Transactions of the Twenty-Sixth Annual Meeting of the Society for Maternal-Fetal Medicine
Are the Agency for Healthcare Research and Quality obstetric trauma indicators valid measures of hospital safety?

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Objective

The objective of the study was to examine whether the United States Agency for Health Care Research and Quality obstetric patient safety indicators are significantly affected by patient-specific and hospital-level characteristics not related to the safety environment.

Study design

Administrative data for all nonfederal Illinois hospitals in 2001 were used to analyze the association of a hospital's obstetric trauma rates with patient and hospital-level factors. Multivariable random effects logistic regression analyses was used to account for hospital-level clustering.

Results

A total of 175,374 deliveries from 142 Illinois hospitals were available for analysis. The frequency of obstetric trauma was significantly associated with multiple patient-specific and hospital-level factors. Specifically, for any vaginal delivery, premature delivery, multiple gestation, excessive fetal growth, and prolonged pregnancy was associated with obstetric trauma risk. For spontaneous delivery, a prior cesarean was associated with trauma risk as well. Maternal age was associated with trauma risk at cesarean as well as at vaginal delivery. With regard to hospital-level factors, a higher annual delivery volume and a higher cesarean rate were associated with increased risk of trauma with either type of vaginal delivery, whereas in the intensity with which hospitals coded their medical records was associated with trauma risk for all routes of delivery.

Conclusion

The risk of obstetric trauma is significantly influenced by both patient and hospital characteristics and is not a good indicator of patient safety.

Section snippets

Data source and calculation of PSI rates

Using the Illinois Department of Public Health's hospital administrative database (UB92 format) from 2001, we identified, using diagnosis-related groups (DRGs) 370-375, all deliveries that occurred in nonfederal Illinois hospitals with more than 50 deliveries. Federal hospitals are not in the Illinois database, and we desired to analyze hospitals with an obstetric volume high enough to provide meaningful data. Published AHRQ ICD-9 coding criteria were then used to calculate hospital-specific

Results

During the year 2001, 175,374 deliveries from 142 Illinois hospitals met inclusion criteria and were available for analysis. The Figure illustrates the distribution of the obstetric trauma rates across the 142 hospitals. The mean PSI rates for the statewide sample were 203 per 1000 instrument-assisted vaginal deliveries (PSI 27), 52 per 1000 spontaneous vaginal deliveries (PSI 28), and 5 per 1000 cesarean deliveries (PSI 29). These rates are similar to the reported 2002 national rates of 237

Comment

In response to quality-of-care issues within the health care system, providers of health care have sought to establish benchmark measures to track and decrease rates of adverse events. One type of widely disseminated measure is the PSI developed by AHRQ, which potentially can be used to compare the frequency of complications over time within a hospital as well as cross-sectionally among hospitals. For obstetrical care, the PSI for maternal morbidity has been chosen to be obstetrical trauma, as

Acknowledgment

These data were presented as an abstract at the 26th annual meeting of the Society for Maternal-Fetal Medicine, 2006.

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    Supported by an Excellence in Academic Medicine grant from the state of Illinois.

    Presented at the 26th Annual Meeting of the Society for Maternal-Fetal Medicine, January 30 through February 4, 2006, Miami, FL.

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