Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study - 27/07/14
, Jennifer L. Bailit, MD, MPH b, Madeline Murguia Rice, PhD o, Ronald J. Wapner, MD c, Michael W. Varner, MD d, John M. Thorp, MD e, Kenneth J. Leveno, MD f, Steve N. Caritis, MD g, Jay D. Iams, MD h, Alan T. Tita, MD, PhD i, George Saade, MD j, Yoram Sorokin, MD k, Dwight J. Rouse, MD l, Jorge E. Tolosa, MD, MSCE m, J. Peter Van Dorsten, MD nfor the
Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
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.
Study Design |
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.
Conclusion |
Hospital differences in the frequency of adverse obstetric outcomes could not be explained by differences in frequency of types of care provided.
Le texte complet de cet article est disponible en PDF.Key words : obstetrics, quality care, quality measures
Plan
| Members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network appear in the Acknowledgments. |
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| Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) [HD21410, HD27869, HD27915, HD27917, HD34116, HD34208, HD36801, HD40500, HD40512, HD40544, HD40545, HD40560, HD40485, HD53097, HD53118] and the National Center for Research Resources [UL1 RR024989; 5UL1 RR025764] and its contents do not necessarily represent the official views of the NICHD, NCRR, or NIH. |
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| The authors report no conflict of interest. |
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| Cite this article as: Grobman WA, Bailit JL, Rice MM, et al. Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study. Am J Obstet Gynecol 2014;211:147.e1-16. |
Vol 211 - N° 2
P. 147.e1-147.e16 - août 2014 Retour au numéro
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