Washington DC - Recognizing the importance of quality healthcare for mothers and newborns the National Quality Forum endorsed 17 perinatal standards to measure and thereby improve care received by mothers and babies during the third trimester of pregnancy through hospital discharge. Consensus standards improve quality of care by standardizing measurement in care settings and encouraging accountability and public reporting.
NQF was guided in its endorsement of these perinatal care measures by nearly 300 comments from NQF members and the public.
Pregnancy, childbirth and care for newborns is the most common reason for hospital admission, and childbirth-related procedures account for the five most common procedures in patients aged 18-44. Poor quality care during the third trimester, labor and delivery, and during the post-partum period can translate into unnecessary complications, prolonged hospital stays, and costly intensive care admissions.
"Without appropriate information about hospital performance at a national level, perinatal quality improvement efforts have been unfocused and incentives for improvement limited," said NQF president and CEO Janet Corrigan. "There have been relatively few standardized measures in the field of perinatal care to assess and publicly report on the safety and quality of care. As evidenced by the record-breaking number of comments NQF received during the endorsement process, there was an enormous need for more standardized consensus standards in this area. A more complete set of NQF-endorsed™ perinatal performance measures will provide the necessary tools for a unified national approach to quality improvement for mothers and babies."
The newly NQF-endorsed measures are patient-focused and address care provided by individual clinicians such as nurses, doctors, and midwives, both in hospitals and in free-standing birth centers. The perinatal standards fill gaps in quality measurement and measure care at critical points for the mother and baby from the third trimester through hospital discharge and reflect aspects of care that can be substantially influenced by provider performance. Ultimately, through public reporting and accountability, the measures - birth trauma rate for the mother and baby, and relevant vaccinations for newborns - increase patient safety and decrease serious complications from childbirth.
Laura Riley, MD, medical director for labor and delivery at Massachusetts General Hospital, and Maureen Corry, MPH, executive director of Childbirth Connection, co-chaired NQF's steering committee on perinatal care.
"This is a huge step forward for the medical community and for women as we all strive to improve obstetrical and neonatal care," said Riley. "Meaningful improvements cannot be made until we have a common set of goals which encompass prenatal, intrapartum, postpartum, and early newborn care. Constant assessment of the care measures endorsed by NQF will allow us to address areas of weakness and reallocate resources where needed to provide babies with the best possible start to life."
In NQF's effort to endorse a set of measures for perinatal care that are relevant, feasible, usable, scientifically acceptable, and will drive toward higher performance, several previously endorsed perinatal measures were retired from endorsement.
"The new perinatal care measure set takes a big leap forward for maternity care quality improvement," said Corry. "With more than 4 million births per year in the United States, these measures will impact a large number of mothers and babies and provide consumers and purchasers with essential information to make informed decisions on maternity care quality and value."
In its ongoing work to improve quality in healthcare, NQF will continue to look at measures addressing vaginal birth after cesarean section (VBAC) to add to this set of measures.
How to Appeal
NQF is a voluntary consensus standards-setting organization. Any party may request reconsideration of the recommendations, in whole or in part, by notifying NQF in writing via e-mail no later than November 25 (appeals@qualityforum.org). For an appeal to be considered, the notification e-mail must include information clearly demonstrating that the appellant has interests that are directly and materially affected by the NQF-endorsed recommendations and that the NQF decision has had (or will have) an adverse effect on those interests.
Funding
This work was funded by the Hospital Corporation of America.
MEASURES ENDORSED BY NQF
Please visit our website at www.qualityforum.org to read the full specifications for all new NQF-endorsed voluntary consensus standards and read NQF's research recommendations.
Title | Measure Description | Level of Analysis | IP Owner |
Elective Delivery Prior to 39 Completed Weeks Gestation | All singletons delivered at > 37 completed weeks gestation that are electively delivered prior to 39 completed weeks gestation. | Facility | HCA - St. Marks Perinatal Center |
Incidence of Episiotomy | Number of vaginal deliveries with episiotomy procedures performed. | Facility | Christiana Care Health Services/NPIC |
Cesarean Rate for Low-Risk First Birth Women | Proportion of livebirths born at or beyond 37.0 weeks gestation to women having their first delivery, that are singleton (no twins or beyond) and vertex presentation (no breech or transverse positions) that had a cesarean birth. | Facility, group, integrated system, or community | California Maternal Quality Care Collaborative |
Prophylactic Antibiotic in C-Section | All women undergoing cesarean delivery without evidence of prior infection or already receiving prophylactic antibiotics for other reasons who received prophylactic antibiotics within one hour prior to surgical incision or at the time of delivery. | Facility | Massachusetts General Hospital |
Appropriate DVT Prophylaxis in Women Undergoing Cesarean Delivery | Women undergoing cesarean delivery who receive either fractionated or unfractionated heparin or pneumatic compression devices prior to surgery. | Facility | HCA - St. Marks Perinatal Center |
Birth Trauma Rate measures (harmonized) | Number of infants with specific birth traumas. | Facility | AHRQ/NPIC |
Hepatitis B Vaccine Administration to All Newborns Prior to Discharge | Number of live newborns discharged from the hospital who were administered hepatitis B vaccine prior to discharge. | Facility, clinician, group, or plan | CDC |
Appropriate Use of Antenatal Steroids | Total number of mothers who delivered preterm infants (24-32 weeks with preterm premature rupture of membranes or 24-34 weeks with intact membranes) who received antenatal steroids at any time prior to delivery. | Facility | Providence St. Vincent's Hospital/CWISH |
Infants Under 1500g Delivered at Appropriate Site | The number per 1,000 livebirths over 24 weeks' gestation weighing less than 1500g delivered at hospitals not appropriate for that size infant. | Facility, integrated system, or community | California Maternal Quality Care Collaborative |
Nosocomial Blood Stream Infections in Neonates | Selected bacterial blood stream infections per 1000 qualifying neonates. | Facility | AHRQ |
Birth Dose of Hepatitis B Vaccine and Hepatitis Immune Globulin for Newborns of Mothers with Chronic Hepatitis B | Percentage of neonates born to hepatitis B surface antigen-positive mothers who receive a birth dose of hepatitis B vaccine and hepatitis B immune globulin within 12 hours of birth. | Facility | Asian Liver Center at Stanford University |
Exclusive Breastfeeding at Hospital Discharge | Livebirths not discharged from the NICU who were fed by "breast only" since birth. | Facility, integrated system, or community | California Maternal Quality Care Collaborative |
First Temperature Within One Hour of Admission to NICU | Proportion of infants with weights between 501-1500g whose first temperature was measured within one hour of admission to the NICU. | Facility | Vermont Oxford Network |
First NICU Temperature < 360 C | Proportion of infants with weights between 501-1500g whose first temperature was taken within one hour of admission to NICU whose first temperature was < 360 C | Facility | Vermont Oxford Network |
Retinopathy of Prematurity Screening | Number of infants born at 22 to 29 weeks gestation hospitalized at the postnatal age at which a retinal eye exam is recommended by the AAP who received a retinal exam for retinopathy of prematurity. | Facility | Vermont Oxford Network |
Timely Surfactant Administration to Premature Neonates | Number of infants born at 22 to 29 weeks gestation who were treated with surfactant at any time who received the surfactant within 2 hours of birth. | Facility | Vermont Oxford Network |
Neonatal Immunization | Neonates with a length of stay greater than 60 days who receive DTaP, Hepatitis B, IPV, Hib, and PCV vaccines according to current AAP guidelines. | Facility | Child Health Corporation of America |
The mission of the National Quality Forum is to improve the quality of American healthcare by setting national priorities and goals for performance improvement, endorsing national consensus standards for measuring and publicly reporting on performance, and promoting the attainment of national goals through education and outreach programs. NQF, a non-profit organization (qualityforum.org) with diverse stakeholders across the public and private health sectors, was established in 1999 and is based in Washington, DC.
