Hospital Rates of Maternal and Neonatal Infection in a Low-Risk Population |
| |
| Authors: | Lisa M. Korst,Michael C. Lu,Carolina Reyes,Calvin J. Hobel,Kimberly D. Gregory |
| |
| Affiliation: | (1) Saban Research Institute of Childrens Hospital Los Angeles, University of Southern California, Southern California, USA;(2) Department of Pediatrics, Keck School of Medicine, University of Southern California, Southern California, USA;(3) Division of Research on Children, Youth, and Families, Keck School of Medicine, University of Southern California, Southern California, USA;(4) Division of Neonatal Medicine, Keck School of Medicine, University of Southern California, Southern California, USA;(5) Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Southern California, USA;(6) Burns and Allen Research Institute of Cedars-Sinai Medical Center, Cedars-Sinai, USA;(7) Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, USA;(8) Division of Maternal-Fetal Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA;(9) Division of Women's Health Services Research and Policy, David Geffen School of Medicine, University of California, Los Angeles, USA;(10) Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, USA;(11) Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, USA;(12) California Department of Health Services, California, USA;(13) LAC+USC Women's and Children's Hospital, 1240 North Mission Road, 5K40, Los Angeles, CA 90033, USA |
| |
| Abstract: | Background: In 2003, the Agency for Healthcare Quality and Research (AHRQ) published its Quality Indicators for healthcare, and set out methodological criteria for the evaluation of potential candidates. Objectives: Because perinatal infections may result from poor obstetrical practices, we intended to describe the variability of maternal and congenital neonatal infections across different types of hospital ownership (e.g., not for profit, government), and to assess whether rates of these infections meet criteria as quality indicators. Research Design: Population-based cohort study. Subjects: All laboring women without maternal, fetal, or placental complications who delivered in California in 1997, and their neonates, as reported through hospital discharge data. Measures: A Bayesian hierarchical logistic regression model was used to quantify the effects of both “patient-level” risk factors such as parity and prior cesarean history, and “hospital-level” risk factors such as ownership and teaching status. Results: The 308,841 mother–newborn pairs in this low-risk study population delivered at 281 hospitals; 0.39% had uterine infections and 1.3% had neonatal infections. Hospital ownership and teaching status were strongly associated with perinatal infection. Secondly, methods used to estimate and analyze hospital-specific infection rates identified hospitals with exceptionally high rates. Twenty-eight hospitals had neonatal infection rates that ranged from 3% to 28%. Conclusions: The methods presented here were consistent with AHRQ methods and criteria for potential Quality Indicators. They also identified hospitals with exceptionally high rates of infectious morbidity. The relationship between hospital ownership and obstetrical practice patterns, and the feasibility of practice improvement, remain to be studied. |
| |
| Keywords: | quality indicators obstetrical care endometritis neonatal sepsis hierarchical modeling |
| 本文献已被 PubMed SpringerLink 等数据库收录！ |
|
