Measuring the quality of inpatient obstetrical care

Abstract

Obstetric admissions are the leading cause of hospitalization for women in the United States, accounting for over 4 million hospital discharges each year. Measuring the quality of inpatient obstetrical care provided to these women is becoming increasingly important to patients, providers, and insurers. While numerous quality measures have been proposed, there is no agreement as to which measures should be used. An ideal quality measure for inpatient obstetrics would encompass 5 major characteristics: 1) association with meaningful maternal and neonatal outcomes, 2) relation to outcomes that are influenced by physician/health system behaviors, 3) affordability for application on a large scale basis, 4) acceptability to practicing obstetricians as a meaningful marker of quality, and 5) reliability/reproducibility. Traditional quality measurement tools such as maternal mortality, neonatal mortality and cesarean delivery rate are flawed measures. New measurements such as risk-adjusted primary cesarean rates, the nulliparous term singleton vertex cesarean birth (NTSV) rate, and the Adverse Outcomes Index (AOI) are currently being studied but these measures require further validation before widespread adoption.

Target audience: Obstetricians & Gynecologists, Family Physicians

Learning objectives: After completion of this article, the reader should be able to summarize that quality measures of inpatient obstetrical care are numerous, explain that no one agrees on which measures should be used, and state that newer measures, once validated, should be considered.