A step‐wise approach to developing indicators to compare the performance of maternity units using hospital administrative data

Abstract

Hospital administrative data are attractive for comparing performance of maternity units because of their often large sample sizes, lack of selection bias and the relatively low costs of accessing these data compared with conducting primary data collection. However, using administrative data to develop indicators can also present challenges including varying data quality, the limited detail on clinical risk factors and a lack of structural and user experience measures. This review illustrates how to develop performance indicators for maternity units using hospital administrative data, including methods to address the challenges that administrative data pose.Tweetable abstractHow to develop maternity indicators from administrative data.

Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation

“…1 As in other areas of clinical practice, it demonstrates a pattern of unwarranted variation in both practices and outcomes. [1][2][3][4] Avoidable harm in childbirth can have devastating consequences for families, 5 6 and is an increasingly important driver of cost pressures in health systems through claims for negligence/ malpractice. 1 7 8 Poor care is increasingly recognised as a threat to human rights and the women's and children's health agenda.…”

“…Ethnographic data collection in these five units took place between September 2017 and June 2018 and included: (1) observations of routine care activities in maternity units (labour wards, birth centres, operating theatres, and antenatal and postnatal wards), including observation of briefings, handovers and training events; (2) semistructured interviews with doctors, midwives and members of the managerial and risk management teams; (3) and informal conversations between the researchers and healthcare professionals.…”

Implementation of an individual patient prospective database of hospital births in Sri Lanka and its use for improving quality of care

“…We could identify only two systems for prospective collection of individual maternal and newborn variables across the time of birth in low-income countries or LMICs22 23 and both collected data from a single facility 22–24. In respect to the average hospital administrative data, even in high-income countries, the dataset implemented in this pilot study contains a large number of variables, such as maternal risk factors, that can be used for evaluating the case mix and for adjusting for confounders 7 21…”

“…Most importantly, routine use of data to improve case management and organisation of care is still not a common practice, even in countries with well-established data collection systems 7. Despite there are some good examples of how routine data collection systems are used to shape policies in low-income and middle-income countries (LMICs), for example, in the paediatric field,25 these are very limited in number.…”

“…Quality of data is also an area of significant concern: according to a WHO review, although most countries are using some core indicators to monitor performance in maternal and newborn care, virtually no low-income or lower middle-income country has a full system of data sharing and transparent quality control in place 6. The availability of accurate data is relatively limited even in high-income countries, where most often hospital administrative datasets lack key information, such as maternal risk factors needed for evaluating the case mix and interpreting the observed outcomes 7…”