In search of perinatal quality outcome measures: 1 hospital's in-depth analysis of the Adverse Outcomes Index.
OBJECTIVE
The purpose of this study was to assess the Adverse Outcome Index perinatal quality indicator system that was derived from administrative data.


METHODS
Adverse events were identified for 10 component measures; the Adverse Outcome Index was calculated by the National Perinatal Information Center from 42 months of administrative data. After retrospective chart review, we estimated positive predictive value for 10 measures that were obtained by corrected calculations of Adverse Outcome Index.


RESULTS
Positive predictive values were 86-100% in 7 indicators, with lower values in 3 indicators: neonatal death, 0/2 fetuses; inborn birth trauma, 22/33 infants (67%); and maternal return to the operating room, 16/33 women (48.5%). In term admission to the neonatal intensive care unit, 107 false negatives were identified, with a negative predictive value of 45%.


CONCLUSIONS
Indicator positive predictive value was variable. Performance can be strengthened by methods to identify both false-positive and false-negative adverse events that would include chart review and some measure specification revisions to improve alignment with original indicator intent. Interhospital comparison application requires further study.
Walker
Suzan
S
Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
Strandjord
Thomas P
TP
Benedetti
Thomas J
TJ
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001720:Birth Injuries / Q000453:epidemiology; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D014861:Washington / Q000453:epidemiology