Observational Study

. 2014 Aug;211(2):147.e1-147.e16.

doi: 10.1016/j.ajog.2014.03.017. Epub 2014 Mar 12.

Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study

William A Grobman¹, Jennifer L Bailit², Madeline Murguia Rice³, Ronald J Wapner⁴, Michael W Varner⁵, John M Thorp Jr⁶, Kenneth J Leveno⁷, Steve N Caritis⁸, Jay D Iams⁹, Alan T Tita¹⁰, George Saade¹¹, Yoram Sorokin¹², Dwight J Rouse¹³, Jorge E Tolosa¹⁴, J Peter Van Dorsten¹⁵; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

Collaborators, Affiliations

Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network:
G Mallett, M Ramos-Brinson, A Roy, L Stein, P Campbell, C Collins, N Jackson, M Dinsmoor, J Senka, K Paychek, A Peaceman, B Mercer, C Milluzzi, W Dalton, T Dotson, P McDonald, C Brezine, A McGrail, M Talucci, M Zylfijaj, Z Reid, R Leed, J Benson, S Forester, C Kitto, S Davis, M Falk, C Perez, K Hill, A Sowles, J Postma, S Alexander, G Andersen, V Scott, V Morby, K Jolley, J Miller, B Berg, K Dorman, J Mitchell, E Kaluta, K Clark, K Spicer, S Timlin, K Wilson, L Moseley, M Santillan, J Price, K Buentipo, V Bludau, T Thomas, L Fay, C Melton, J Kingsbery, R Benezue, H Simhan, M Bickus, D Fischer, T Kamon, D DeAngelis, C Latimer, L Guzzo, F Johnson, L Gerwig, S Fyffe, D Loux, S Frantz, D Cline, S Wylie, P Shubert, M Wallace, A Northen, J Grant, C Colquitt, J Moss, A Salazar, A Acosta, G Hankins, N Hauff, L Palmer, P Lockhart, D Driscoll, L Wynn, C Sudz, D Dengate, C Girard, S Field, P Breault, F Smith, N Annunziata, D Allard, J Silva, M Gamage, J Hunt, J Tillinghast, Corcoran N, M Jimenez, S Blackwell, F Ortiz, P Givens, B Rech, C Moran, M Hutchinson, Z Spears, C Carreno, B Heaps, G Zamora, J Seguin, M Rincon, J Snyder, C Farrar, E Lairson, C Bonino, W Smith, S Van Dyke, S Butcher, E Thom, Y Zhao, P McGee, V Momirova, R Palugod, B Reamer, M Larsen, C Spong, S Tolivaisa

Affiliations

¹ Departments of Obstetrics and Gynecology, Northwestern University, Chicago, IL. Electronic address: w-grobman@northwestern.edu.
² Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH.
³ George Washington University Biostatistics Center, Washington, DC; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
⁴ College of Physicians and Surgeons, Columbia University, New York, NY.
⁵ University of Utah Health Sciences Center, Salt Lake City, UT.
⁶ University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, NC.
⁷ University of Texas Southwestern Medical Center, Dallas, TX.
⁸ University of Pittsburgh School of Medicine, Pittsburgh, PA.
⁹ The Ohio State University School of Medicine, Columbus, OH.
¹⁰ University of Alabama at Birmingham School of Medicine, Birmingham, AL.
¹¹ University of Texas Medical Branch, Galveston, TX.
¹² Wayne State University School of Medicine, Detroit, MI.
¹³ Alpert Medical School, Brown University, Providence, RI.
¹⁴ Oregon Health & Science University, Portland, OR.
¹⁵ Medical University of South Carolina, Charleston, SC.

PMID: 24631441
PMCID: PMC4117924
DOI: 10.1016/j.ajog.2014.03.017

Observational Study

Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study

William A Grobman et al. Am J Obstet Gynecol. 2014 Aug.

. 2014 Aug;211(2):147.e1-147.e16.

doi: 10.1016/j.ajog.2014.03.017. Epub 2014 Mar 12.

Authors

Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network:
G Mallett, M Ramos-Brinson, A Roy, L Stein, P Campbell, C Collins, N Jackson, M Dinsmoor, J Senka, K Paychek, A Peaceman, B Mercer, C Milluzzi, W Dalton, T Dotson, P McDonald, C Brezine, A McGrail, M Talucci, M Zylfijaj, Z Reid, R Leed, J Benson, S Forester, C Kitto, S Davis, M Falk, C Perez, K Hill, A Sowles, J Postma, S Alexander, G Andersen, V Scott, V Morby, K Jolley, J Miller, B Berg, K Dorman, J Mitchell, E Kaluta, K Clark, K Spicer, S Timlin, K Wilson, L Moseley, M Santillan, J Price, K Buentipo, V Bludau, T Thomas, L Fay, C Melton, J Kingsbery, R Benezue, H Simhan, M Bickus, D Fischer, T Kamon, D DeAngelis, C Latimer, L Guzzo, F Johnson, L Gerwig, S Fyffe, D Loux, S Frantz, D Cline, S Wylie, P Shubert, M Wallace, A Northen, J Grant, C Colquitt, J Moss, A Salazar, A Acosta, G Hankins, N Hauff, L Palmer, P Lockhart, D Driscoll, L Wynn, C Sudz, D Dengate, C Girard, S Field, P Breault, F Smith, N Annunziata, D Allard, J Silva, M Gamage, J Hunt, J Tillinghast, Corcoran N, M Jimenez, S Blackwell, F Ortiz, P Givens, B Rech, C Moran, M Hutchinson, Z Spears, C Carreno, B Heaps, G Zamora, J Seguin, M Rincon, J Snyder, C Farrar, E Lairson, C Bonino, W Smith, S Van Dyke, S Butcher, E Thom, Y Zhao, P McGee, V Momirova, R Palugod, B Reamer, M Larsen, C Spong, S Tolivaisa

Affiliations

¹ Departments of Obstetrics and Gynecology, Northwestern University, Chicago, IL. Electronic address: w-grobman@northwestern.edu.
² Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH.
³ George Washington University Biostatistics Center, Washington, DC; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
⁴ College of Physicians and Surgeons, Columbia University, New York, NY.
⁵ University of Utah Health Sciences Center, Salt Lake City, UT.
⁶ University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, NC.
⁷ University of Texas Southwestern Medical Center, Dallas, TX.
⁸ University of Pittsburgh School of Medicine, Pittsburgh, PA.
⁹ The Ohio State University School of Medicine, Columbus, OH.
¹⁰ University of Alabama at Birmingham School of Medicine, Birmingham, AL.
¹¹ University of Texas Medical Branch, Galveston, TX.
¹² Wayne State University School of Medicine, Detroit, MI.
¹³ Alpert Medical School, Brown University, Providence, RI.
¹⁴ Oregon Health & Science University, Portland, OR.
¹⁵ Medical University of South Carolina, Charleston, SC.

PMID: 24631441
PMCID: PMC4117924
DOI: 10.1016/j.ajog.2014.03.017

Abstract

Objective: The purpose of this study was to determine whether hospital differences in the frequency of adverse obstetric outcomes are related to differences in care.

Study design: The Assessment of Perinatal EXcellence cohort comprises 115,502 women and their neonates who were born in 25 hospitals in the United States between March 2008 and February 2011. Hierarchical logistic regression was used to quantify the amount of variation in postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite adverse neonatal outcome among hospitals that is explained by differences in patient characteristics, hospital characteristics, and obstetric care provided.

Results: The study included 115,502 women. For most outcomes, 20-40% of hospital differences in outcomes were related to differences in patient populations. After adjusting for patient-, provider-, and hospital-level factors, multiple care processes were associated with the predefined adverse outcomes; however, these care processes did not explain significant variation in the frequency of adverse outcomes among hospitals. Ultimately, 50-100% of the interhospital variation in outcomes was unexplained.

Conclusion: Hospital differences in the frequency of adverse obstetric outcomes could not be explained by differences in frequency of types of care provided.

Keywords: obstetrics; quality care; quality measures.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: The authors have no disclosures

Comment in

Quality in obstetrics: the search continues.
Pettker CM. Pettker CM. Am J Obstet Gynecol. 2014 Aug;211(2):85-6. doi: 10.1016/j.ajog.2014.04.019. Am J Obstet Gynecol. 2014. PMID: 25077457 No abstract available.

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1. Pronovost PJ, Thompson DA, Holzmueller CG, Lubomski LH, Morlock LL. Defining and measuring patient safety. Crit Care Clin. 2005;21:1–19. - PubMed
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Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study

Collaborators

Affiliations

Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Miscellaneous