A Framework for the Development of maternal quality of care indicators.
BACKGROUND
In collaboration with the California Department of Health Maternal and Child Health Branch, the authors formed a Working Group to identify potential clinical indicators that could be used to inform decision making regarding maternal health care quality.


OBJECTIVE
To develop potential indicators for the assessment of maternal health care quality.


METHODS
A Working Group was convened to review information from the published literature and expert opinion. Selection of potential indicators was guided by the following goals: 1) To identify key areas for routine aggregate monitoring; 2) To include perspectives of relevant stakeholders in maternal health care services; 3) To include measures that are comprehensive and reflect a balance between maternal and fetal interests; and 4) To develop measures that would be valid, generalizable, mutable, and feasible.


RESULTS
Ninety potential indicators were identified. Each underwent a thorough review based on: its definition, objective, and validity; its contribution to innovation; the cost and timeliness of implementation; its feasibility, acceptability, and potential effectiveness; and its compatibility with ethics, values, and social policy. This process yielded 24 final indicators from the following categories: Health Status and Access (e.g., availability of 24 h inpatient anesthesia); Preconception and Interconception Care (e.g., Pap smear use); Antenatal Care (e.g., hospitalization for uncontrolled diabetes or pyelonephritis); Labor and Delivery Care (e.g., chorioamnionitis or obstetrical hemorrhage), and Postpartum Care (e.g., rate of postpartum visits).


CONCLUSIONS
These potential indicators, representative of the women's health continuum, can serve as a foundation to structure the development of consensus and methods for maternal health care quality assessment.
Korst
Lisa M
LM
Saban Research Institute of Childrens Hospital Los Angeles, Los Angeles, 90033, USA. korst@usc.edu
Gregory
Kimberly D
KD
Lu
Michael C
MC
Reyes
Carolina
C
Hobel
Calvin J
CJ
Chavez
Gilberto F
GF
D002140:California; D003299:Cooperative Behavior; D005260:Female; D006126:Group Processes; D006801:Humans; D008430:Maternal-Child Health Centers / Q000592:standards*; D011247:Pregnancy; D019984:Quality Indicators, Health Care