American Journal of Obstetrics & Gynecology
Volume 200, Issue 6 , Pages 681.e1-681.e7, June 2009

Global measures of quality- and patient safety-related childbirth outcomes: should we monitor adverse or ideal rates?

Presented at the 75th Annual Meeting of the Pacific Coast Obstetrical and Gynecological Society, Victoria, BC, Canada, Oct. 15-19, 2008.

  • Kimberly D. Gregory, MD, MPH

      Affiliations

    • Department Obstetrics and Gynecology, Burns Allen Research Institute, Cedars Sinai Medical Center, Los Angeles, CA
    • Department of Obstetrics and Gynecology, David Geffen School of Medicine, and the Department of Community Health Sciences, University of California, Los Angeles, School of Public Health, Los Angeles, CA
    • ,
  • Moshe Fridman, PhD

      Affiliations

    • AMF Consulting, Los Angeles, CA
    • ,
  • Sonal Shah, MPH

      Affiliations

    • Department Obstetrics and Gynecology, Burns Allen Research Institute, Cedars Sinai Medical Center, Los Angeles, CA
    • ,
  • Lisa M. Korst, MD, PhD

      Affiliations

    • Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Received 15 August 2008; received in revised form 31 December 2008; accepted 26 February 2009.

Objective

The objective of the study was to propose a new measure of ideal childbirth outcome, based on the proportion of women delivering without maternal or newborn childbirth morbidity.

Study Design

Using the 2002 California discharge dataset, we calculated rates of childbirth complications among women with singleton, term deliveries, stratified by pregnancy risk status, method of delivery, and parity. An ideal delivery (ID) was defined as a delivery without any complications. The distribution of hospital-level ID rates was calculated for laboring women stratified by parity.

Results

Among 382,276 women, the ID rate was 78.5%. Rates, type, and severity of complications varied by risk group (high vs low risk), parity, delivery method, and across hospitals. Complications in childbirth were not rare; approximately 22% of deliveries had at least 1 complication. Women who delivered vaginally and multiparous women were more likely to have an ideal delivery.

Conclusion

The ID rate is a simple hospital-level measure of childbirth outcome that is easy to calculate and interpret.

Key words: labor complications, maternal morbidity and mortality, patient safety, quality of care

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 Cite this article as: Gregory KD, Fridman M, Shah S, et al. Global measures of quality- and patient safety-related childbirth outcomes: should we monitor adverse or ideal rates? Am J Obstet Gynecol 2009;200:681.e1-681.e7.

 Reprints not available from the authors.

PII: S0002-9378(09)00224-5

doi:10.1016/j.ajog.2009.02.033

American Journal of Obstetrics & Gynecology
Volume 200, Issue 6 , Pages 681.e1-681.e7, June 2009

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