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Severe maternal morbidity and related hospital quality measures in Maryland
Lawrence D Reid1, Andreea A Creanga2,3
1Office of Maternal and Child Health Epidemiology, Maryland Department of Health, Baltimore, MD, USA. lawrence.reid@maryland.gov.
Objective:
To determine hospital characteristics and quality metrics associated with severe maternal morbidity (SMM) in Maryland.
Study Design:
A population-based observational study of 364,113 statewide delivery hospitalizations during 2010-2015 linked with socio-economic community measures and hospital characteristics and quality measures. Multivariable logistic regression models with generalized estimating equations estimated SMM adjusting for individual, community, and hospital-level factors and clustering within hospitals and residence zip codes.
Results:
The SMM prevalence was 197 per 10,000 deliveries. Adjusted SMM risk ratios were higher for younger (<20 years), older (35+ years), non-White non-Hispanic, unmarried, multiple substance users, women with multiple gestations, and chronic medical and mental health conditions than their counterparts. Communities with greater socio-economic disadvantage and hospitals with poorer patient experience and clinical care quality had higher rates of SMM.
Conclusion:
Addressing socio-economic disparities and improving quality of care in delivery hospitals are key to reducing the SMM burden in Maryland.
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