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Measuring severe maternal morbidity: validation of potential measures
Elliott K Main1, Anisha Abreo1, Jennifer McNulty2
1California Maternal Quality Care Collaborative, Stanford University, Palo Alto, CA.
American Journal of Obstetrics and Gynecology
|November 20, 2015
Summary
The Centers for Disease Control and Prevention (CDC) criteria for severe maternal morbidity show reasonable accuracy for population-level analysis but require caution for individual hospital assessment due to case-mix variations.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Health Services Research
Background:
- Maternal mortality and severe maternal morbidity rates are increasing in the United States.
- The Centers for Disease Control and Prevention (CDC) developed International Classification of Diseases, 9th revision (ICD-9) criteria for severe maternal morbidity using administrative data.
- Validation of these CDC ICD-9 criteria through chart review is necessary.
Purpose of the Study:
- To validate the CDC ICD-9 criteria for identifying severe maternal morbidity.
- To establish a clinical gold standard for severe maternal morbidity using a modified Delphi technique.
- To examine alternative criteria for severe maternal morbidity detection.
Main Methods:
- Screened 67,468 deliveries across 16 California hospitals for severe maternal morbidity using four criteria: ICD-9 codes, prolonged postpartum length of stay, maternal intensive care unit admission, or blood product administration.
- Reviewed medical records of screen-positive cases against a clinical gold standard established by a modified Delphi technique.
- Performed statistical analyses, including receiver operating characteristic curve and C-statistic.
Main Results:
- The CDC ICD-9 criteria demonstrated a sensitivity of 0.77 and a positive predictive value of 0.44, with a C-statistic of 0.87.
- False positives were often associated with the administration of 1-2 units of blood products.
- Severe maternal morbidity rates varied significantly between hospitals, with lower rates observed in facilities with lower-level neonatal intensive care units.
Conclusions:
- The CDC ICD-9 criteria offer a viable administrative measure for population-level severe maternal morbidity surveillance.
- Application of these criteria for individual hospital assessment requires careful consideration of case-mix effects.
- Further research may refine administrative criteria for more precise individual hospital evaluation.
