title: Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study.
abstract: OBJECTIVE
  The purpose of this study was to determine whether hospital differences in the frequency of adverse obstetric outcomes are related to differences in care.
  
  
  METHODS
  The Assessment of Perinatal EXcellence cohort comprises 115,502 women and their neonates who were born in 25 hospitals in the United States between March 2008 and February 2011. Hierarchical logistic regression was used to quantify the amount of variation in postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite adverse neonatal outcome among hospitals that is explained by differences in patient characteristics, hospital characteristics, and obstetric care provided.
  
  
  RESULTS
  The study included 115,502 women. For most outcomes, 20-40% of hospital differences in outcomes were related to differences in patient populations. After adjusting for patient-, provider-, and hospital-level factors, multiple care processes were associated with the predefined adverse outcomes; however, these care processes did not explain significant variation in the frequency of adverse outcomes among hospitals. Ultimately, 50-100% of the interhospital variation in outcomes was unexplained.
  
  
  CONCLUSIONS
  Hospital differences in the frequency of adverse obstetric outcomes could not be explained by differences in frequency of types of care provided.
authors.affiliation: Departments of Obstetrics and Gynecology, Northwestern University, Chicago, IL. Electronic address: w-grobman@northwestern.edu.
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
authors.affiliation: Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bailit
authors.affiliation: George Washington University Biostatistics Center, Washington, DC; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
authors.forename: Madeline Murguia
authors.initials: MM
authors.lastname: Rice
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.affiliation: University of Utah Health Sciences Center, Salt Lake City, UT.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.affiliation: University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, NC.
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Leveno
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.affiliation: The Ohio State University School of Medicine, Columbus, OH.
authors.forename: Jay D
authors.initials: JD
authors.lastname: Iams
authors.affiliation: University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Tita
authors.affiliation: University of Texas Medical Branch, Galveston, TX.
authors.forename: George
authors.initials: G
authors.lastname: Saade
authors.affiliation: Wayne State University School of Medicine, Detroit, MI.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Sorokin
authors.affiliation: Alpert Medical School, Brown University, Providence, RI.
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.affiliation: Oregon Health & Science University, Portland, OR.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Tolosa
authors.affiliation: Medical University of South Carolina, Charleston, SC.
authors.forename: J Peter
authors.initials: JP
authors.lastname: Van Dorsten
mesh_terms: D000328:Adult; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007239:Infections / Q000453:epidemiology; D007751:Labor, Induced / Q000706:statistics & numerical data; D022125:Lacerations / Q000453:epidemiology; D016015:Logistic Models; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010502:Perineum / Q000293:injuries; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011787:Quality of Health Care; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology; D055815:Young Adult
keywords: obstetrics; quality care; quality measures