Maternal and Child Health Journal

, Volume 9, Issue 3, pp 307–316

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

  • Lisa M. Korst
  • Moshe Fridman
  • Philippe S. Friedlich
  • Michael C. Lu
  • Carolina Reyes
  • Calvin J. Hobel
  • Gilberto F. Chavez
  • Kimberly D. Gregory
Article

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 

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Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Lisa M. Korst
    • 1
    • 2
    • 3
    • 5
    • 13
  • Moshe Fridman
  • Philippe S. Friedlich
    • 1
    • 2
    • 4
  • Michael C. Lu
    • 7
    • 11
  • Carolina Reyes
    • 5
  • Calvin J. Hobel
    • 6
    • 7
    • 8
    • 10
  • Gilberto F. Chavez
    • 12
  • Kimberly D. Gregory
    • 6
    • 7
    • 8
    • 9
    • 11
  1. 1.Saban Research Institute of Childrens Hospital Los AngelesUniversity of Southern CaliforniaSouthern CaliforniaUSA
  2. 2.Department of Pediatrics, Keck School of MedicineUniversity of Southern CaliforniaSouthern CaliforniaUSA
  3. 3.Division of Research on Children, Youth, and Families, Keck School of MedicineUniversity of Southern CaliforniaSouthern CaliforniaUSA
  4. 4.Division of Neonatal Medicine, Keck School of MedicineUniversity of Southern CaliforniaSouthern CaliforniaUSA
  5. 5.Department of Obstetrics and Gynecology, Keck School of MedicineUniversity of Southern CaliforniaSouthern CaliforniaUSA
  6. 6.Burns and Allen Research Institute of Cedars-Sinai Medical CenterCedars-SinaiUSA
  7. 7.Department of Obstetrics and Gynecology, David Geffen School of MedicineUniversity of CaliforniaLos AngelesUSA
  8. 8.Division of Maternal-Fetal Medicine, David Geffen School of MedicineUniversity of CaliforniaLos AngelesUSA
  9. 9.Division of Women's Health Services Research and Policy, David Geffen School of MedicineUniversity of CaliforniaLos AngelesUSA
  10. 10.Department of Pediatrics, David Geffen School of MedicineUniversity of CaliforniaLos AngelesUSA
  11. 11.Department of Community Health Sciences, School of Public HealthUniversity of CaliforniaLos AngelesUSA
  12. 12.California Department of Health ServicesCaliforniaUSA
  13. 13.LAC+USC Women's and Children's HospitalLos AngelesUSA

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