933: Frequency of “Unexpected Complications in Term Newborns” quality measure and association with patient characteristics

Abstract

There are limited national data pertaining to the recently introduced perinatal care measure “Unexpected Complications in Term Newborns” (PC-06.0), which is also sub-categorized into severe (PC-06.1) and moderate (PC-06.2). Our objective was to determine the frequencies of these measures in different hospitals, as well as which patient characteristics may be associated with PC-06. This is a secondary analysis of a multi-center randomized clinical trial (RCT) of fetal monitoring with adjunctive ST segment analysis (STAN) performed in 26 hospitals across the US. For this analysis, we excluded cases that would not have been included in the measure, as defined by the Joint Commission, and those who did not have complete data required to evaluate. Univariate and multivariable analysis were performed to determine the association of the measures with patient characteristics. Given that cord gases are not always collected, the analysis was repeated without the criterion of cord artery pH < 7.1. Because the measure is also used as a balancing measure for the NTSV cesarean rate, the analysis was also performed in this subgroup. Of the 11,108 participants randomized, 9,646 met inclusion criteria for this secondary analysis, had complete data to define PC-06, and were delivered at a hospital that enrolled 100 or more women. The frequency of the measures varied between hospitals, and the hospital ranking was not concordant for all 3 measures (Figure A). Several patient characteristics were significantly and independently associated with PC-06.0 (Table). When the measure was evaluated without cord artery pH < 7.1 and when applied to NTSV subgroup, the number of severe cases decreased by half, although the overall frequency of the measure was much higher (Figure B). When using the recently-introduced PC-06 measure to evaluate quality of care or as a balancing measure to the NTSV cesarean rate, it is important to take into consideration that its frequency varies between hospitals and is affected by patient characteristics, and by whether cord gases are performed.View Large Image Figure ViewerDownload Hi-res image Download (PPT)