Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures

Joanne C. Armstrong, Katy B. Kozhimannil, Patricia McDermott, George Saade, Sindhu K. Srinivas

    Research output: Contribution to journalArticle

    22 Citations (Scopus)

    Abstract

    This report describes the development of a measure of low-risk cesarean delivery by the Society for Maternal-Fetal Medicine (SMFM). Safely lowering the cesarean delivery rate is a priority for maternity care clinicians and health care delivery systems. Therefore, hospital quality assurance programs are increasingly tracking cesarean delivery rates among low-risk pregnancies. Two commonly used definitions of "low risk" are available, the Joint Commission (JC) and the Agency for Healthcare Research and Quality (AHRQ) measures, but these measures are not clinically comprehensive. We sought to refine the definition of the low-risk cesarean delivery rate to enhance the validity of the metric for quality measurement. We created this refined definition-called the SMFM definition-and compared it to the JC and AHRQ measures using claims-based data from the 2011 Nationwide Inpatient Sample of >863,000 births in 612 hospitals. Using these definitions, we calculated means and interquartile ranges (25th-75th percentile range) for hospital low-risk cesarean delivery rates, stratified by hospital size, teaching status, urban/rural location, and payer mix. Across all hospitals, the mean low-risk cesarean delivery rate was lowest for the SMFM definition (12.65%), but not substantially different from the JC and AHRQ measures (13.12% and 13.29%, respectively). We empirically examined the SMFM definition to ensure its validity and utility. This refined definition performs similarly to existing measures and has the added advantage of clinical perspective, enhanced face validity, and ease of use.

    Original languageEnglish (US)
    Pages (from-to)153-163
    Number of pages11
    JournalAmerican Journal of Obstetrics and Gynecology
    Volume214
    Issue number2
    DOIs
    StatePublished - Feb 1 2016

    Fingerprint

    Health Services Research
    Joints
    Mothers
    Medicine
    Health Facility Size
    Delivery of Health Care
    Reproducibility of Results
    Inpatients
    Teaching
    Parturition
    Pregnancy

    Keywords

    • cesarean delivery rate variation
    • hospital variation
    • low-risk cesarean delivery rate
    • quality measurement
    • Society for Maternal-Fetal Medicine

    ASJC Scopus subject areas

    • Obstetrics and Gynecology

    Cite this

    Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures. / Armstrong, Joanne C.; Kozhimannil, Katy B.; McDermott, Patricia; Saade, George; Srinivas, Sindhu K.

    In: American Journal of Obstetrics and Gynecology, Vol. 214, No. 2, 01.02.2016, p. 153-163.

    Research output: Contribution to journalArticle

    Armstrong, Joanne C. ; Kozhimannil, Katy B. ; McDermott, Patricia ; Saade, George ; Srinivas, Sindhu K. / Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures. In: American Journal of Obstetrics and Gynecology. 2016 ; Vol. 214, No. 2. pp. 153-163.
    @article{51b17c8020ff4367b9d7a620c74f950a,
    title = "Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures",
    abstract = "This report describes the development of a measure of low-risk cesarean delivery by the Society for Maternal-Fetal Medicine (SMFM). Safely lowering the cesarean delivery rate is a priority for maternity care clinicians and health care delivery systems. Therefore, hospital quality assurance programs are increasingly tracking cesarean delivery rates among low-risk pregnancies. Two commonly used definitions of {"}low risk{"} are available, the Joint Commission (JC) and the Agency for Healthcare Research and Quality (AHRQ) measures, but these measures are not clinically comprehensive. We sought to refine the definition of the low-risk cesarean delivery rate to enhance the validity of the metric for quality measurement. We created this refined definition-called the SMFM definition-and compared it to the JC and AHRQ measures using claims-based data from the 2011 Nationwide Inpatient Sample of >863,000 births in 612 hospitals. Using these definitions, we calculated means and interquartile ranges (25th-75th percentile range) for hospital low-risk cesarean delivery rates, stratified by hospital size, teaching status, urban/rural location, and payer mix. Across all hospitals, the mean low-risk cesarean delivery rate was lowest for the SMFM definition (12.65{\%}), but not substantially different from the JC and AHRQ measures (13.12{\%} and 13.29{\%}, respectively). We empirically examined the SMFM definition to ensure its validity and utility. This refined definition performs similarly to existing measures and has the added advantage of clinical perspective, enhanced face validity, and ease of use.",
    keywords = "cesarean delivery rate variation, hospital variation, low-risk cesarean delivery rate, quality measurement, Society for Maternal-Fetal Medicine",
    author = "Armstrong, {Joanne C.} and Kozhimannil, {Katy B.} and Patricia McDermott and George Saade and Srinivas, {Sindhu K.}",
    year = "2016",
    month = "2",
    day = "1",
    doi = "10.1016/j.ajog.2015.10.935",
    language = "English (US)",
    volume = "214",
    pages = "153--163",
    journal = "American Journal of Obstetrics and Gynecology",
    issn = "0002-9378",
    publisher = "Mosby Inc.",
    number = "2",

    }

    TY - JOUR

    T1 - Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures

    AU - Armstrong, Joanne C.

    AU - Kozhimannil, Katy B.

    AU - McDermott, Patricia

    AU - Saade, George

    AU - Srinivas, Sindhu K.

    PY - 2016/2/1

    Y1 - 2016/2/1

    N2 - This report describes the development of a measure of low-risk cesarean delivery by the Society for Maternal-Fetal Medicine (SMFM). Safely lowering the cesarean delivery rate is a priority for maternity care clinicians and health care delivery systems. Therefore, hospital quality assurance programs are increasingly tracking cesarean delivery rates among low-risk pregnancies. Two commonly used definitions of "low risk" are available, the Joint Commission (JC) and the Agency for Healthcare Research and Quality (AHRQ) measures, but these measures are not clinically comprehensive. We sought to refine the definition of the low-risk cesarean delivery rate to enhance the validity of the metric for quality measurement. We created this refined definition-called the SMFM definition-and compared it to the JC and AHRQ measures using claims-based data from the 2011 Nationwide Inpatient Sample of >863,000 births in 612 hospitals. Using these definitions, we calculated means and interquartile ranges (25th-75th percentile range) for hospital low-risk cesarean delivery rates, stratified by hospital size, teaching status, urban/rural location, and payer mix. Across all hospitals, the mean low-risk cesarean delivery rate was lowest for the SMFM definition (12.65%), but not substantially different from the JC and AHRQ measures (13.12% and 13.29%, respectively). We empirically examined the SMFM definition to ensure its validity and utility. This refined definition performs similarly to existing measures and has the added advantage of clinical perspective, enhanced face validity, and ease of use.

    AB - This report describes the development of a measure of low-risk cesarean delivery by the Society for Maternal-Fetal Medicine (SMFM). Safely lowering the cesarean delivery rate is a priority for maternity care clinicians and health care delivery systems. Therefore, hospital quality assurance programs are increasingly tracking cesarean delivery rates among low-risk pregnancies. Two commonly used definitions of "low risk" are available, the Joint Commission (JC) and the Agency for Healthcare Research and Quality (AHRQ) measures, but these measures are not clinically comprehensive. We sought to refine the definition of the low-risk cesarean delivery rate to enhance the validity of the metric for quality measurement. We created this refined definition-called the SMFM definition-and compared it to the JC and AHRQ measures using claims-based data from the 2011 Nationwide Inpatient Sample of >863,000 births in 612 hospitals. Using these definitions, we calculated means and interquartile ranges (25th-75th percentile range) for hospital low-risk cesarean delivery rates, stratified by hospital size, teaching status, urban/rural location, and payer mix. Across all hospitals, the mean low-risk cesarean delivery rate was lowest for the SMFM definition (12.65%), but not substantially different from the JC and AHRQ measures (13.12% and 13.29%, respectively). We empirically examined the SMFM definition to ensure its validity and utility. This refined definition performs similarly to existing measures and has the added advantage of clinical perspective, enhanced face validity, and ease of use.

    KW - cesarean delivery rate variation

    KW - hospital variation

    KW - low-risk cesarean delivery rate

    KW - quality measurement

    KW - Society for Maternal-Fetal Medicine

    UR - http://www.scopus.com/inward/record.url?scp=84960100860&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=84960100860&partnerID=8YFLogxK

    U2 - 10.1016/j.ajog.2015.10.935

    DO - 10.1016/j.ajog.2015.10.935

    M3 - Article

    C2 - 26593970

    AN - SCOPUS:84960100860

    VL - 214

    SP - 153

    EP - 163

    JO - American Journal of Obstetrics and Gynecology

    JF - American Journal of Obstetrics and Gynecology

    SN - 0002-9378

    IS - 2

    ER -