This project seeks to identify and endorse performance measures for accountability and quality improvement that specifically address conditions, treatments, interventions, or procedures relating to reproductive health, pregnancy planning and contraception, pregnancy, childbirth, and post-partum and neonatal care. As part of this project, twenty-four (24) NQF-endorsed measures that are due for maintenance of endorsement review will be re-evaluated against the most recent NQF measure evaluation criteria. Specific conditions and topics addressed by these endorsed measures include: cesarean section rates, early elective deliveries, maternal and newborn infection rates, access to prenatal and postpartum care, screening measures, and breastfeeding measures.
Despite the fact that the US spends more on perinatal healthcare than any other health
sector ($111 billion in 2010)1 the US is ranked 61st in the world for maternal health2.
In 2014, there were nearly 4 million births in the United States3 and more than half of all hospital stays were
a result of premature birth, low birth weight, or inadequate fetal growth4. Pregnancy- and childbirth-related procedures accounted for
four out of the five most common procedures for individuals ages 18-44 in 20115. The two most common conditions
billed to Medicaid as the primary payer in 2010 were pregnancy and childbirth (24%) and newborns (23%), which together comprised 47% of discharges billed to
Medicaid6. For the 61 million women of reproductive age in the US access to high-quality care before and between pregnancies, including pregnancy planning, contraception and preconception care, can reduce the risk of pregnancy-related complications, including maternal and infant mortality.7
Disparities in access to quality reproductive and perinatal care and in outcomes among
different racial and ethnic groups in the US, as well as sociodemographic
disparities, are major topics of interest for quality measurement.8 Deaths during pregnancy and childbirth have doubled for all US women in the
past 20 years. 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 women9. Moreover, numerous studies have documented persistent racial, ethnic, and socioeconomic disparities in maternal morbidity and mortality, preterm births, low birthweight infants, access to contraception and reproductive healthcare, and
other adverse outcomes.
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. However, without appropriate
information about performance at a national level, perinatal quality
improvement efforts will be unfocused and incentives for improvement
About the Project
Perinatal and Reproductive Healthcare project launched on October 16, 2015. 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 with similar measures 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.
Endorsement maintenance provides the opportunity to harmonize specifications as
multi-stakeholder Standing Committee will be established to evaluate newly
submitted measures and make recommendations for which measures should be
endorsed as consensus standards. This Committee will work to identify and
endorse new performance measures for accountability and quality improvement
that specifically address conditions, treatments, interventions,
or procedures relating to perinatal and reproductive healthcare. Additionally, the Committee will
evaluate consensus standards previously endorsed by NQF under the maintenance
seeks to identify and endorse additional measures for public reporting and
quality improvement that specifically address:
planning and contraception;
- post-partum and
Measures will be considered for NQF endorsement as
national voluntary consensus standards. Consensus on the recommendations
developed through NQF’s formal Consensus Development
Process (CDP, Version 1.9). This project involves the active
participation of representatives from across the spectrum of healthcare stakeholders
and will be guided by a Standing Committee.
This project is supported under a contract provided by the Department of Health and Human Services.
For information about the
availability of auxiliary aids and services for NQF’s federally funded
projects, please visit: http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html.
Related NQF Work
For further information, contact Nadine Allen at 202-783-1300 or via email at firstname.lastname@example.org.
- National Partnership for Women & Families. United States Maternity Care Facts and Figures Website.
Available at http://transform.childbirthconnection.org/resources/datacenter/factsandfigures/. Last accessed October 2015.
- Save the Children. State of the World’s Mothers 2015 Report: The Urban Disadvantage. Available at
http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/SOWM_2015.PDF. Last accessed October 2015.
- Hamilton BE, Martin JA, Osterman MJK, Curtin SC. Births: Preliminary data for 2014. National
vital statistics reports. Hyattsville, MD: National Center for Health
Statistics 2015; 64(6). Available at http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_06.pdf Last
accessed October 2015
- Pfuntner A, Wier LM , Stocks C . Most Frequent Conditions in U.S. Hospitals, 2010. HCUP Statistical Brief #148. Rockville, MD: Agency for Healthcare Research and Quality 2013. Available at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb148.pdf Last accessed October 2015
- Pfuntner A, Wier LM , Stocks C . Most Frequent Procedures Performed in U.S. Hospitals, 2011. HCUP Statistical Brief #165. Rockville, MD: Agency for Healthcare Research and Quality 2013.Available at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb165.pdf. Last accessed October 2015
- National Partnership for Women & Families. United States Maternity Care Facts and Figures Website. Available at http://transform.childbirthconnection.org/resources/datacenter/factsandfigures/ Last accessed October 2015
- Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry (ATSDR). Recommendations to improve preconception health and health care—United States: A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. Atlanta: CDC; 2006. 23 p. (MMWR Recomm Rep. 2006;55[RR-06]).
- Dehlendorf C, Rodriguez MI, Levy
K, Borrero S, Steinauer J. Disparities in family planning. AJOG 202(3):214-220. March 2010. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835625/. Last accessed October 2015
- CDC. Pregancy Mortality Surveillance System Website. Available at http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html. Last
accessed October 2015.