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Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study
William A Grobman1, Jennifer L Bailit2, Madeline Murguia Rice3
1Departments of Obstetrics and Gynecology, Northwestern University, Chicago, IL.
American Journal of Obstetrics and Gynecology
|March 18, 2014
Summary
Hospital variations in adverse obstetric outcomes are not explained by differences in care processes. Most outcome variations stem from patient populations, with care processes failing to account for significant interhospital differences.
Area of Science:
- Obstetrics and Gynecology
- Healthcare Quality Improvement
- Perinatal Health
Background:
- Adverse obstetric outcomes represent a significant concern in maternal and neonatal health.
- Interhospital variations in these outcomes suggest potential differences in care quality or patient populations.
Purpose of the Study:
- To investigate the relationship between hospital-level variations in adverse obstetric outcomes and differences in provided obstetric care.
- To determine the extent to which patient characteristics, hospital factors, and care processes explain outcome disparities among hospitals.
Main Methods:
- Analysis of the Assessment of Perinatal EXcellence (APEX) cohort, including 115,502 women and neonates from 25 US hospitals (March 2008-February 2011).
- Utilized hierarchical logistic regression to assess variation in postpartum hemorrhage, peripartum infection, severe perineal laceration, and composite adverse neonatal outcomes.
- Adjusted for patient, provider, and hospital-level factors to isolate the impact of care processes.
Main Results:
- Patient population differences accounted for 20-40% of interhospital outcome variations.
- While several care processes were associated with adverse outcomes, they did not significantly explain the variation in outcome frequency among hospitals.
- A substantial portion (50-100%) of interhospital variation in adverse obstetric outcomes remained unexplained by the studied factors.
Conclusions:
- Differences in the frequency of specific obstetric care processes do not explain the observed variations in adverse obstetric outcomes among hospitals.
- The majority of interhospital disparities in adverse obstetric outcomes are attributable to factors other than the types of care provided, including patient characteristics.
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