Association between hospital-level obstetric quality indicators and maternal and neonatal morbidity.
Association between hospital-level obstetric quality indicators and maternal and neonatal morbidity.
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DOI：
10.1001/jama.2014.13381
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发表时间：
2014-10-15
影响因子：
120.7
通讯作者：
Egorova, Natalia
中科院分区：
文献类型：
--
作者：
Howell, Elizabeth A.;Zeitlin, Jennifer;Hebert, Paul L.;Balbierz, Amy;Egorova, Natalia
为了提高护理质量，目前正在监测和公开报告一些产科专门的质量措施。这些措施在多大程度上与孕产妇和新生儿发病率有关尚不清楚。研究两项联合委员会产科质量指标是否与孕产妇和新生儿发病率相关。基于人群的观察研究，使用2010年纽约市出院和出生证明数据集。确定所有分娩住院情况，并计算两项围产期质量指标。已发表的算法用于确定严重的产妇发病率（分娩时伴有危及生命的并发症或实施挽救生命的手术）和正常足月新生儿的发病率（分娩时伴有分娩创伤、缺氧和住院时间延长等并发症）。混合效应逻辑回归模型用于检验产妇发病率、新生儿发病率和医院质量措施之间的关系，同时对患者社会人口统计学和临床特征进行风险调整。两项联合委员会围产期质量措施：1)妊娠37周和< 39周的选择性（非医学指征）分娩和2)低风险母亲的剖宫产。个人和医院一级的产妇和新生儿发病率。在115,742例分娩中，重度产妇发病率为2.4%，在103,416例正常足月新生儿中，新生儿发病率为7.8%。在41家医院中，在妊娠39周之前进行的选择性分娩的比率从15.5至41.9 / 100不等。在低风险母亲中，每100例分娩中有11.7至39.3例剖腹产。总体产妇发病率为每100例分娩出现并发症的产妇0.9至5.7例，每100例分娩出现并发症的新生儿3.1至21.3例。低危产妇妊娠39周前择期分娩和剖宫产与严重产妇并发症（RR, 1.00; 95% CI: 0.98-1.02， RR, 0.99, 95% CI: 0.96-1.01）或新生儿发病率（RR, 0.99; 95% CI: 0.97-1.01， RR, 1.01, 95% CI: 0.99 - 1.03）无关。纽约市各医院的质量指标、低风险母亲妊娠39周前的选择性分娩和剖宫产率差异很大，产妇和新生儿并发症率也差异很大。然而，质量指标率与孕产妇和新生儿发病率之间没有相关性。目前的质量指标可能不够全面，无法指导提高产科护理的质量。
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. To examine whether 2 Joint Commission obstetric quality indicators are associated with maternal and neonatal morbidity. 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. 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. Individual and hospital level maternal and neonatal morbidity. 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). 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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影响因子：
9.8
作者：
Grobman, William A.;Bailit, Jennifer L.;Van Dorsten, J. Peter
通讯作者：
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