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Optimal maternal and neonatal outcomes and associated hospital characteristics
Author(s) -
Campbell Katherine H.,
Illuzzi Jessica L.,
Lee Henry C.,
Lin Haiqun,
Lipkind Heather S.,
Lundsberg Lisbet S.,
Pettker Christian M.,
Xu Xiao
Publication year - 2019
Publication title -
birth
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.233
H-Index - 83
eISSN - 1523-536X
pISSN - 0730-7659
DOI - 10.1111/birt.12400
Subject(s) - medicine , quartile , birth certificate , medical record , pediatrics , emergency medicine , confidence interval , population , environmental health
Background This study aims to examine hospital variation in both maternal and neonatal morbidities and identify institutional characteristics associated with hospital performance in a combined measure of maternal and neonatal outcomes. Methods Using the California Linked Birth File containing data from birth certificate and hospital discharge records, we identified 1 322 713 term births delivered at 248 hospitals during 2010‐2012. For each hospital, a risk‐standardized rate of severe maternal morbidities and a risk‐standardized rate of severe newborn morbidities were calculated after adjusting for patient clinical risk factors. Hospitals were ranked based on combined information on their maternal and newborn morbidity rates. Results Risk‐standardized severe maternal and severe newborn morbidity rates varied substantially across hospitals (10th to 90th percentile range = 67.5‐148.2 and 141.8‐508.0 per 10 000 term births, respectively), although there was no significant association between the two ( P = 0.15). Government hospitals (non‐Federal) were more likely than other hospitals to be in worse rank quartiles ( P value for trend = 0.004), whereas larger volume was associated with better rank among hospitals in the first three quartiles ( P = 0.004). The most prevalent morbidities that differed progressively across hospital rank quartiles were severe hemorrhage, disseminated intravascular coagulation, and heart failure during procedure/surgery for mothers, and severe infection, respiratory complication, and shock/resuscitation for neonates. Conclusions Hospitals with low maternal morbidity rates may not have low neonatal morbidity rates and vice versa, highlighting the importance of assessing joint maternal‐newborn outcomes in order to fully characterize a hospital's obstetrical performance. Hospitals with smaller volume and government ownership tend to have less desirable outcomes and warrant additional attention in future quality improvement efforts.