This second model is important because of biases inherent in the general model that is based on all deliveries. The second, restricted model includes only term singleton primiparous women without a history of a prior cesarean delivery. The first, general model includes all women in the dataset to evaluate RACD as a general quality metric for all delivering women. We evaluated RACD as a quality measure in 2 separate population-based cohorts of women to improve the face validity of the results. Combined with prior data, this new analysis will help measure the reproducibility of prior RACD results across different periods of time and across different states. With these concerns, we seek to validate RACD as a measure of obstetric quality by measuring the correlation, or the statistical relationship, between RACD rate and important maternal and neonatal outcomes in recent data from multiple states. 3, 4 These results suggest that both higher and lower-than-expected rates may be associated with adverse maternal and neonatal outcomes, although more evidence is needed. These studies also find those hospitals with a lower-than-expected cesarean delivery rate have higher rates of maternal infection, longer lengths of stay, and neonatal asphyxia than the hospitals in the expected rate group. ![]() Finally, these studies do not compare the association of a hospital’s RACD to other measures, such as the Agency for Healthcare Research and Quality (AHRQ) patient safety indicators, as additional measures of its construct validity. Second, prior studies use data from nearly 10 years ago when the cesarean delivery rate was significantly lower 3– 7 these results have not been validated using more recent data or in additional states. This criticism diminishes its face validity. First, obstetricians argue that using all CD in the measure is inappropriate, because in some situations CD is the standard of care. 2– 4 However, there are several issues with RACD as a quality measure. The risk adjusted cesarean delivery (RACD) rate has historically been a proposed quality measure in obstetric care given its face validity, easy measurability and construct validity demonstrated in prior work where a high cesarean delivery (CD) rate at individual hospitals was associated with other markers of poor quality of care, such as infections, severe perineal lacerations, and neonatal complications. Additionally, the measure should be reproducible across different patient populations and across different time periods. The measure should also have construct validity demonstrating that hospitals that perform well on the quality measure of interest also perform well on other possible measures of quality. 2 A valid obstetric quality measure should have face validity, in which both obstetricians and patients believe that it measures the quality of obstetric care. Despite the over 4 million deliveries in the United States each year 1 there are currently no uniformly accepted measures of obstetric quality.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |