Assessing quality obstetrical care: development of standardized measures.
BACKGROUND
No nationally accepted set of quality indicators exists in obstetrics. A set of 10 outcome measures and three quality improvement tools was developed as part of a study evaluating the effects of teamwork on obstetric care in 15 institutions and > 28,000 patients. Each outcome was assigned a severity weighting score.


METHODS
Three new obstetrical quality improvement outcome tools were developed. The Adverse Outcome Index (AOI) is the percent of deliveries with one or more adverse events. The average AOI during the pre-implementation data collection period of the teamwork study was 9.2% (range, 5.9%-16.6%). The Weighted Adverse Outcome Score (WAOS) describes the adverse event score per delivery. It is the sum of the points assigned to cases with adverse outcomes divided by the number of deliveries. The average WAOS for the preimplementation period was 3 points (range, 1.0-6.0). The Severity Index (SI) describes the severity of the outcomes. It is the sum of the adverse outcome scores divided by the number of deliveries with an identified adverse outcome. The average SI for the pre-implementation period was 31 points (range, 16-49).


CONCLUSIONS
The outcome measures and the AOI, WAOS, and SI can be used to benchmark ongoing care within and among organizations. These tools may be useful nationally for determining quality obstetric care.
Mann
Susan
S
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, USA. smann@bidmc.harvard.edu
Pratt
Stephen
S
Gluck
Paul
P
Nielsen
Peter
P
Risser
Daniel
D
Greenberg
Penny
P
Marcus
Ronald
R
Goldman
Marlene
M
Shapiro
David
D
Pearlman
Mark
M
Sachs
Benjamin
B
D036861:Delivery, Obstetric / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D009774:Obstetrics / Q000592:standards* / Q000706:statistics & numerical data; D009775:Obstetrics and Gynecology Department, Hospital / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D011247:Pregnancy; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States