Using Longitudinally Linked Data to Measure Severe Maternal Morbidity.
Using Longitudinally Linked Data to Measure Severe Maternal Morbidity.
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DOI：
10.1097/aog.0000000000004641
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发表时间：
2022-02-01
影响因子：
7.2
通讯作者：
Diop H
中科院分区：
文献类型：
--
作者：
Declercq ER;Cabral HJ;Cui X;Liu CL;Amutah-Onukagha N;Larson E;Meadows A;Diop H
评估标准算法应用于产前和产后（42天）期间的住院是否增加了对重度孕产妇发病率的识别，而不仅仅是对分娩事件的分析。我们使用来自妊娠至早期生活纵向数据库的数据进行了一项回顾性队列研究，该数据库是一个基于马萨诸塞州人口的数据系统，将所有分娩个体的出生证明记录与分娩医院出院记录和非分娩医院记录联系起来。我们纳入了2009年1月1日至2018年12月31日的分娩，区分了ICD-9和ICD-10编码。我们应用了修改后的疾病控制和预防中心（CDC）的算法，用于孕产妇健康创新联盟使用的严重孕产妇发病率，从产前到产后42天的住院治疗。在输血和不输血的情况下均检查了死亡率。总的来说，594，056例分娩被纳入分析，3，947例分娩在未输血的情况下符合重度孕产妇发病率标准，9，593例输血，总发病率为150.1（95%置信区间（CI）：146.7-153.5），使用ICD-9代码; 196.6（95% CI：189.5-203.7），使用ICD-10代码。在ICD-9和ICD-10中，出生时重度孕产妇发病率从2009年使用ICD-9的129.4（95% CI：126.2-132.6）稳步增加到2018年使用ICD-10的214.3/10，000（95% CI：206.9-221.8）。根据ICD-9和ICD-10，加上产前和产后住院的病例增加了21.9%，导致2018年的发病率为258.7/10，000（95%CI：250.5-266.9）。在产前或产后时间段检测到的发病率增加最多的是败血症病例。包括产前和产后住院的严重孕产妇发病率的确定增加了确定的病态事件。这些结果表明，有必要确保监测的护理质量活动超出了出生事件。包括产前和产后住院的严重孕产妇发病率的确定导致21.9%的发病事件的确定增加。
To assess whether application of a standard algorithm to hospitalizations in the prenatal and postpartum (42 days) periods increases identification of severe maternal morbidity beyond analysis of only the delivery event. We performed a retrospective cohort study using data from the Pregnancy to Early Life Longitudinal database, a Massachusetts population-based data system that links records from birth certificates to delivery hospital discharge records and non-birth hospital records for all birthing individuals. We included deliveries from January 1, 2009, to December 31, 2018, distinguishing between ICD-9 and ICD-10 coding. We applied the modified Centers for Disease Control and Prevention (CDC) algorithm for severe maternal morbidity used by the Alliance for Innovation on Maternal Health to hospitalizations across the antenatal period through 42 days postpartum. Morbidity was examined both with and without blood transfusion. Overall, 594,056 deliveries were included in the analysis, and 3,947 deliveries met criteria for severe maternal morbidity at delivery without transfusion and 9,593 with transfusion for aggregate rates of 150.1 (95% confidence interval (CI): 146.7–153.5) using ICD-9 codes and 196.6 (95% CI: 189.5–203.7) using ICD-10 codes per 10,000 deliveries. Severe maternal morbidity at birth increased steadily across both ICD-9 and ICD-10 from 129.4 in 2009 (95% CI: 126.2–132.6) using ICD-9 to 214.3 per 10,000 (95% CI: 206.9–221.8) in 2018 using ICD-10. Adding prenatal and postpartum hospitalizations increased cases by 21.9% under both ICD-9 and ICD-10, resulting in a 2018 rate of 258.7 per 10,000 (95% CI: 250.5–266.9). The largest increase in detected morbidity in the prenatal or postpartum time period was attributed to sepsis cases. Inclusion of prenatal and postpartum hospitalizations in the identification of severe maternal morbidity resulted in increased ascertainment of morbid events. These results suggest a need to ensure surveillance of care quality activities beyond the birth event. Inclusion of prenatal and postpartum hospitalizations in the identification of severe maternal morbidity resulted in a 21.9% increase in ascertainment of morbid events.