Background
Methods
Data
Sample
Outcome variables
AHRQ measures
Numerator | Denominator | Exclusion | |
---|---|---|---|
Maternal quality indicator
| |||
Cesarean delivery rate | MS-DRG: 765, 766 | MS-DRG: 765, 766, 767, 768, 774, 775 | Abnormal presentation, preterm, fetal death, multiple gestation diagnosis codes: ‘64420','64421','65100','65101','65103','65110','65111','65113', '65120','65121','65123','65130','65131','65133','65140','65141', '65143','65150','65151','65153','65160','65161','65163','65180', '65181','65183','65190','65191','65193','65220','65221','65223', '65230','65231','65233','65240','65241','65243','65260','65261', '65263','65640','65641','65643','66050','66051','66053','66230', '66231','66233','66960','66961','67810','67811','67813','7615', 'V271','V272','V273', 'V274','V275','V276','V277' |
Breech procedure codes: '7251', '7252', '7253', '7254' | |||
Primary Cesarean delivery rate | MS-DRG: 765, 766 | MS-DRG: 765, 766, 767, 768, 774, 775 | Abnormal presentation, preterm, fetal death, multiple gestation diagnoses, or breech procedure(ICD-9-CM codes as the above); |
Previous Cesarean delivery diagnosis codes: '65420','65421','65423' | |||
Vaginal Birth After Cesarean, all rate | MS-DRG: 767, 768, 774, 775 | MS-DRG: 765, 766, 767, 768, 774, 775 and diagnosis codes: '65420','65421','65423' | N/A |
Vaginal Birth After Cesarean, Uncomplicated rate | MS-DRG: 767, 768, 774, 775 | MS-DRG: 765, 766, 767, 768, 774, 775 and diagnosis codes: '65420','65421','65423' | Abnormal presentation, preterm, fetal death, multiple gestation diagnoses, or breech procedure(ICD-9-CM code as the above); |
Obstetric Trauma Rate - Vaginal Delivery Without Instrument | MS-DRG: 767, 768, 774, 775 and diagnosis code: '66420', '66421', '66424', '66430', '66431', '66434' | MS-DRG: 767, 768, 774, 775 | Instrument-assisted delivery procedure codes: '720', '721', '7221', '7229', '7231', '7239','724','7251','7253','726','7271','7279', '728','729' |
Obstetric Trauma Rate - Vaginal Delivery With Instrument | MS-DRG: 767, 768, 774, 775 , diagnosis code: '66420', '66421', '66424', '66430', '66431','66434', and procedure codes: '720','721','7221','7229','7231','7239','724', '7251','7253','726','7271','7279','728','729' | MS-DRG: 767, 768, 774, 775 and procedure codes: '720', '721', '7221', '7229', '7231','7239','724','7251','7253','726','7271', '7279', '728','729' | N/A |
Obstetric Trauma Rate - Cesarean delivery | MS-DRG: 765, 766 and diagnosis codes: '66420','66421','66424','66430','66431', '66434' | MS-DRG: 765, 766 | N/A |
Non-complicated deliveries
| |||
Ideal Delivery Rate | Diagnosis code not in (664.2, 664.3 665.5 665.4, 664.4, 664.8, 664.9, 665.8, 665, 665.1, 674.1, 666.0, 666.1, 666.2, 666.3, 665.7, 664.5, 670.xx, 038.xx, 658.4, 659.2, 659.3, 674.2, 674.3, 668.xx, 349.xx 671.4, 673.0, 673.1, 673.2, 673.3, 518.xx (except 03, 06, 83, 84, 89), 998.xx, 669.0, 669.1, 669.2, 669.3, 669.4); Procedure codes not in (6831-6849, 6861-6869, 689, 99.0x) | MS-DRG: 765, 766, 767, 768, 774, 775 | N/A |
Total maternal complications
Race/ethnicity
Control variables
Statistical methods
Results
Demographics
Chinese | Filipino | Native Hawaiian | Japanese | Other | Other Pacific Islander | White | Total | P-values*
| |
---|---|---|---|---|---|---|---|---|---|
Childbirth Hospitalizations
| 2,335 | 14,965 | 17,081 | 7,888 | 10,126 | 8,326 | 15,004 | 75,725 | |
Patients
| 1,968 | 12,545 | 13,094 | 6,608 | 8,904 | 6,366 | 12,831 | 62,316 | |
Multiple maternal hospitalizations during study period (% from total # of maternity-related hospitalizations)
| 686 (29.4%) | 4,577 (30.6%) | 7,145 (41.8%) | 2,408 (30.5%) | 2,969 (29.3%) | 3,570 (42.9%) | 4,224 (28.2%) | 25,579 (33.8%) | <.0001 |
# patients with Multiple maternal hospitalizations (% from # of patients)
| 353 (17.6%) | 2,252 (17.8%) | 3,524 (26.2%) | 1,227 (18.3%) | 1,120 (13.5%) | 1,665 (25.9%) | 2,029 (15.8%) | 12,170 (19.5%) | <.0001 |
N (%)
|
N (%)
|
N (%)
|
N (%)
|
N (%)
|
N (%)
|
N (%)
|
N (%)
|
P-values
*
| |
Age
| <.0001 | ||||||||
<20 | 28 (1.4%) | 1,029 (8.2%) | 2,077 (15.9%) | 207 (3.1%) | 716 (8.0%) | 695 (10.9%) | 747 (5.8%) | 5,499 (8.8%) | <.0001 |
20-29 | 620 (31.5%) | 5,971 (47.6%) | 7,185 (54.9%) | 1,887 (28.6%) | 4,189 (47.0%) | 3,672 (57.7%) | 5,986 (46.7%) | 29,510 (47.4%) | <.0001 |
30-39 | 1,176 (59.8%) | 4,977 (39.7%) | 3,510 (26.8%) | 3,963 (60.0%) | 3,667 (41.2%) | 1,803 (28.3%) | 5,452 (42.5%) | 24,548 (39.4%) | <.0001 |
40+ | 144 (7.3%) | 568 (4.5%) | 322 (2.5%) | 551 (8.3%) | 332 (3.7%) | 196 (3.1%) | 646 (5.0%) | 2,759 (4.4%) | <.0001 |
Payer
| <.0001 | ||||||||
Dept of Defense | 18 (0.9%) | 216 (1.7%) | 118 (0.9%) | 72 (1.1%) | 419 (4.7%) | 75 (1.2%) | 1,121 (8.7%) | 2,039 (3.3%) | <.0001 |
Private | 1,461 (74.2%) | 8,550 (68.2%) | 6,277 (47.9%) | 5,542 (83.9%) | 4,882 (54.8%) | 1,861 (29.2%) | 7,757 (60.5%) | 36,330 (58.3%) | <.0001 |
Public | 451 (22.9%) | 3,711 (29.6%) | 6,650 (50.8%) | 776 (11.7%) | 3,175 (35.7%) | 4,221 (66.3%) | 3,866 (30.1%) | 22,850 (36.7%) | <.0001 |
Self Pay | 38 (1.9%) | 68 (0.5%) | 49 (0.4%) | 218 (3.3%) | 428 (4.8%) | 209 (3.3%) | 87 (0.7%) | 1,097 (1.8%) | <.0001 |
Hospital
| |||||||||
Urban | 1,831 (93.0%) | 9,119 (72.7%) | 7,737 (59.1%) | 5,453 (82.5%) | 6,322 (71.0%) | 5,329 (83.7%) | 7,252 (56.5%) | 43,043 (69.1%) | <.0001 |
High Risk
| |||||||||
Yes | 706 (35.9%) | 4,919 (39.2%) | 4,907 (37.5%) | 2,418 (36.6%) | 3,005 (33.7%) | 2,404 (37.8%) | 4,558 (35.5%) | 22,917 (36.8%) | <.0001 |
Multiple Gestation
| |||||||||
Yes | 33 (1.7%) | 159 (1.3%) | 159 (1.2%) | 153 (2.3%) | 115 (1.3%) | 98 (1.5%) | 263 (2.1%) | 980 (1.6%) | <.0001 |
Newborn birth weight
| <.0001 | ||||||||
Low(<2500 g) | 155 (6.6%) | 1,681 (11.2%) | 1,306 (7.6%) | 729 (9.2%) | 752 (7.4%) | 670 (8.0%) | 917 (6.1%) | 6,210 (8.2%) | <.0001 |
Normal(2500-4000 g) | 2,093 (89.6%) | 12,809 (85.6%) | 14,486 (84.8%) | 6,886 (87.3%) | 8,777 (86.7%) | 6,862 (82.4%) | 12,676 (84.5%) | 64,589 (85.3%) | <.0001 |
High(>4000 g) | 87 (3.7%) | 475 (3.2%) | 1,289 (7.5%) | 273 (3.5%) | 597 (5.9%) | 794 (9.5%) | 1,411 (9.4%) | 4,926 (6.5%) | <.0001 |
Clinical quality and safety outcomes
Chinese | Filipino | Native Hawaiian | Japanese | Other | Other Pacific Islander | White | Total | P-values*
| |
---|---|---|---|---|---|---|---|---|---|
N (%) | N (%) | N (%) | N (%) | N (%) | N (%) | N (%) | N (%) | P-values*
| |
Maternal quality indicator
| |||||||||
Cesarean delivery rate | 414 (19.7%) | 3,367 (25.8%) | 3,509 (22.9%) | 1,497 (21.5%) | 2,297 (25.2%) | 1,713 (23.4%) | 3,293 (24.4%) | 16,090 (23.9%) | <.0001 |
Primary Cesarean delivery rate | 226 (12.0%) | 1,713 (15.4%) | 1,559 (11.9%) | 820 (13.2%) | 1,217 (15.5%) | 877 (14.3%) | 1,810 (15.3%) | 8,222 (14.1%) | <.0001 |
Vaginal Birth After Cesarean, all rate | 42 (16.4%) | 316 (14.2%) | 333 (12.8%) | 114 (12.9%) | 174 (12.4%) | 357 (25.7%) | 233 (12.1%) | 1,569 (14.7%) | <.0001 |
Vaginal Birth After Cesarean, Uncomplicated rate | 41 (17.4%) | 310 (15.0%) | 323 (13.5%) | 108 (13.1%) | 166 (12.7%) | 349 (27.3%) | 230 (12.9%) | 1,527 (15.4%) | <.0001 |
Obstetric Trauma Rate - Vaginal Delivery Without Instrument | 92 (5.7%) | 276 (2.8%) | 198 (1.6%) | 242 (4.5%) | 222 (3.3%) | 151 (2.7%) | 286 (2.8%) | 1,467 (2.8%) | <.0001 |
Obstetric Trauma Rate - Vaginal Delivery With Instrument | 44 (29.7%) | 182 (21.6%) | 69 (12.6%) | 103 (21.4%) | 110 (21.2%) | 68 (15.8%) | 123 (18.8%) | 699 (19.3%) | <.0001 |
Obstetric Trauma Rate - Cesarean delivery | Too small to report | Too small to report | Too small to report | Too small to report | Too small to report | Too small to report | Too small to report | Too small to report | 0.188 |
Non-complicated deliveries
| |||||||||
ID Rate | 1,827 (78.2%) | 11,671 (78.0%) | 14,410 (84.4%) | 6,166 (78.2%) | 8,148 (80.5%) | 6,498 (78.0%) | 12,718 (84.8%) | 61,438 (81.1%) | <.0001 |
Cesarean Delivery Rate | Primary Cesarean Delivery Rate | Vaginal Birth After Cesarean Rate, All | Vaginal Birth After Cesarean Rate, Uncomplicated | Obstetric Trauma Rate - Vaginal Delivery Without Instrument | Obstetric Trauma Rate - Vaginal Delivery With Instrument | Non-Complicated Deliveries-ID rate | |
---|---|---|---|---|---|---|---|
RR [95% CI] | RR [95% CI] | RR [95% CI] | RR [95% CI] | RR [95% CI] | RR [95% CI] | RR [95% CI] | |
Race/Ethnicity
| |||||||
Chinese vs. White | 0.96 [0.88, 1.05] | 1.00 [0.88, 1.14] | 0.79 [0.58, 1.08] | 0.78 [0.57, 1.06] | 1.95 [1.53, 2.48] | 1.42 [1.06, 1.91] | 0.97 [0.95, 0.99] |
Filipino vs. White | 1.15 [1.11, 1.20] | 1.11 [1.04, 1.18] | 0.97 [0.82, 1.13] | 0.91 [0.78, 1.07] | 1.04 [0.88, 1.23] | 1.07 [0.87, 1.31] | 0.96 [0.95, 0.97] |
Hawaiian vs. White | 1.02 [0.98, 1.06] | 0.83 [0.78, 0.88] | 0.99 [0.84, 1.17] | 0.94 [0.79, 1.11] | 0.62 [0.52, 0.74] | 0.66 [0.50, 0.87] | 1.01 [1.00, 1.02] |
Japanese vs. White | 0.96 [0.91, 1.02] | 1.00 [0.92, 1.08] | 0.84 [0.73, 1.03] | 0.77 [0.63, 0.94] | 1.52 [1.27, 1.81] | 1.02 [0.80, 1.29] | 0.97 [0.95, 0.98] |
Other vs. White | 1.14 [1.09, 1.19] | 1.16 [1.09, 1.25] | 0.87 [0.73, 1.05] | 0.82 [0.68, 0.99] | 1.21 [1.01, 1.44] | 1.06 [0.84, 1.33] | 0.98 [0.97, 0.99] |
Other PI vs. White | 1.16 [1.10, 1.22] | 1.16 [1.07, 1.26] | 1.28 [1.08, 1.51] | 1.23 [1.03, 1.46] | 1.09 [0.89, 1.34] | 0.80 [0.60, 1.06] | 0.97 [0.96, 0.98] |
Age Groups
| |||||||
<20 vs. 40+ | 0.47 [0.44, 0.51] | 0.80 [0.72, 0.88] | 1.96 [1.39, 2.78] | 2.02 [1.41, 2.89] | 1.76 [1.26, 2.46] | 1.30 [0.85, 1.99] | 0.90 [0.88, 0.92] |
20-29 vs. 40+ | 0.60 [0.57, 0.63] | 0.66 [0.61, 0.72] | 1.55 [1.21, 1.98] | 1.50 [1.15, 1.95] | 1.32 [0.98, 1.78] | 1.41 [0.99, 2.01] | 0.96 [0.94, 0.97] |
30-39 vs. 40+ | 0.75 [0.72, 0.79] | 0.71 [0.66, 0.77] | 1.31 [1.03, 1.67] | 1.32 [1.02, 1.71] | 1.15 [0.85, 1.55] | 1.23 [0.87, 1.74] | 0.99 [0.98, 1.01] |
Payer
| |||||||
DOD vs. private | 0.98 [0.90, 1.07] | 0.87 [0.77, 0.99] | 0.88 [0.67, 1.14] | 0.88 [0.68, 1.14] | 0.74 [0.55, 1.00] | 0.64 [0.41, 0.98] | 1.06 [1.04, 1.08] |
Public vs. private | 0.98 [0.95, 1.01] | 0.84 [0.81, 0.88] | 1.23 [1.10, 1.37 ] | 1.25 [1.11, 1.41] | 0.54 [0.48, 0.61] | 0.76 [0.65, 0.90] | 1.02 [1.01, 1.03] |
Self Pay vs. private | 0.84 [0.76, 0.94] | 0.82 [0.70, 0.97] | 1.28 [0.87, 1.88] | 1.23 [0.82, 1.86] | 0.90 [0.63, 1.28] | 1.09 [0.73, 1.62] | 0.98 [0.95, 1.01] |
High Risk
| |||||||
Yes vs. No | 1.52 [1.48, 1.55] | 2.43 [2.25, 2.43] | 0.70 [0.63, 0.78] | 0.74 [0.67, 0.82] | 1.14 [1.03, 1.28] | 1.04 [0.90, 1.20] | 0.98 [0.97, 0.99] |
Hospital
| |||||||
rural vs. urban | 1.66 [1.61, 1.71] | 1.73 [1.66, 1.81] | 0.09 [0.07, 0.12] | 0.10 [0.07, 0.13] | 0.81 [0.71, 0.92] | 0.65 [0.54, 0.77] | 1.14 [1.13, 1.14] |
Multiple Gestation
| |||||||
Yes vs. No | NA1
| NA | 0.34 [0.15, 0.80] | NA | 0.94 [0.47, 1.87] | 1.46 [0.82, 2.59] | 0.98 [0.97, 1.03] |
Baby Birth Weight
| |||||||
Low vs. Normal | 1.20 [1.10,1.31] | 1.11 [0.97, 1.26] | 1.22 [0.90, 1.65] | 1.17 [0.87, 1.59] | 0.53 [0.42,0.67] | 0.75 [0.57,0.99] | 0.98 [0.96, 1.01] |
High vs. Normal | 1.06 [0.97, 1.16] | 0.83 [0.73, 0.95] | 1.25 [0.92, 1.69] | 1.21 [0.89, 1.63] | 0.32 [0.25, 0.41] | 0.47 [0.33,0.65] | 1.04 [1.02, 1.06] |