Measuring the quality of inpatient obstetrical care.
Obstetric admissions are the leading cause of hospitalization for women in the United States, accounting for over 4 million hospital discharges each year. Measuring the quality of inpatient obstetrical care provided to these women is becoming increasingly important to patients, providers, and insurers. While numerous quality measures have been proposed, there is no agreement as to which measures should be used. An ideal quality measure for inpatient obstetrics would encompass 5 major characteristics: 1) association with meaningful maternal and neonatal outcomes, 2) relation to outcomes that are influenced by physician/health system behaviors, 3) affordability for application on a large scale basis, 4) acceptability to practicing obstetricians as a meaningful marker of quality, and 5) reliability/reproducibility. Traditional quality measurement tools such as maternal mortality, neonatal mortality and cesarean delivery rate are flawed measures. New measurements such as risk-adjusted primary cesarean rates, the nulliparous term singleton vertex cesarean birth (NTSV) rate, and the Adverse Outcomes Index (AOI) are currently being studied but these measures require further validation before widespread adoption.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians


OBJECTIVE
After completion of this article, the reader should be able to summarize that quality measures of inpatient obstetrical care are numerous, explain that no one agrees on which measures should be used, and state that newer measures, once validated, should be considered.
Bailit
Jennifer L
JL
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Health Care Research and Policy, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. jbailit@metrohealth.org
D002585:Cesarean Section / Q000009:adverse effects* / Q000639:trends; D005260:Female; D006760:Hospitalization; D006801:Humans; D008428:Maternal Mortality; D009774:Obstetrics / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011256:Pregnancy Outcome; D011787:Quality of Health Care / Q000639:trends; D014481:United States