In search of perinatal quality outcome measures: 1 hospital's in-depth analysis of the Adverse Outcomes Index

Abstract

The purpose of this study was to assess the Adverse Outcome Index perinatal quality indicator system that was derived from administrative data. Adverse events were identified for 10 component measures; the Adverse Outcome Index was calculated by the National Perinatal Information Center from 42 months of administrative data. After retrospective chart review, we estimated positive predictive value for 10 measures that were obtained by corrected calculations of Adverse Outcome Index. Positive predictive values were 86-100% in 7 indicators, with lower values in 3 indicators: neonatal death, 0/2 fetuses; inborn birth trauma, 22/33 infants (67%); and maternal return to the operating room, 16/33 women (48.5%). In term admission to the neonatal intensive care unit, 107 false negatives were identified, with a negative predictive value of 45%. Indicator positive predictive value was variable. Performance can be strengthened by methods to identify both false-positive and false-negative adverse events that would include chart review and some measure specification revisions to improve alignment with original indicator intent. Interhospital comparison application requires further study.