Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Apr 7;11(4):e0153370.
doi: 10.1371/journal.pone.0153370. eCollection 2016.

Establishing a National Maternal Morbidity Outcome Indicator in England: A Population-Based Study Using Routine Hospital Data

Manisha Nair  1 , Jennnifer J Kurinczuk  1 , Marian Knight  1
Affiliations

Establishing a National Maternal Morbidity Outcome Indicator in England: A Population-Based Study Using Routine Hospital Data

Manisha Nair et al. PLoS One. .

Abstract

Introduction: As maternal deaths become rarer, monitoring near-miss or severe maternal morbidity becomes important as a tool to measure changes in care quality. Many calls have been made to use routinely available hospital administration data to monitor the quality of maternity care. We investigated 1) the feasibility of developing an English Maternal Morbidity Outcome Indicator (EMMOI) by reproducing an Australian indicator using routinely available hospital data, 2) the impact of modifications to the indicator to address potential data quality issues, 3) the reliability of the indicator.

Methods: We used data from 6,389,066 women giving birth in England from April 2003 to March 2013 available in the Hospital Episode Statistics (HES) database of the Health and Social care Information centre (HSCIC). A composite indicator, EMMOI, was generated from the diagnoses and procedure codes. Rates of individual morbid events included in the EMMOI were compared with the rates in the UK reported by population-based studies.

Results: EMMOI included 26 morbid events (17 diagnosis and 9 procedures). Selection of the individual morbid events was guided by the Australian indicator and published literature for conditions associated with maternal morbidity and mortality in the UK, but was mainly driven by the quality of the routine hospital data. Comparing the rates of individual morbid events of the indicator with figures from population-based studies showed that the possibility of false positive and false negative cases cannot be ruled out.

Conclusion: While routine English hospital data can be used to generate a composite indicator to monitor trends in maternal morbidity during childbirth, the quality and reliability of this monitoring indicator depends on the quality of the hospital data, which is currently inadequate.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Comparison of the estimated rates of transfusion of blood and blood products and postpartum haemorrhage among women giving birth in England from 2003 to 2013; Hospital Episode Statistics data England.
Fig 2
Fig 2. Comparison of the estimated rates of uterine rupture and repair of ruptured or inverted uterus among women giving birth in England from 2003 to 2013; Hospital Episode Statistics data England.
Fig 3
Fig 3. Trends in maternal morbidity outcomes during childbirth in England from 2003–04 to 2012–13 using the EMMOI; Hospital Episode Statistics data England.
Fig 4
Fig 4. Annual rate per 10,000 women of the individual morbid events/ diagnoses included in the EMMOI (2003 to 2013); Hospital Episode Statistics data England.
Fig 5
Fig 5. Annual rate per 10,000 women of the individual procedures included in the EMMOI (2003 to 2013); Hospital Episode Statistics data England.
See this image and copyright information in PMC

References

    1. Hollowel J, Puddicombe D, Rowe R, Linsell L, Hardy P, Stewart M, et al. (2011) The Birthplace national prospective cohort study: perinatal and maternal outcomes by planned place of birth. Birthplace in England research programme. Final report part 4. NIHR Service Delivery and Organisation programme.
    1. Lim SS, Dandona L, Hoisington JA, James SL, Hogan MC, Gakidou E (2010) India's Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation. The Lancet 375: 2009–2023. - PubMed
    1. Paul BK, Rumsey DJ (2002) Utilization of health facilities and trained birth attendants for childbirth in rural Bangladesh: an empirical study. Social science & medicine 54: 1755–1765. - PubMed
    1. Mpembeni RN, Killewo JZ, Leshabari MT, Massawe SN, Jahn A, Mushi D, et al. (2007) Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: implications for achievement of MDG-5 targets. BMC pregnancy and childbirth 7: 29 - PMC - PubMed
    1. Randive B, Diwan V, De Costa A (2013) India’s Conditional Cash Transfer Programme (the JSY) to Promote Institutional Birth: Is There an Association between Institutional Birth Proportion and Maternal Mortality? PLoS ONE 8: e67452 - PMC - PubMed

Publication types