Can Differences in Obstetric Outcomes Be Explained by Differences in the Care Provided? The MFMU Network APEX Study

Citation

Grobman, William A.; Bailit, Jennifer L.; Rice, Madeline Murguia; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M., Jr.; Leveno, Kenneth J.; Caritis, Steve N.; Iams, Jay D.; & Tita, Alan T. N., et al. (2014). Can Differences in Obstetric Outcomes Be Explained by Differences in the Care Provided? The MFMU Network APEX Study. American Journal of Obstetrics & Gynecology, 211(2), 147.e1–16. PMCID: PMC4117924

Abstract

OBJECTIVE: To determine whether hospital differences in the frequency of adverse obstetric outcomes are related to differences in care.
STUDY DESIGN: The Assessment of Perinatal EXcellence (APEX) cohort of 115,502 women and their neonates born in 25 hospitals in the United States between March 2008 and February 2011. Hierarchical logistic regression was used to quantify the amount of variation in postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite adverse neonatal outcome among hospitals that is explained by differences in patient characteristics, hospital characteristics, and the obstetric care provided.
RESULTS: 115,502 women were included in the study. For most outcomes, between 20 and 40% of hospital differences in outcomes were related to differences in patient populations. After controlling for patient-, provider- and hospital-level factors, multiple care processes were associated with the predefined adverse outcomes, but these care processes did not explain significant variation in the frequency of adverse outcomes among hospitals. Ultimately, between 50 and 100% of the inter-hospital variation in outcomes was unexplained.
CONCLUSION: Hospital differences in the frequency of adverse obstetric outcomes could not be explained by differences in frequency of types of care provided.

URL

http://dx.doi.org/10.1016/j.ajog.2014.03.017

Reference Type

Journal Article

Year Published

2014

Journal Title

American Journal of Obstetrics & Gynecology

Author(s)

Grobman, William A.
Bailit, Jennifer L.
Rice, Madeline Murguia
Wapner, Ronald J.
Varner, Michael W.
Thorp, John M., Jr.
Leveno, Kenneth J.
Caritis, Steve N.
Iams, Jay D.
Tita, Alan T. N.
Saade, George R.
Sorokin, Yoram
Rouse, Dwight J.
Tolosa, Jorge E.
VanDorsten, J. Peter, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network

PMCID

PMC4117924

ORCiD

Thorp - 0000-0002-9307-6690