Assessing Quality in Obstetrical Care: Development of Standardized Measures

Author： Mann Susan Pratt Stephen Gluck Paul Nielsen Peter Risser Daniel Greenberg Penny Marcus Ronald Goldman Marlene Shapiro David Pearlman Mark Sachs Benjamin

Publisher： Joint Commission Resources

ISSN： 1553-7250

Source： Joint Commission Journal on Quality and Patient Safety, Vol.32, Iss.9, 2006-09, pp. : 497-505

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Abstract

Background: No nationally accepted set of quality indicators exists in obstetrics. A set of 10 outcome measures and three quality improvement tools was developed as part of a study evaluating the effects of teamwork on obstetric care in 15 institutions and > 28,000 patients. Each outcome was assigned a severity weighting score.Measures: Three new obstetrical quality improvement outcome tools were developed. The Adverse Outcome Index (AOI) is the percent of deliveries with one or more adverse events. The average AOI during the pre-implementation data collection period of the team-work study was 9.2% (range, 5.9%–16.6%). The Weighted Adverse Outcome Score (WAOS) describes the adverse event score per delivery. It is the sum of the points assigned to cases with adverse outcomes divided by the number of deliveries. The average WAOS for the pre-implementation period was 3 points (range, 1.0–6.0). The Severity Index (SI) describes the severity of the outcomes. It is the sum of the adverse outcome scores divided by the number of deliveries with an identified adverse outcome. The average SI for the pre-implementation period was 31 points (range, 16–49).Discussion: The outcome measures and the AOI, WAOS, and SI can be used to benchmark ongoing care within and among organizations. These tools may be useful nationally for determining quality obstetric care.