title: Rural Implications of Expanded Birth Volume Threshold for Reporting Perinatal Care Measures.
abstract: BACKGROUND
  In 2016 the minimum annual birth volume threshold for required reporting of the Joint Commission Perinatal Care measures by accredited hospitals decreased from 1,100 to 300 births.
  
  
  METHODS
  Publicly available Joint Commission Quality Check data from April 2014 to March 2015 for three Perinatal Care measures were linked to Medicare Provider of Services and American Hospital Association Annual Survey data. For each measure, hospital-level reporting and performance among accredited hospitals providing obstetric care were compared using Fisher's exact tests.
  
  
  RESULTS
  Sixty-seven percent of the 2,396 accredited hospitals with obstetric services reported at least one eligible patient for two of the four reported Perinatal Care measures: Elective delivery and exclusive breast milk feeding. Fewer hospitals (35.0%) had data on the antenatal steroids measure; many hospitals may not have any eligible patients for this measure. Hospitals with higher birth volume, those in urban counties, and those with private, nonprofit ownership or system affiliation were more likely to report the perinatal measures (p < 0.001). Across states, reporting rates varied considerably. By hospital volume, performance varied more on the antenatal steroids measure (78.0% to 91.5%) than on the breast milk feeding measure (48.4% to 49.5%) and the elective delivery measure (2.5% to 3.0%).
  
  
  CONCLUSIONS
  Expansion of the minimum birth volume threshold nearly doubles the number of accredited hospitals required to report the Perinatal Care measures to The Joint Commission. However, 485 accredited hospitals with obstetric services that are either critical access hospitals or have fewer than 300 births annually are still exempt from reporting. Although many rural hospitals remain exempt from reporting requirements, the measures offer an opportunity for both rural and urban hospitals to assess and improve care.
authors.affiliation: Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, USA.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Casey
authors.forename: Peiyin
authors.initials: P
authors.lastname: Hung
authors.forename: Carrie
authors.initials: C
authors.lastname: Henning-Smith
authors.forename: Shailendra
authors.initials: S
authors.lastname: Prasad
authors.forename: Katy B
authors.initials: KB
authors.lastname: Kozhimannil
mesh_terms: D000068:Accreditation / Q000592:standards*; D036861:Delivery, Obstetric; D006780:Hospitals, Rural / Q000592:standards*; D007591:Joint Commission on Accreditation of Healthcare Organizations; D018743:Perinatal Care / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards*; D014481:United States