title: Monitoring childbirth morbidity using hospital discharge data: further development and application of a composite measure.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the use of a childbirth composite morbidity indicator for monitoring childbirth morbidity at hospital and regional levels in California.
  
  
  METHODS
  Study data were obtained from the 2005 linked maternal and neonatal discharge dataset for California hospitals. The study population was limited to laboring women with singleton, term (≥37 weeks' gestation), inborn, and live births. Women with and without pregnancy complications were stratified into high- and low-risk groups. The composite outcome was defined as any significant morbidity of the mother or newborn infant during the childbirth admission. Submeasures for maternal and neonatal composite morbidity and for severe maternal morbidity were examined with both aggregate and hospital-level analyses.
  
  
  RESULTS
  Of 377,869 eligible deliveries, 120,218 (31.8%) were categorized as high risk and 257,651 (68.2%) were categorized as low risk. High-risk women had higher morbidity rates for all comparisons. The mean childbirth composite morbidity rate was 21% overall: 28% for high-risk women and 18% for low-risk women. For high- and low-risk strata, the rates of maternal complications were 18% and 13%, and the rates of severe maternal morbidity were 1.4% and 0.5%, respectively. There was substantial variation across hospitals for all measures.
  
  
  CONCLUSIONS
  The childbirth composite morbidity rate is designed to report childbirth complication rates that combine maternal and neonatal morbidity. This measure and its submeasures met the criteria for quality indicator evaluation as specified by the Agency for Healthcare Research and Quality and can be used for benchmarking or for monitoring childbirth outcomes at regional levels.
authors.affiliation: Childbirth Research Associates, LLC, and Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Korst
authors.affiliation: AMF Consulting, Los Angeles, CA.
authors.forename: Moshe
authors.initials: M
authors.lastname: Fridman
authors.affiliation: Department of Obstetrics and Gynecology, David Geffen School of Medicine at University California Los Angeles, and Department of Community Health Sciences, Fielding UCLA School of Public Health, Los Angeles, CA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Lu
authors.affiliation: Office of Health Equity, California Department of Public Health, Sacramento, CA.
authors.forename: Connie
authors.initials: C
authors.lastname: Mitchell
authors.affiliation: Maternal, Child and Adolescent Health Division, California Department of Public Health under contract with the University of California San Francisco, Sacramento, CA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lawton
authors.affiliation: Maternal, Child and Adolescent Health Division, California Department of Public Health under contract with the University of California San Francisco, Sacramento, CA.
authors.forename: Flojaune
authors.initials: F
authors.lastname: Griffin
authors.affiliation: Department of Obstetrics and Gynecology, David Geffen School of Medicine at University California Los Angeles, and Department of Community Health Sciences, Fielding UCLA School of Public Health, Los Angeles, CA; Divisions of Women's Health Services Research and Policy and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Gregory
mesh_terms: D005260:Female; D006801:Humans; D009017:Morbidity; D036801:Parturition; D010351:Patient Discharge; D011247:Pregnancy
keywords: administrative data; childbirth morbidity; composite morbidity; quality monitoring