CHICAGO – Pregnancy-related deaths and serious maternal complications during and after childbirth continue to rise in the United States, with wide variation across hospitals. New research published in the Online First edition of Anesthesiology, the peer-reviewed medical journal of the American Society of Anesthesiologists (ASA), reports on a new risk-adjusted, composite measure that allows maternal and newborn outcomes to be reported in a single measure. This measure is based on readily available data that are collected by all hospitals and could be used to provide accurate and meaningful feedback on outcomes.
“Childbirth presents a unique challenge to the development of outcome measures because it involves two patients in one episode of care,” said Laurent G. Glance, MD, professor and vice-chair for research in the Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine in New York. “In some cases, clinicians may select treatments that increase the risk of complications to the mother in order to reduce the risk of something going wrong to the newborn, and vice versa. Few other areas of medical or surgical care involve caring for two patients whose outcomes are so interdependent.”
The American College of Obstetricians and Gynecologists (ACOG) and ASA created the Maternal Quality Improvement Program (MQIP) outcomes registry in 2014 to serve as a platform for reporting risk-adjusted outcome metrics and improving the quality of obstetrical care. Because the use of MQIP-compliant electronic medical records among U.S. hospitals is still limited, it is not yet possible to create a national obstetric report card based on clinical data from the electronic medical record. However, this study shows that it is feasible to use widely available administrative and birth certificate data that are collected by all hospitals in the U.S. to measure and report risk-adjusted obstetrical outcomes for all U.S. hospitals.
The study was based on 883,121 obstetric deliveries in 2011 and 2012, using linked administrative and birth certificate data from the California Office of Statewide Health Planning & Development. Researchers studied the most severe maternal and newborn complications. Because hospital maternal outcomes are poorly correlated with hospital newborn outcomes, the study’s authors recommended that childbirth outcomes be reported using a measure that combines maternal and newborn outcomes in addition to separate measures for maternal and newborn outcomes.
“We have created a composite measure of severe maternal complications and severe newborn complications, which can serve as a team-based shared accountability measure for anesthesiologists, obstetricians, pediatricians, and intensivists,” said Dr. Glance. “The measures could be used by clinicians to identify areas of improvement, and help expectant mothers decide where they will deliver their babies. We believe this could be an important step toward reducing the rates of severe complications in mothers and newborns, perhaps reversing the maternal mortality trend in the U.S.”
In an accompanying editorial, Brian T. Bateman, M.D., MSc, associate professor and chief of obstetric anesthesia, The Brigham and Women’s Hospital, Harvard Medical School in Boston, noted this is the “first composite measure that integrates risk-adjusted maternal and neonatal morbidity and mortality,” which may serve as “the foundation of a suite of measurements that women and families could use to select their hospital for delivery, and that government and private payers may use to ensure safety, equity and value.”
THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 53,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.
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