Hospital rates of maternal and neonatal infection in a low-risk population.
BACKGROUND
In 2003, the Agency for Healthcare Quality and Research (AHRQ) published its Quality Indicators for healthcare, and set out methodological criteria for the evaluation of potential candidates.


OBJECTIVE
Because perinatal infections may result from poor obstetrical practices, we intended to describe the variability of maternal and congenital neonatal infections across different types of hospital ownership (e.g., not for profit, government), and to assess whether rates of these infections meet criteria as quality indicators.


METHODS
Population-based cohort study.


METHODS
All laboring women without maternal, fetal, or placental complications who delivered in California in 1997, and their neonates, as reported through hospital discharge data.


METHODS
A Bayesian hierarchical logistic regression model was used to quantify the effects of both "patient-level" risk factors such as parity and prior cesarean history, and "hospital-level" risk factors such as ownership and teaching status.


RESULTS
The 308,841 mother-newborn pairs in this low-risk study population delivered at 281 hospitals; 0.39% had uterine infections and 1.3% had neonatal infections. Hospital ownership and teaching status were strongly associated with perinatal infection. Secondly, methods used to estimate and analyze hospital-specific infection rates identified hospitals with exceptionally high rates. Twenty-eight hospitals had neonatal infection rates that ranged from 3% to 28%.


CONCLUSIONS
The methods presented here were consistent with AHRQ methods and criteria for potential Quality Indicators. They also identified hospitals with exceptionally high rates of infectious morbidity. The relationship between hospital ownership and obstetrical practice patterns, and the feasibility of practice improvement, remain to be studied.
Korst
Lisa M
LM
Saban Research Institute of Childrens Hospital Los Angeles, University of Southern California, Southern California, USA. korst@usc.edu
Fridman
Moshe
M
Friedlich
Philippe S
PS
Lu
Michael C
MC
Reyes
Carolina
C
Hobel
Calvin J
CJ
Chavez
Gilberto F
GF
Gregory
Kimberly D
KD
D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008429:Maternal Welfare; D009775:Obstetrics and Gynecology Department, Hospital; D011787:Quality of Health Care; D018570:Risk Assessment