Initial development of a system-wide maternal-fetal outcomes assessment program

OBJECTIVE: This study was undertaken to develop a comprehensive risk-assess ment approach capable of evaluating maternal and fetal outcomes. STUDY DESIGN: Data from 10,984 women and 11,066 infants delivered at 79 mil itary treatment facilities in the United States from 1995 to 1997 were used to develop two individual but complementary risk-adjustment models for mat ernal and, separately, fetal outcomes. A range of maternal and delivery-rel ated risk variables and clinically important outcomes were identified by ex pert opinion and selected and weighted with ordinal logistic regression ana lysis. Receiver operating characteristic curves for the maternal and fetal models were determined. Variation across the facilities in risk-adjusted pe rformance was also evaluated. RESULTS: Risk factors and poor outcomes were rare for both mothers and infa nts, with 96.9% of infants and 97.7% of mothers having good or excellent ou tcomes (0.7% mortality and 0.01% mortality, respectively). Despite the low frequency of poor outcomes both models performed well, with receiver operat ing characteristic curves of 0.75 for maternal outcomes and 0.78 for infant outcomes. When the models were applied to the military treatment facilitie s, there were significant differences among facilities in risk-adjusted out comes. Twenty-four of the facilities in the study (30%) had outcomes odds r atios that were significantly >1 or significantly <1 (P < .05). There did n ot appear to be any relationship between the performance of a military trea tment facility for maternal outcome and that for infant outcome. CONCLUSION: Complementary risk models for maternal and infant outcomes were developed that had satisfactory discriminatory power across a variety of f acilities within a large health system. With further development and refine ment this approach holds promise of being able to detect Variations in risk -adjusted performance that could be used to identify best practices. The re sults might also be used to help coordinate and improve the quality of care for the entire conception-to-delivery process.