A Simple Risk Adjustment for Hospital-Level Nulliparous, Term, Singleton, Vertex, Cesarean Delivery Rates and Its Implications for Public Reporting

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES Joint Commission journal on quality and patient safety Pub Date : 2024-07-01 DOI:10.1016/j.jcjq.2024.04.006

Benjamin D. Pollock PhD, MSPH (is Assistant Professor of Health Services Research and Senior Associate Consultant II–Research, Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida.), Leslie Carranza MD (is Quality Chair, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.), Elizabeth Braswell-Pickering MPH (is Senior Quality Informatics Analyst, Mayo Clinic, Rochester, Minnesota.), Christine M. Sing DPT, MBA (is Operations Manager, Quality & Value, Mayo Clinic, Rochester, Minnesota.), Lindsay L. Warner MD (is Anesthesiologist and Pediatric Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.), Regan N. Theiler MD, PHD (is Associate Professor, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota. Please address correspondence to Benjamin D. Pollock)

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Abstract

Background

The Joint Commission uses nulliparous, term, singleton, vertex, cesarean delivery (NTSV-CD) rates to assess hospitals’ perinatal care quality through the Cesarean Birth measurement (PC-02). However, these rates are not risk-adjusted for maternal health factors, putting this measure at odds with the risk adjustment paradigm of most publicly reported hospital quality measures. Here, the authors tested whether risk adjustment for readily documented maternal risk factors affected hospital-level NTSV-CD rates in a large health system.

Methods

Included were all consecutive NTSV pregnancies from January 2019 to April 2023 across 10 hospitals in one health system. Logistic regression, adjusting for age, obesity, diabetes, and hypertensive disorders. was used to calculate hospital-level risk-adjusted NTSV-CD rates by multiplying observed vs. expected ratios for each hospital by the systemwide unadjusted NTSV-CD rate. The authors calculated intrahospital risk differences between unadjusted and risk-adjusted rates and calculated the percentage of hospitals qualifying for different reporting status after risk adjustment using the 30% Joint Commission reporting threshold rate.

Results

Of 23,866 pregnancies, 6,550 (27.4%) had cesarean deliveries. Across 10 hospitals, the number of deliveries ranged from 393 to 7,671, with unadjusted NTSV-CD rates ranging from 21.0% to 30.5%. Risk-adjusted NTSV-CD rates ranged from 21.5% to 30.4%, with absolute intrahospital differences in risk-adjusted vs. unadjusted rates ranging from −1.33% (indicating lower rate after risk adjustment) to 3.37% (indicating higher rate after risk adjustment). Three of 10 (30.0%) hospitals qualified for different reporting statuses after risk adjustment.

Conclusion

Risk adjustment for age, obesity, diabetes, and hypertensive disorders is feasible and resulted in meaningful changes in hospital-level NTSV-CD rates with potentially impactful consequences for hospitals near The Joint Commission reporting threshold.

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对医院级别的无胎儿、足月、单胎、顶体、剖宫产率进行简单的风险调整及其对公开报告的影响

背景联合委员会通过剖宫产测量（PC-02）使用无子宫、足月、单胎、顶点、剖宫产率（NTSV-CD）来评估医院的围产期护理质量。然而，这些比率并没有根据产妇的健康因素进行风险调整，这使得该测量方法与大多数公开报道的医院质量测量方法的风险调整范式相悖。在此，作者测试了对容易记录的孕产妇风险因素进行风险调整是否会影响一个大型医疗系统的医院级 NTSV-CD 率。方法包括一个医疗系统中 10 家医院 2019 年 1 月至 2023 年 4 月期间所有连续的 NTSV 妊娠。将每家医院的观察比值与预期比值乘以全系统未调整的 NTSV-CD 率，利用逻辑回归计算出医院级别的风险调整 NTSV-CD 率，并对年龄、肥胖、糖尿病和高血压疾病进行了调整。作者计算了未调整率与风险调整率之间的院内风险差异，并使用联合委员会报告阈值率 30% 计算了风险调整后符合不同报告条件的医院比例。结果在 23866 例妊娠中，6550 例（27.4%）为剖宫产。10家医院的分娩数量从393例到7671例不等，未经调整的NTSV-CD率从21.0%到30.5%不等。经风险调整后的 NTSV-CD 发生率为 21.5% 至 30.4%，经风险调整与未经调整的发生率在医院内的绝对差异为-1.33%（表明经风险调整后发生率较低）至 3.37%（表明经风险调整后发生率较高）。结论对年龄、肥胖、糖尿病和高血压疾病进行风险调整是可行的，并能使医院层面的 NTSV-CD 发生有意义的变化，对接近联合委员会报告阈值的医院具有潜在的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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