Mount Sinai Study Results Argue for Expanded Obstetric Quality of Care Measures

Newswise — (NEW YORK – Oct. 15) Rates of birth complications for mothers and newborns varied substantially between hospitals and were not correlated with performance measures designed to assess quality of obstetric care, according to a study in the October 15 issue of the Journal of the American Medical Association (JAMA). The research, led by Elizabeth Howell, MD, MPP, Associate Professor in the Department of Population Health Science and Policy, and Associate Professor of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, analyzed data on more than 100,000 deliveries and term newborns from New York City hospitals, including related complications for both mothers or newborns Severe maternal complications occur in about 60,000 women – or 1.6 per 100 deliveries – annually in the United States; in addition, about ten percent of term low-risk term infants experience neonatal complications. In an effort to improve the quality of care, several obstetric-specific quality measures are now monitored and publicly reported. Dr. Howell and her team at Mount Sinai sought to ascertain the extent to which two of these measures track with actual maternal and neonatal complications.

In terms of quality measures, Dr. Howell and her colleagues reviewed how closely two Joint Commission obstetric quality indicators -- elective, non-medically indicated deliveries performed at 37 weeks or more of gestation and prior to 39 weeks, and cesarean deliveries performed in low-risk women -- were associated with severe maternal or neonatal complications. The data came from New York City discharge and birth certificate data sets from 2010.

“Expectant mothers want a safe and high quality medical environment for childbirth and quality indicators can inform women and families about the quality of obstetric care in hospitals,” said Dr. Howell. “The two measures we examined were not associated with severe maternal and neonatal complications. Our findings highlight the need for an expanded set of obstetric quality measures.” Mount Sinai researchers found that severe maternal complications (deliveries associated with a life-threatening complication or performance of a lifesaving procedure) occurred among 2,372 of 115,742 deliveries (2.4 percent), and that neonatal complications (births associated with complications such as birth trauma, hypoxia, and prolonged length of stay) occurred among 8,057 of 103,416 term newborns without birth defects, or 7.8 percent. Rates for elective deliveries performed before 39 weeks of gestation ranged from 15.5 to 41.9 per 100 deliveries among 41 hospitals. There were 11.7 to 39.3 cesarean deliveries per 100 deliveries performed in low-risk mothers. Severe maternal complication rates varied 4- to 5-fold between hospitals, and there was a 7-fold variation in neonatal complications at term between hospitals. The maternal quality indicators of elective delivery before 39 weeks of gestation and cesarean delivery performed in low-risk mothers were not associated with severe maternal or neonatal complications. About the Mount Sinai Health System
The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven member hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services—from community-based facilities to tertiary and quaternary care. The System includes approximately 6,600 primary and specialty care physicians, 12-minority-owned free-standing ambulatory surgery centers, over 45 ambulatory practices throughout the five boroughs of New York City, Westchester, and Long Island, as well as 31 affiliated community health centers. Physicians are affiliated with the Icahn School of Medicine at Mount Sinai, which is ranked among the top 20 medical schools both in National Institutes of Health funding and by U.S. News & World Report.

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