A new data collection method instituted by the Louisiana Department of Health and Hospitals is valid to inform quality improvement and payment reform related to elective deliveries, according to a new study by researchers at Brown University, Louisiana State University, and the National Perinatal Information Center.
[Photo: Dr. Valery Danilack]
In 2012, the Louisiana Department of Health and Hospitals implemented a high priority birth outcomes initiative primarily aimed at improving hospital-based maternity care. There was a growing concern about increasing rates of elective deliveries, which has been shown to result in poorer newborn outcomes than full-term deliveries. However, there were concerns that birth certificate data may not be detailed enough to provide a complete determination of whether a delivery should be classified as elective. Subsequently, the birth certificate was modified to collect a more comprehensive list of the reasons for births occurring before 39 weeks instead of relying, as had been traditionally done, on chart abstraction.
Led by Dr. Valery Danilack, Assistant Professor in the Departments of Epidemiology and Obstetrics and Gynecology, the researchers compared the new birth certificate data to hospital discharge data and the Joint Commission Early Elective Deliveries measure, which represents a national benchmark definition for early elective delivery. Among 4353 birth certificates indicating delivery at Women’s Hospital in Baton Rouge, Louisiana, 99.5% were matched to corresponding Woman’s administrative data. Among 1293 early term singleton births, the most common reasons for early delivery listed on the birth certificate were spontaneous active labor (57.5%), gestational hypertensive disorders (15.3%), gestational diabetes (8.7%) and premature rupture of membranes (8.1%). Most reasons for early delivery had greater than 80% correspondence with hospital discharge codes.
The results of this study, published in Maternal and Child Health Journal, suggest that the agreement between established data and the new birth certificate data is high, and can be considered a valid source from which to base quality improvement and payment reform.