Obstetric Quality Indicators Need Revamping

The morbidity measures used to evaluate the quality of obstetric care at hospitals are insufficient, suggested researchers who delved into two of the current assessment standards employed by the Joint Commission.

Writing in JAMA, the researchers explained that while they found wide variances in complication rates throughout hospitals in New York City, there was no correlation between the currently used quality assessment standards and maternal and neonatal morbidity rates.

Key Findings

- There is a need for better ways to effectively measure obstetric care at hospitals.

- The current standards used by the Joint Commission do not correlate with complication rates for mothers or babies.

The researchers looked at whether elective deliveries done between 37 weeks and prior to 39 weeks of gestation and cesarean deliveries performed in low-risk nulliparous women were associated with severe maternal or neonatal morbidity in New York City hospitals. The researchers identified cases of severe maternal morbidity and cases of morbidity in newborns without anomalies. They defined the former as delivery associated with a life-threatening complication or performance of a lifesaving procedure, while the latter was defined as births associated with a complication, including birth trauma, hypoxia, and prolonged length of stay.

The study was devised in part because the Joint Commission uses elective deliveries performed prior to 39 weeks' gestation and cesarean deliveries performed in low-risk nulliparous women as two of its quality measures. The researchers did not include the three other indicators-exclusive breastfeeding, antenatal steroid use among premature deliveries, and infections acquired among very low–birth-weight infants-used by the Joint Commission because they focus more exclusively on the outcomes of newborns and not their mothers.

“Our findings suggest that other quality measures should be developed that focus on suboptimal care,” the authors wrote. “Examples include whether hemorrhage and preeclampsia protocols are used in the delivery suite. Given that we did not find a relationship between the quality indicators we examined and maternal or neonatal morbidity, these measures do not adequately capture obstetric hospital quality.”

In assessing the current quality measures, the researchers evaluated deliveries among 41 hospitals in New York City during 2010. The differences in severe maternal morbidity ranged significantly, from 0.9 complications per 100 deliveries to 5.7 complications per 100 deliveries. Neonatal morbidity was even more far-ranging, from 3.1 complications per 100 births to 21.3 complications per 100 births.