Advertisement

Performance of racial and ethnic minority-serving hospitals on delivery-related indicators

      Objective

      We sought to explore how racial/ethnic minority-serving hospitals perform on 15 delivery-related indicators, and examine whether indicators vary by race/ethnicity within the same type of hospitals.

      Study Design

      We used 2008 through 2011 linked State Inpatient Database and American Hospital Association data from 7 states, and designated hospitals with >50% of deliveries to non-Hispanic white, non-Hispanic black, and Hispanic women as white-, black-, and Hispanic-serving, respectively. We calculated indicator rates per 1000 deliveries by hospital type and, separately, for non-Hispanic white, non-Hispanic black, and Hispanic women within each hospital type. We fitted multivariate Poisson regression models to examine associations between delivery-related indicators and patient and hospital characteristics by hospital type.

      Results

      White-serving hospitals offer obstetric care to an older and wealthier population than black- or Hispanic-serving hospitals. Rates of the most prevalent indicators examined (complicated vaginal delivery, complicated cesarean delivery, obstetric trauma) were lowest in Hispanic-serving hospitals. Generally, indicator rates were similar in Hispanic- and white-serving hospitals. Black-serving hospitals performed worse than other hospitals on 12 of 15 indicators. Indicator rates varied greatly by race/ethnicity in white- and Hispanic-serving hospitals, with non-Hispanic blacks having 1.19-3.27 and 1.15-2.68 times higher rates than non-Hispanic whites, respectively, for 11 of 15 indicators. Conversely, there were few indicator rate differences by race/ethnicity in black-serving hospitals, suggesting an overall lower performance of these hospitals compared to white- and Hispanic-serving hospitals.

      Conclusion

      We found considerable differences in delivery-related indicators by hospital type and patients’ race/ethnicity. Obstetric care quality measures are needed to track racial/ethnic disparities at the facility and population levels.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. James CV, Salganico A, Thomas M, Ranji U, Lillie-Blanton M, Wyn R. Putting women’s health care disparities on the map: examining racial and ethnic disparities at the state level. Available at: http://www.kff.org/minorityhealth/upload/7886.pdf. Accessed March 30, 2014.

        • Shen J.J.
        • Tymkow C.
        • MacMullen N.
        Disparities in maternal outcomes among four ethnic populations.
        Ethn Dis. 2005; 15: 492-497
        • Cabacungan E.T.
        • Ngui E.M.
        • McGinley E.L.
        Racial/ethnic disparities in maternal morbidities: a statewide study of labor and delivery hospitalizations in Wisconsin.
        Matern Child Health J. 2012; 16: 1455-1467
        • Bryant A.S.
        • Worjoloh A.
        • Caughey A.B.
        • Washington A.E.
        Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants.
        Am J Obstet Gynecol. 2010; 202: 335-343
        • Creanga A.A.
        • Berg C.J.
        • Syverson C.
        • Seed K.
        • Bruce F.C.
        • Callaghan W.M.
        Race, ethnicity, and nativity differentials in pregnancy-related mortality in the United States: 1993-2006.
        Obstet Gynecol. 2012; 120: 261-268
      2. US Census Bureau. Income, poverty, and health insurance coverage in the United States: 2007. Current population reports: 2009. Available at: http://www.census.gov/prod/2008pubs/p60-235.pdf. Accessed March 30, 2014.

      3. National Center for Health Statistics. Health, United States, 2009: with special feature on medical technology. Hyattsville, MD. Available at: http://www.cdc.gov/nchs/data/hus/hus09.pdf. Accessed March 30, 2014.

        • Kogan M.D.
        • Kotelchuck M.
        • Alexander G.R.
        • Johnson W.E.
        Racial disparities in reported prenatal care advice from health care providers.
        Am J Public Health. 1994; 84: 82-88
        • Paul D.A.
        • Locke R.
        • Zook K.
        • Leef K.H.
        • Stefano J.L.
        • Colmorgen G.
        Racial differences in prenatal care of mothers delivering very low birth weight infants.
        J Perinatol. 2006; 26: 74-78
      4. Agency for Healthcare Research and Quality. National healthcare disparities report, 2011. US Department of Health and Human Services, Washington, DC: US Department of Health and Human Services. Available at: http://www.ahrq.gov/research/findings/nhqrdr/nhdr11/nhdr11.pdf. Accessed March 30, 2014.

        • Ly D.P.
        • Lopez L.
        • Isaac T.
        • Jha A.K.
        How do black-serving hospitals perform on patient safety indicators? Implications for national public reporting and pay-for-performance.
        Med Care. 2010; 48: 1133-1137
      5. Agency for Healthcare Research and Quality. Overview of the State Inpatient Databases. Available at: http://www.hcup-us.ahrq.gov/sidoverview.jsp. Accessed March 30, 2014.

      6. The American Hospital Association. American Hospital Association Data and Directories. Available at: http://www.aha.org/research/rc/stat-studies/data-and-directories.shtml. Accessed March 30, 2014.

        • Kuklina E.V.
        • Whiteman M.K.
        • Hillis S.D.
        • et al.
        An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity.
        Matern Child Health J. 2008; 12: 469-477
      7. Agency for Healthcare Research and Quality. Quality indicator development. Available at: http://www.qualityindicators.ahrq.gov/Modules/Default.aspx. Accessed March 30, 2014.

      8. National Quality Measures Clearinghouse. Australian Council on Healthcare Standards: obstetrics. Available at: http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?orgid=1984&term=obstetrics. Accessed March 30, 2014.

      9. California Maternal Quality Care Collaborative. Maternity quality measures. Available at: http://www.cmqcc.org/maternity_quality_measures. Accessed March 30, 2014.

      10. Centers for Medicare and Medicaid Services. Adult health care quality measures. Available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Adult-Health-Care-Quality-Measures.html. Accessed March 30, 2014.

      11. Healthy People. 2020 Topics and objectives: maternal, infant, and child health. Available at: http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=26. Accessed March 30, 2014.

      12. Institute for Healthcare Improvement. The IHI improvement map. Available at: http://www.ihi.org/offerings/Initiatives/Improvemaphospitals/Pages/default.aspx. Accessed March 30, 2014.

      13. March of Dimes. PeriStats. Available at: https://www.marchofdimes.com/peristats/calculations.aspx?reg=&top=&id=6. Accessed March 30, 2014.

      14. National Quality Forum. Measures, clinical condition/topic area: perinatal and reproductive health. Available at: http://www.qualityforum.org/Qps/QpsTool.aspx. Accessed March 30, 2014.

      15. The Joint Commission. Specifications manual for Joint Commission national quality measures (v2013B): perinatal care. Available at: https://manual.jointcommission.org/releases/TJC2013B/PerinatalCare.html. Accessed March 30, 2014.

      16. The Leapfrog Group. The Leapfrog hospital survey reference book: normal deliveries measures references. p. 113-22. Available at: https://leapfroghospitalsurvey.org/wp-content/uploads/2012/03/2012SurveyReference.pdf. Accessed March 30, 2014.

      17. United Nations, World Health Organization. Indicators for monitoring the millennium development goals, goal 5: improve maternal health. Available at: http://mdgs.un.org/unsd/mi/wiki/MainPage.ashx. Accessed March 30, 2014.

        • Callaghan W.M.
        • Creanga A.A.
        • Kuklina E.V.
        Severe maternal morbidity among delivery and postpartum hospitalizations in the United States.
        Obstet Gynecol. 2012; 120: 1029-1036
        • Creanga A.A.
        • Bateman B.T.
        • Kuklina E.V.
        • Callaghan W.M.
        Racial and ethnic disparities in severe maternal morbidity: a multistate analysis, 2008-2010.
        Am J Obstet Gynecol. 2014; 210: 435.e1-435.e8
        • Acevedo-Garcia D.
        • Soobader M.J.
        • Berkman L.F.
        Low birthweight among US Hispanic/Latino subgroups: the effect of maternal foreign-born status and education.
        Soc Sci Med. 2007; 65: 2503-2516
        • Centers for Disease Control and Prevention
        Use of hospital discharge data to monitor uterine rupture–Massachusetts, 1990-1997.
        MMWR Morb Mortal Wkly Rep. 2000; 49: 245-248
        • Howell E.A.
        • Zeitlin J.
        • Hebert P.
        • Balbierz A.
        • Egorova N.
        Paradoxical trends and racial differences in obstetric quality and neonatal and maternal mortality.
        Obstet Gynecol. 2013; 121: 1201-1208
      18. Centers for Disease Control and Prevention. Pregnancy-related mortality surveillance. Available at: http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PMSS.html. Accessed March 30, 2014.