Using publicly reported hospital data to predict obstetric quality

Abstract

Purpose: To determine the association between obstetric outcomes and publicly reported hospital data on patient satisfaction, surgical quality measures and medical outcomes.

Materials and methods: Hospitals in the Nationwide Inpatient Sample in 2011 were linked to Hospital Compare, a source of hospital data on patient satisfaction, quality and mortality for medical conditions. The risk-adjusted hospital-level rates of obstetric morbidity, episiotomy and lacerations were compared across the hospitals and reported as the absolute reduction in risk (ARR).

Results: We identified 528 708 women. There was no association between any of the metrics and risk-adjusted obstetric morbidity (range −0.15% to 0.03% difference). Hospitals with a high mortality rate for pneumonia had a 0.38% (95% CI: 0.13% to 0.64%) higher rate of risk-adjusted third- and fourth-degree lacerations, while hospitals with a higher death rate for myocardial infarction had a −0.74% (95% CI, −1.34% to −0.14%) lower risk-adjusted episiotomy rate. The differences in the remainder of the publicly reported metrics and the risk adjusted rates of third- and fourth-degree lacerations and episiotomy were small and not statistically significant (p  > 0.05).

Conclusion: There is little association between currently available, publically reported hospital data and obstetric quality. Obstetric-specific hospital measures of quality and satisfaction are needed.

Keywords:

• Obstetrics
• quality
• satisfaction
• Hospital Compare

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article. Dr. Wright (R40 MC28312-01) is a recipient of a grant from the Department of Health and Human Services, 10.13039/100000016.

Supplementary materials available on line