Obstetric Outcomes and Delivery-Related Health Care Utilization and Costs Among Pregnant Women With Multiple Chronic Conditions

Admon, Lindsay K.; Winkelman, Tyler N.A.; Heisler, Michele; Dalton, Vanessa K.

doi:10.5888/pcd15.170397

Cited by 40 publications

(55 citation statements)

References 7 publications

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“…( 36 The prevalence of reproductive-aged women with chronic conditions continues to rise, and pregnant women with multiple chronic conditions are at 276% higher risk of SMM and mortality than women with no chronic conditions. (38) Women with multiple chronic conditions are often older than women with a single chronic condition or no chronic conditions. Noncardiovascular medical conditions accounted for 14.3% of pregnancy-related deaths during the period from 2011 to 2015.…”

Section: Causes Of Maternal Mortality and Morbiditymentioning

confidence: 99%

Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions

2019

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The rising trend in pregnancy-related deaths during the past 2 decades in the United States stands out among other high-income countries where pregnancy-related deaths are declining. Cardiomyopathy and other cardiovascular conditions, hemorrhage, and other chronic medical conditions are all important causes of death. Unintentional death from violence, overdose, and self-harm are emerging causes that require medical and public health attention. Significant racial/ ethnic inequities exist in pregnancy care with non-Hispanic black women incurring 3 to 4 times higher rates of pregnancy-related death than non-Hispanic white women. Varied terminology and lack of standardized methods for identifying maternal deaths in the United States have resulted in nuanced data collection and interpretation challenges. State maternal mortality review committees are important mechanisms for capturing and interpreting data on cause, timing, and preventability of maternal deaths. Importantly, a thorough standardized review of each maternal death leads to recommendations to prevent future pregnancy-associated deaths. Key interventions to improve maternal health outcomes include 1) integrating multidisciplinary care for women with high-risk comorbidities during preconception care, pregnancy, postpartum, and beyond; 2) addressing structural racism and the social determinants of health; 3) implementing hospital-wide safety bundles with team training and simulation; 4) providing patient education on early warning signs for medical complications of pregnancy; and 5) regionalizing maternal levels of care so that women with risk factors are supported when delivering at facilities with specialized care teams.

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Section: Causes Of Maternal Mortality and Morbiditymentioning

confidence: 99%

Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions

2019

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“…Chronic conditions account for one‐third of maternal deaths nationally . A recent national study using the 2013‐2014 National Inpatient Sample of delivery hospitalizations reported that the rate of SMM and mortality among deliveries with at least one chronic condition was nearly two times the rate of those without chronic conditions . Cesarean birth is associated with maternal morbidity in index and future pregnancies, including postpartum hemorrhage, blood transfusion, hysterectomy due to placental implantation disorders, and maternal ICU admission, and may have some adverse neonatal outcomes …”

Section: Introductionmentioning

confidence: 99%

“…8 A recent national study using the 2013-2014 National Inpatient Sample of delivery hospitalizations reported that the rate of SMM and mortality among deliveries with at least one chronic condition was nearly two times the rate of those without chronic conditions. 9 Cesarean birth is associated with maternal morbidity in index and future pregnancies, including postpartum hemorrhage, blood transfusion, hysterectomy due to placental implantation disorders, and maternal ICU admission, 10 and may have some adverse neonatal outcomes. 7,11 Bateman et al used Medicaid health care use data to develop a maternal comorbidity index, which is a simple measure for summarizing the burden of medical (chronic and behavioral) and obstetric (pregnancy-induced) conditions that can be used in population-level research, for example, epidemiologic, comparative effectiveness, and health services research.…”

Section: Introductionmentioning

confidence: 99%

Maternal comorbidity index and severe maternal morbidity during delivery hospitalizations in Texas, 2011‐2014

Salahuddin

Mandell

Lakey

et al. 2019

Birth

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Background Severe maternal morbidity (SMM) prevalence was 194.0 per 10 000 deliveries in Texas in 2015. Chronic, behavioral, and pregnancy‐induced conditions, as captured by a maternal comorbidity index, increase the risk for delivery‐related morbidity and mortality. The objective of the study was to examine the association between maternal comorbidity index and SMM among delivery hospitalizations in Texas. Methods Delivery‐related hospitalizations among Texan women aged 15‐49 years were identified using the 2011‐2014 Texas all‐payer inpatient hospitalization public use data files (n = 1 434 441). The primary outcome of interest was SMM, based on the Alliance for Innovation on Maternal Health's coding scheme. The exposure of interest was a maternal comorbidity index. Multivariable logistic regression model was used to examine the association between maternal comorbidity index and SMM. Results SMM prevalence remained consistent between 2011 and 2014 (196.0‐197.0 per 10 000 deliveries, P > .05; n = 1 434 441). Nearly 40% of delivery‐related hospitalizations had a maternal comorbidity index of at least 1, and the proportion of deliveries in the highest risk category of comorbidity index (≥5) increased by 12.0% from 2011 to 2014. SMM prevalence was highest among the youngest and oldest age groups. With each unit increase in maternal comorbidity index, the odds of SMM increase was 1.43 (95% CI 1.42‐1.43). Conclusions Maternal comorbidity index is associated with SMM; however, the low predictive power of the model suggests that other, unmeasured factors may influence SMM in Texas. These findings highlight a need to understand broader contextual factors (practitioner, facility, systems of care, and community) that may be associated with SMM to reduce maternal morbidity and mortality in Texas.

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“…Many of these patients suffer chronic medical conditions that are correlated with adverse pregnancy outcomes. 10,11…”

Section: Methodsmentioning

confidence: 99%

“…Many of these patients suffer chronic medical conditions that are correlated with adverse pregnancy outcomes. 10,11 Beginning in 2010, MWH leadership launched a multi-pronged effort to decrease patient harms and improve outcomes.…”

Section: Health System Obstetrical Servicesmentioning

confidence: 99%

Malpractice litigation, quality improvement, and the University Hospitals Obstetric Quality Network

Cossler

Liu

Porter

et al. 2019

Journal of Patient Safety and Risk Management

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Objective: A healthcare organization's medical malpractice data can help identify patient safety risks and drive improvement. In most organizations, obstetric malpractice losses are assumed to be part of the risk of delivering obstetric care. We describe a systematic approach to mitigating risks for obstetric patients and their newborns while simultaneously improving patient outcomes and reducing obstetric litigation costs at University Hospitals, a northeast Ohio-based health system of 18 hospitals, including seven hospitals providing obstetric services and delivering approximately 8000 women per year. Methods: From multiple data sources, including malpractice claims data, the team identified four key drivers of risk on the obstetric service: hypoxic ischemic encephalopathy, obstetric hemorrhage, hypertensive disorders of pregnancy, and shoulder dystocia. Collectively, these contributed to multiple adverse maternal and neonatal outcomes and accounted for 71% of obstetric litigation costs from 2009 to 2015. In response, the team built a regional obstetric quality network and implemented interventions to mitigate the four major risk areas. Results: We achieved a substantial reduction in serious safety events from 2010 to 2018, defined as any event where the standard of care was not met and the level of harm to mother or baby was one (death) or two (severe permanent or temporary harm). We also achieved a reduction in obstetric litigation costs between 2009-2012 and 2015-2018. Discussion: This multifaceted intervention was associated with decreased patient harm and reduced obstetric litigation costs. Application of this approach to other hospitals could result in improvements in obstetric patient safety and reduced obstetric litigation costs.

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Obstetric Outcomes and Delivery-Related Health Care Utilization and Costs Among Pregnant Women With Multiple Chronic Conditions

Cited by 40 publications

References 7 publications

Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions

Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions

Maternal comorbidity index and severe maternal morbidity during delivery hospitalizations in Texas, 2011‐2014

Malpractice litigation, quality improvement, and the University Hospitals Obstetric Quality Network

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