Average total charges for vaginal deliveries [maternal plus total baby charges that includes NICU utilization (X=$17 624.38)] may be higher than average total charges for Cesarean sections [maternal plus total baby charges that includes NICU utilization (X=$13 805.47)]. Specifically, maternal race--being African American--was indirectly associated with overall charges through its association with mode of delivery and NICU utilization patterns. The presence of maternal co-morbidities--Herpes Simplex Virus, hypertension and diabetes--most probably influenced babies' hospital stay charges as well as NICU charges when transferred to NICU following both vaginal and Cesarean section deliveries. Thus, prenatal care targeting co-morbidities management may reduce the odds of a newborn's transfer to NICU thus avoiding greater lengths of stay, medical care and charges. Recommendations for obstetrical practices as well as health care policy on their charges should not assume that Cesarean section deliveries are always costlier than vaginal deliveries.

This paper identifies, perhaps for the first time, how traditional indicators of hospital performance are being used to understand a hospital's performance and associated safety of care. Although the study's time frame is limited to 3 years, the findings seem to suggest that the interest in using these traditional indicators as proxies for safer practice measures is increasing among the QI Project participants worldwide. The challenge of using inherently value-free indicators as indicators of safety (hence de facto labelled as 'error' focused) should be further studied.

Traditional performance measures continue to assist hospitals in identifying crucial aspects of safety in the delivery of care. Building on the findings of a previous study, there are emerging trends in the type of measures used in hospitals in Asia, Europe and the USA pursuing the improvement of overall performance. The increasing use of patient-level data specifically, in tandem with organizational level indicators, may signal the continuum of measurement strategies, now still predominantly in the USA but anticipated to be adopted both in Europe and Asia.

MEDSAFE has directly assisted Maryland hospitals in improving medication use safety. The strategies and tools of MEDSAFE have been used in Maryland since 2000 and Singapore and Austria since 2006.

With the emergence of so many methodologies for generating comparison data and with the growing accountability demands from so many sectors (each, seemingly, with its own preferred comparative methodology), nurses and quality improvement professionals may feel as if they have many masters to serve. This article outlines the Maryland Hospital Association's Quality Indicator Project's approach to working with quality improvement professionals to build their understanding of comparative data and help them determine which data analysis tools best fit their reporting needs.