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)
{"title":"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","authors":"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)","doi":"10.1016/j.jcjq.2024.04.006","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 7","pages":"Pages 500-506"},"PeriodicalIF":2.3000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Simple Risk Adjustment for Hospital-Level Nulliparous, Term, Singleton, Vertex, Cesarean Delivery Rates and Its Implications for Public Reporting\",\"authors\":\"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)\",\"doi\":\"10.1016/j.jcjq.2024.04.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>\",\"PeriodicalId\":14835,\"journal\":{\"name\":\"Joint Commission journal on quality and patient safety\",\"volume\":\"50 7\",\"pages\":\"Pages 500-506\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Joint Commission journal on quality and patient safety\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S155372502400117X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S155372502400117X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
A Simple Risk Adjustment for Hospital-Level Nulliparous, Term, Singleton, Vertex, Cesarean Delivery Rates and Its Implications for Public Reporting
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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