Perinatal Care 2008 

Access the final report: National Voluntary Consensus Standards for Perinatal Care 2008. 

The Opportunity 

To date, quality measurement and reporting has focused primarily on common medical conditions such as acute coronary syndrome, pneumonia, and surgical performance, while the focus on maternal-child care has been limited. Morbidity and mortality associated with pregnancy and childbirth remain substantial and, research suggests, are to a large extent preventable through adherence to existing evidence-based guidelines. Because pregnancy/childbirth is the second most common reason for hospital admission, deficiencies in perinatal care affect a large population of vulnerable patients and represent a significant opportunity for quality improvement. However, without appropriate information about hospital performance at a national level, perinatal quality improvement efforts will be unfocused and incentives for improvement limited.

Statistics 

In the United States, pregnancy/child birth is the second most common reason for hospital admission.¹ In 2005, 4.2 million childbirth-related hospital stays were recorded,² and during these stays the 5 most common procedures performed for patients ages 18 through 44 were related to pregnancy and childbirth.³ Birth-related procedures were the most common procedures for infants.⁴ Given the sizeable volume of maternity admissions, deficiencies in perinatal care can affect a large population of vulnerable patients. Morbidity and mortality associated with pregnancy and childbirth are substantial and, evidence suggests, are largely preventable through the delivery of high-quality perinatal care and adherence to evidence-based guidelines. Poor-quality care during the third trimester, labor and delivery, and the postpartum period can translate into unnecessary complications, prolonged lengths of stay, costly neonatal intensive care unit (NICU) admissions, and anxiety and suffering for patients and families. Moreover, numerous studies have documented persistent racial, ethnic, and socioeconomic disparities in maternal morbidity and mortality, preterm births, low birthweight infants, and other adverse outcomes.^5,6,7 

About the Project 

Recognizing the importance of quality healthcare for mothers and newborns, in October 2008  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.

Results  

This report presents 17 consensus standards addressing care received during the last trimester of pregnancy through hospital discharge for both mother and newborn. The consensus standards address care provided by both individual clinicians (i.e., physicians and midwives) and facilities, including both hospitals and freestanding birthing centers. These standards reflect aspects of care—both processes and outcomes—that can be substantially influenced by provider performance. Four of the five measures previously endorsed by NQF have been retired and replaced by this measure set. The purpose of these consensus standards is to improve the quality of maternal-child care—through accountability and public reporting—by standardizing quality measurement in all relevant care settings.

Process 

This project, like all NQF activities, involved the active participation of representatives from across the spectrum of healthcare stakeholders.  The project was guided by a Steering Committee  whose members were nominated by NQF membership and members of the public.  Candidate measures were considered for NQF endorsement as national voluntary consensus standards. Agreement was developed through NQF’s Consensus Development Process (CDP, version 1.8).

Funding 

Funding for this project has been provided by the Hospital Corporation of America (HCA), Inc.

Contact Information 

Reva Winkler, MD, MPH, Program Director, at (202) 783-1300 or email your questions toperinatalcare@qualityforum.org 

Notes 

1 Agency for Healthcare Quality and Research, Healthcare Cost and Utilization Project. HCUP Facts and Figures: Statistics on Hospital-based Care in the United States, 2005, p. 43. Available at www.hcup-us.ahrq.gov/reports/factsandfigures/ HAR_2005.pdf. Last accessed March 2009.

2 Ibid.

3 Ibid., p. 42.

4 Ibid.

5 David RJ, Collins JW Jr, Differing birth weight among infants of U.S.-born blacks, African-born blacks, and U.S.-born whites, N Engl J Med, 1997;337(17):1209-1214.

6 Saftlas AF, Koonin LM, Atrash KH, Racial disparity in pregnancy-related mortality associated with livebirth: can established risk factors explain it? Am J Epidemiol, 2000;152(5):413-419.

7 Luo ZC, Wilkims R, Kramer MS, The fetal and infant health study group of the Canadian Perinatal Surveillance System, disparities in pregnancy outcomes according to marital and cohabitation status,Obstet Gynecol, 2004;103(6):1300-1307.