Evaluation of an adverse outcome index for the quality of obstetric care delivered by multidisciplinary care chains

Over the last few years obstetric professionals in primary, secondary, and tertiary care in the Netherlands have been encouraged by health authorities and insurers to build partnerships, to improve the medical outcomes of perinatal care. To establish the effects of these efforts, functional rather than professional outcome measures are required, covering performance of the entire perinatal care chain. We evaluated the feasibility of the Adverse Outcome Index (AOI), developed by Mann et al [1], to evaluate medical outcomes of three obstetric care chains, including primary, secondary and tertiary caregivers and hospitals, in the Netherlands. We investigated in particular if AOI scores could be calculated based on data currently collected in routine obstetric care. This measure focusses on intrapartum care, where serious adverse events result from insufficient teamwork and communication barriers across obstetric professionals. Theory and Methods: The AOI is defined as the percentage of deliveries with one or more of ten specified adverse events affecting both mother and child. These adverse events are: maternal death, intrapartum or neonatal death >2500g, uterine rupture, maternal ICU admission, return to OR, birth trauma, admission to NICU >2500g, Apgar 26.000 singleton deliveries between 2009 and 2011 under care of practitioners from 18 independent midwifery practices, 3 university hospitals and 1 general hospital. Data were obtained from electronic patient records. Deliveries before the 32th week and of children with severe congenital anomalies were excluded. Two modifications were