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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Initial development of a system-wide maternal-fetal outcomes assessment program
W M Novicoff1, D P Wagner, W A Knaus
1Departments of Health Evaluation Science, University of Virginia School of Medicine, Charlottesville 22908, USA.
American Journal of Obstetrics and Gynecology
|August 15, 2000
Summary
Developed risk-adjustment models accurately assessed maternal and infant outcomes in a large health system. These models can identify variations in care quality and improve practices for better conception-to-delivery processes.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Health Services Research
Background:
- Assessing maternal and fetal outcomes is crucial for quality improvement in healthcare systems.
- Existing risk-adjustment models may not fully capture the complexities of perinatal care.
- Standardized approaches are needed to evaluate performance across diverse healthcare facilities.
Purpose of the Study:
- To develop and validate comprehensive risk-adjustment models for maternal and fetal outcomes.
- To evaluate the performance of these models across multiple military treatment facilities.
- To identify variations in risk-adjusted outcomes that could indicate areas for practice improvement.
Main Methods:
- Utilized data from 10,984 women and 11,066 infants from 79 US military treatment facilities (1995-1997).
- Developed two complementary risk-adjustment models for maternal and fetal outcomes using ordinal logistic regression.
- Determined model performance using receiver operating characteristic (ROC) curves and evaluated facility-specific risk-adjusted outcomes.
Main Results:
- Both maternal and infant outcomes were generally good, with low mortality rates (0.7% and 0.01% respectively).
- The developed models demonstrated satisfactory discriminatory power (ROC 0.75 for maternal, 0.78 for infant outcomes).
- Significant variations in risk-adjusted outcomes were observed across facilities, with 30% showing statistically significant differences.
Conclusions:
- Complementary risk models for maternal and infant outcomes were successfully developed with good discriminatory power.
- This approach shows promise for detecting variations in risk-adjusted performance to identify best practices.
- The models can aid in coordinating and improving the quality of care throughout the conception-to-delivery continuum.
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