal addresses AHRQ stated priorities to develop and test practical, ready-to-use outcome measures, and to assess the quality of services and treatment approaches to the most common, high cost medical condition in women-pregnancy and childbirth. This proposal for the development of quality indicators for pregnancy and childbirth services will build on existing AHRQ indicators for non-pregnant adults, and provides for a mechanism to develop and immediately pilot additional pregnancy specific indicators using administrative data.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Health Care Quality and Effectiveness Research (HQER)
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Chaves, Karen
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Cedars-Sinai Medical Center
Los Angeles
United States
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El Haj Ibrahim, Samia; Fridman, Moshe; Korst, Lisa M et al. (2014) Anesthesia complications as a childbirth patient safety indicator. Anesth Analg 119:911-7
Korst, Lisa M; Fridman, Moshe; Lu, Michael C et al. (2014) Monitoring childbirth morbidity using hospital discharge data: further development and application of a composite measure. Am J Obstet Gynecol 211:268.e1-268.e16
Gregory, Kimberly D; Korst, Lisa M; Lu, Michael C et al. (2013) AHRQ patient safety indicators: time to include hemorrhage and infection during childbirth. Jt Comm J Qual Patient Saf 39:114-22