Dataset Information

Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study.

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.

SUBMITTER: Grobman WA

PROVIDER: S-EPMC4117924 | biostudies-literature | 2014 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study.

Grobman William A WA Bailit Jennifer L JL Rice Madeline Murguia MM Wapner Ronald J RJ Varner Michael W MW Thorp John M JM Leveno Kenneth J KJ Caritis Steve N SN Iams Jay D JD Tita Alan T AT Saade George G Sorokin Yoram Y Rouse Dwight J DJ Tolosa Jorge E JE Van Dorsten J Peter JP

American journal of obstetrics and gynecology 20140312 2

<h4>Objective</h4>The purpose of this study was to determine whether hospital differences in the frequency of adverse obstetric outcomes are related to differences in care.<h4>Study design</h4>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, sev ...[more]

PMID: 24631441

Similar Datasets

Project description:BackgroundDespite large numbers of asylum seekers, there is a lack of evidence on pregnancy outcomes and obstetric care of asylum seeking women in Germany.MethodsCross-sectional study (2010-2016) using administrative data of the main referral hospital for pregnant asylum seekers of the reception center of a large federal state in South Germany.Inclusion criteriawomen aged 12-50 years, admitted in relation to pregnancy, childbirth or post-partum complications.Outcomesdifferences between asylum seekers and residents in the prevalence of high-risk pregnancy conditions, abortive outcomes/stillbirths, peri- and postnatal maternal complications, neonatal complications, and caesarean sections.Analysisodds ratios (OR) and 95% confidence intervals (CI) obtained by single and multiple logistic regression analysis. Attributable fractions among the exposed (Afe) and among the total population (Afp) were calculated for selected outcomes.ResultsOf 19,864 women admitted in relation to pregnancy, childbirth or post-partum complications, 2.9% (n = 569) were asylum seekers. Adjusted odds for high-risk pregnancy conditions (OR = 0.76, 95%CI: 0.63-0.91, p < 0.0001), caesarean sections (OR = 0.84, 95%CI 0.66-1.07, p = 0.17) and perinatal complications (OR = 0.65, 95%CI: 0.55-0.78, p < 0.0001) were lower; those for abortive outcomes/stillbirths (OR = 1.58, 95%CI: 1.11-2.20, p = 0.01) and postnatal complications (OR = 1.80, 95%CI: 0.93-3.19, p = 0.06) higher among asylum seeking women relative to residents in models adjusted for age, length of admission, and high-risk pregnancy conditions. The Afe for abortive outcomes and stillbirths among asylum seekers was 40.3% (95% CI, 16.3-56.5) and the Afp was 1.8%. The Afe for postnatal complications was 53.1% (95% CI, 7.1-74.0) and the Afp was 3.1%.ConclusionAsylum seeking women are at higher risk of abortive outcomes/stillbirths and show a tendency towards higher postnatal complications. This excess risk calls for adequate responses by health care providers and policy makers to improve outpatient postnatal care in reception centers and mitigate adverse birth outcomes among asylum seeking women. Although further research is needed, scaling-up midwivery care, improving outreach by maternity care teams, and routinely identifying and addressing mental illness by psychosocial services could be ways forward to improve outcomes in this population.

Project description:OBJECTIVE:There has been concern that an increase in billing for high-intensity emergency care is due to changes in coding practices facilitated by electronic health records. We sought to characterise the trends in billing for high-intensity emergency care among Medicare beneficiaries and to examine the degree to which trends in high-intensity billing are explained by changes in patient characteristics and services provided in the emergency department (ED). DESIGN, SETTING AND PARTICIPANTS:Observational study using traditional Medicare claims to identify ED visits at non-federal acute care hospitals for elderly beneficiaries in 2006, 2009 and 2012. OUTCOMES MEASURES:Billing intensity was defined by emergency physician evaluation and management (E&M) codes. We tested for overall trends in high-intensity billing (E&M codes 99285, 99291 and 99292) and in services provided over time using linear regression models, adjusting for patient characteristics. Additionally, we tested for time trends in rates of admission to the hospital and to the intensive care unit (ICU). Next, we classified outpatient visits into 39 diagnosis categories and analysed the change in proportion of high-intensity visits versus the change in number of services. Finally, we quantified the extent to which trends in high-intensity billing are explained by changes in patient demographics and services provided in the ED using multivariable modelling. RESULTS:High-intensity visits grew from 45.8% of 671?103 visits in 2006 to 57.8% of 629?010 visits in 2012 (2.0% absolute increase per year; 95%?CI 1.97% to 2.03%) as did the mean number of services provided for admitted (1.28 to 1.41; +0.02?increase in procedures per year; 95%?CI 0.018 to 0.021) and discharged ED patients (7.1 to 8.6; +0.25?increase in services per year; 95%?CI 0.245 to 0.255). There was a reduction in hospital admission rate from 40.1% to 35.9% (-0.68% per year; 95%?CI -0.71% to -0.65%; P<0.001), while the ICU rate of admission rose from 11.7% to 12.3% (+0.11% per year; 95%?CI 0.09% to 0.12%; P<0.001). When we stratified by diagnosis category, there was a moderate correlation between change in visits billed as high intensity and the change in mean number of services provided per visit (r=0.38; 95%?CI 0.07 to 0.63). Trends in patient characteristics and services provided accounted moderately for the trend in practice intensity for outpatient visits (pseudo R2 of 0.47) but very little for inpatient visits (0.051) and visits overall (0.148). CONCLUSIONS:Increases in services provided in the ED moderately account for the trends in billing for high-intensity emergency care for outpatient visits.

Project description:BACKGROUND:Obstetric fistula (OF) is a maternal morbidity associated with high rates of stillbirth, amenorrhea, and sexual dysfunction. Limited data exists on the reproductive outcomes of women in the years following a fistula repair. The objective of this study is to describe the fertility outcomes and family planning practices in a population of Malawian women 1-4 years after fistula repair. METHODS:Women who had enrolled into a clinical database of OF patients and undergone OF repair between January 1, 2012 and July 31, 2014 were recruited and enrolled to complete a home-based survey of their demographic and reproductive health data 1-4 years after their repair. Pregnancy, amenorrhea, and sexual function were described using frequency analysis, and we compared antimüllerian hormone (AMH) concentrations between women with menses or pregnancy with women with amenorrhea or no pregnancy using Wilcoxon rank sum tests. RESULTS:Of 297 women with a prior OF repair, 148 had reproductive potential and were included in this analysis. Overall 30 women of these women (21%) became pregnant since their fistula repair, with most pregnancies ending with cesarean delivery. Of the 32 women who were amenorrheic at the time of repair, 25 (78.1%) had resumption of menses. Only 11 (8.6%) of sexually active women reported dyspareunia, and among women who were not trying to conceive, 53.1% were currently using a method of family planning. No significant differences were found in AMH concentrations between those who were pregnant or had menses versus those without pregnancy or menses, respectively. CONCLUSIONS:In this long-term follow-up study of women after OF repair, many women were able to achieve a pregnancy with a live birth, have normal menses, be sexually active, and access contraception. These achievements will further assist a population of women whose reintegration and restoration of dignity is closely tied to their ability to achieve their reproductive goals. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT02685878 .

Dataset Information

Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study.

Publications

Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets