Examining Trends in Obstetric Quality Measures for Monitoring Health Care Disparities

Bibliographic Data

ID9102518
AuthorsT Janevic (0000-0002-9934-4406, Institute of Population and Public Health, corresponding author), Natalia Egorova (0000-0002-9244-2900, Institute of Population and Public Health, corresponding author), Natalia N Egorova (Population Health Science and Policy), Jennifer Zeitlin (0000-0002-9568-2969, Population Health Science and Policy, corresponding author), Amy Balbierz (Population Health Science and Policy, corresponding author), Paul L Hebert (0000-0002-5886-7964, University of Washington School of Public Health, Seattle, WA), Evan A Howell (0009-0008-0048-411X, Institute of Population and Public Health, corresponding author), Elizabeth A Howell (Population Health Science and Policy)
Year2018
Volume56
Issue6
Pages470-476
Publication date2018-06-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000919
PMID29668651
OpenAlexW2800908969
LanguageEN
Citations received1
References cited34

BACKGROUND: Elective delivery (ED) before 39 weeks, low-risk cesarean delivery, and episiotomy are routinely reported obstetric quality measures and have been the focus of quality improvement initiatives over the past decade. OBJECTIVE: To estimate trends and differences in obstetric quality measures by race/ethnicity. RESEARCH DESIGN: We used 2008-2014 linked birth certificate-hospital discharge data from New York City to measure ED before 39 gestational weeks (ED <39), low-risk cesarean, and episiotomy by race/ethnicity. Measures were following the Joint Commission and National Quality Forum specifications. Average annual percent change (AAPC) was estimated using Poisson regression for each measure by race/ethnicity. Risk differences (RD) for non-Hispanic black women, Hispanic women, and Asian women compared with non-Hispanic white women were calculated. RESULTS: ED<39 decreased among whites [AAPC=-2.7; 95% confidence interval (CI), -3.7 to -1.7), while it increased among blacks (AAPC=1.3; 95% CI, 0.1-2.6) and Hispanics (AAPC=2.4; 95% CI, 1.4-3.4). Low-risk cesarean decreased among whites (AAPC=-2.8; 95% CI, -4.6 to -1.0), and episiotomy decreased among all groups. In 2008, white women had higher risk of most measures, but by 2014 incidence of ED<39 was increased among Hispanics (RD=2/100 deliveries; 95% CI, 2-4) and low-risk cesarean was increased among blacks (RD=3/100; 95% CI, 0.5-6), compared with whites. Incidence of episiotomy was lower among blacks and Hispanics than whites, and higher among Asian women throughout the study period. CONCLUSIONS: Existing measures do not adequately assess health care disparities due to modest risk differences; nonetheless, continued monitoring of trends is warranted to detect possible emergent disparities

Birth certificate · Childbirth · Confidence interval · Environmental health · Episiotomy · Ethnic group · Incidence (geometry) · Obstetrics · Poisson regression · Population · Pregnancy · Demography · Hospital Admissions and Outcomes · Maternal and fetal healthcare · Maternal and Perinatal Health Interventions · Medicine

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