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The Opportunity
In 2009, there were more than 4.1 million births in the US1 and conditions related to pregnancy, childbirth, and live born infants were the most frequent reasons for hospitalization, accounting for nearly one in four discharges in 2008.2 Pregnancy- and childbirth-related procedures accounted for all five of the most common procedures for individuals ages 18-44.3 Cesarean section was the most frequent major operating room procedure—performed on 1.4 million women in 2008.4 Maternal and neonatal stays were responsible for the greatest portion of Medicaid hospitalization costs (27 percent) and 14 percent of private payer costs.5
Deaths during pregnancy and childbirth have doubled for all U.S. women in the past 20 years.6 Figures compiled by the Centers for Disease Control and Prevention show that black women are nearly four times more likely to die from pregnancy-related causes than white women.7 In the U.S. in 2006, the infant mortality rate due to maternal complications of pregnancy was 39.3 per 100,000 live births; this accounted for 5.9 percent of all infant death in the U.S. in 2006.8
Research suggests that morbidity and mortality associated with pregnancy and childbirth are to a large extent preventable through adherence to existing evidence-based guidelines. Lower quality care during pregnancy, 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.9 However, without appropriate information about hospital performance at a national level, perinatal quality improvement efforts will be unfocused and incentives for improvement limited.
As of July 8, 2011, NQF has endorsed 33 consensus standards applicable to perinatal and reproductive health in a number of previous projects, including Hospital Care-Initial Performance Set 2003; National Voluntary Consensus Standards for Ambulatory Care; National Voluntary Consensus Standards for Emergency Care; National Voluntary Consensus Standards for Ambulatory Care Using Clinically Enriched Administrative Data; and Patient Outcomes: Child Health. The NQF project focused on healthcare disparities will provide important guidance to this project.
List of previously endorsed perinatal and reproductive health measures:
Table of Measures (PDF)
About the Project
The 90-day Call for Measures for this project will open in July 2011.
Objectives
This project seeks to identify and endorse additional measures for public reporting and quality improvement that specifically address:
- reproductive health;
- pregnancy;
- childbirth and post-partum care; and
- newborn care.
As part of this endorsement maintenance project, NQF will solicit measures applicable to any healthcare setting and utilize any data sources. Measures that are harmonized across settings (e.g., hospitals and outpatient facilities) are preferred. NQF is particularly seeking composite and outcome measures and measures that are sensitive to the needs of vulnerable populations, including racial/ethnic minorities and Medicaid populations. Additionally, as part of this process, perinatal and reproductive health-related consensus standards that were endorsed by NQF before June 2009 will be evaluated under the maintenance process. Endorsement maintenance provides the opportunity to harmonize specifications and to ensure that an endorsed measure represents the best in class. Evaluating all NQF-endorsed® perinatal and reproductive health measures and considering new measures will ensure the currency of NQF's portfolio of voluntary consensus standards.
NQF Process
The candidate measures will be considered for NQF endorsement as voluntary consensus standards. Agreement around the recommendations will be developed through NQF’s formal Consensus Development Process (CDP). This project will involve the active participation of representatives from across the spectrum of healthcare stakeholders and will be guided by a multiple-stakeholder Steering Committee.
Funding
This project is supported under a contract provided by the Department of Health and Human Services.
Related NQF Work
National Voluntary Consensus Standards for Perinatal Care 2008
Contact Information
For further information, contact Reva Winkler, MD, or Suzanne Theberge, MPH, at 202-783-1300 or via email at perinatal@qualityforum.org.
Notes
1 Health and Human Services (DHHS), Centers for Disease Control and Prevention (CDC), National Vital Statistics System, Birth Data. Atlanta, GA:CDC, 2011. Available at www.cdc.gov/nchs/births.htm. Last accessed July 2011.
2 Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project HCUP Facts and Figures 2008 – Section 2. Rockville, MD:AHRQ, 2011. Available at www.hcup-us.ahrq.gov/reports/factsandfigures/2008/section2_TOC.jsp. Last accessed July 2011.
3 AHRQ, Healthcare Cost and Utilization Project, HCUP Facts and Figures, 2006, Statistics on Hospital-based Care in the United States. Rockville, MD:AHRQ, 2011. Available at www.hcup-us.ahrq.gov/reports/factsandfigures/facts_figures_2006.jsp. Last accessed July 2011.
4 AHRQ, Healthcare Cost and Utilization Project, HCUP Facts and Figures 2008 – Section 2:Inpatient Hospital Stays by Procedure. Rockville, MD:AHRQ, 2011. Available at www.hcup-us.ahrq.gov/reports/factsandfigures/2008/section3_TOC.jsp. Last accessed July 2011.
5 AHRQ, Healthcare Cost and Utilization Project, HCUP Facts and Figures Statistics on Hospital-Based Care in the United States, 2008. Rockville, MD:AHRQ, 2010. Available at www.hcup-us.ahrq.gov/reports/factsandfigures/2008/exhibit4_5.jsp. Last accessed July 2011.
6 Smith S. CNN Health, Doubling of maternal deaths in U.S. ‘scandelous,’ rights groups says. Atlanta, GA:CNN, March 12, 2010. Available at http://articles.cnn.com/2010-03-12/health/maternal.mortality_1_maternal-deaths-deaths-and-complications-pregnancy?_s=PM:HEALTH. Last accessed July 2011.
7 Amnesty International, Deadly Delivery: The Maternal Health Care Crisis in the USA. London, U.K.:Amnesty International, 2010. Available at http://www.amnestyusa.org/sites/default/files/pdfs/deadlydelivery.pdf. Last accessed July 2011.
Heron M, Hoyert DL, Murphy SL et al, Deaths: Final Data for 2006, Natl Vital Stat Rep, 2009;57(14):116, Table 34. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf. Last accessed July 2011.
8 March of Dimes, Peristats, United States, Infant Mortality, White Plains, NY: March of Dimes, 2011. Available at http://www.marchofdimes.com/peristats/level1.aspx?reg=99&top=6&stop=113&lev=1&slev=1&obj=1. Last accessed July 2011.
9 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.
Saftlas AF, Koonin LM, Atrash HK, Racial disparity in pregnancy-related mortality associated with livebirth: can established risk factors explain it? Am J Epidemiol, 2000;152(5):413-419.
Luo ZC, Wilkins 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.
