Article

Maternal and Child Health Journal

, Volume 9, Issue 3, pp 307-316

First online:

Hospital Rates of Maternal and Neonatal Infection in a Low-Risk Population

  • Lisa M. KorstAffiliated withSaban Research Institute of Childrens Hospital Los Angeles, University of Southern CaliforniaDepartment of Pediatrics, Keck School of Medicine, University of Southern CaliforniaDivision of Research on Children, Youth, and Families, Keck School of Medicine, University of Southern CaliforniaDepartment of Obstetrics and Gynecology, Keck School of Medicine, University of Southern CaliforniaLAC+USC Women's and Children's Hospital Email author 
  • , Moshe Fridman
  • , Philippe S. FriedlichAffiliated withSaban Research Institute of Childrens Hospital Los Angeles, University of Southern CaliforniaDepartment of Pediatrics, Keck School of Medicine, University of Southern CaliforniaDivision of Neonatal Medicine, Keck School of Medicine, University of Southern California
  • , Michael C. LuAffiliated withDepartment of Obstetrics and Gynecology, David Geffen School of Medicine, University of CaliforniaDepartment of Community Health Sciences, School of Public Health, University of California
  • , Carolina ReyesAffiliated withDepartment of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California
  • , Calvin J. HobelAffiliated withBurns and Allen Research Institute of Cedars-Sinai Medical CenterDepartment of Obstetrics and Gynecology, David Geffen School of Medicine, University of CaliforniaDivision of Maternal-Fetal Medicine, David Geffen School of Medicine, University of CaliforniaDepartment of Pediatrics, David Geffen School of Medicine, University of California
  • , Gilberto F. ChavezAffiliated withCalifornia Department of Health Services
  • , Kimberly D. GregoryAffiliated withBurns and Allen Research Institute of Cedars-Sinai Medical CenterDepartment of Obstetrics and Gynecology, David Geffen School of Medicine, University of CaliforniaDivision of Maternal-Fetal Medicine, David Geffen School of Medicine, University of CaliforniaDivision of Women's Health Services Research and Policy, David Geffen School of Medicine, University of CaliforniaDepartment of Community Health Sciences, School of Public Health, University of California

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

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.

KEY WORDS:

quality indicators obstetrical care endometritis neonatal sepsis hierarchical modeling