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Hospitals should report maternal and newborn outcomes together. A composite measure is useful, but separate tracking is needed due to poor correlation between maternal and newborn complication rates.

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Area of Science:

  • Obstetrics and Gynecology
  • Public Health
  • Health Services Research

Background:

  • Rising rates of pregnancy-related deaths and severe maternal complications in the U.S.
  • Uneven quality of obstetrical care across hospitals
  • Need for performance feedback to reduce maternal and newborn complications.

Purpose of the Study:

  • Develop a risk-adjusted composite measure for severe maternal and newborn morbidity.
  • Utilize administrative and birth certificate data for the measure.
  • Improve hospital performance feedback for better maternal and infant outcomes.

Main Methods:

  • Linked administrative and birth certificate data from California (2011-2012).
  • Developed hierarchical logistic regression models for severe maternal morbidity (SMM) and severe newborn morbidity (SNM).
  • Calculated composite metric using geometric mean of risk-standardized rates.

Main Results:

  • Study included 883,121 deliveries; SMM rate 1.53%, SNM rate 3.67%.
  • Models showed acceptable discrimination and calibration.
  • Hospital SMM and SNM rates poorly correlated (ICC 0.016); composite rankings showed moderate agreement with individual rankings.

Conclusions:

  • Joint reporting of maternal and newborn outcomes is recommended due to poor correlation.
  • A composite childbirth measure should complement separate maternal and newborn outcome measures.
  • Identified potential for misclassification of hospital performance when using composite measures alone.