Validity of a Classification System for the Levels of Maternal Care

To assess the content validity of the classification of maternal level of care of the American Hospital Association Database for research use.

This was a secondary data analysis where we classified the maternal level of care in the 2018 American Hospital Association Database and linked this to birth hospitalizations from five states in the 2016 and 2017 State Inpatient Databases: Delaware, Florida, Kentucky, Maryland, and Washington. We compared maternal level of care classification with birth volume quartiles, hospital size quartiles, and teaching status to predict the birth hospital for women with high OCI (Obstetric Comorbidity Index) scores and hospital-to-hospital transfers. We calculated the odds of birth at the highest-level hospital, controlling for maternal race, rural residence, primary payer, and state.

People with high OCI scores and hospital-to-hospital transfer had increased odds of birth at hospitals classified as maternal level III or IV, large hospitals, and teaching hospitals. The probability of birth at the highest-level hospital for people with high OCI scores was increased 4.9% for a level III or IV hospital, 2.6% for a large hospital, and 1.2% for a teaching hospital. The probability of birth at the highest-level hospital for people with hospital transfer was increased 5.2% for a level III or IV hospital, 1.4% for a large hospital, and 14.4% for a teaching hospital.

Researchers can classify the maternal level of care using the American Hospital Association Database to study maternal risk-appropriate care.