StORQS: Washington's Statewide Obstetrical Review and Quality System: overview and provider evaluation

Using hospital discharge data for determining neonatal morbidity and mortality: a validation study

BACKGROUND

Despite widespread use of neonatal hospital discharge data, there are few published reports on the accuracy of population health data with neonatal diagnostic or procedure codes. The aim of this study was to assess the accuracy of using routinely collected hospital discharge data in identifying neonatal morbidity during the birth admission compared with data from a statewide audit of selected neonatal intensive care (NICU) admissions.

METHODS

Validation study of population-based linked hospital discharge/birth data against neonatal intensive care audit data from New South Wales, Australia for 2,432 babies admitted to NICUs, 1994-1996. Sensitivity, specificity and positive predictive values (PPV) with exact binomial confidence intervals were calculated for 12 diagnoses and 6 procedures.

RESULTS

Sensitivities ranged from 37.0% for drainage of an air leak to 97.7% for very low birthweight, specificities all exceeded 85% and PPVs ranged from 70.9% to 100%. In-hospital mortality, low birthweight (< or =1500 g), retinopathy of prematurity, respiratory distress syndrome, meconium aspiration, pneumonia, pulmonary hypertension, selected major anomalies, any mechanical ventilation (including CPAP), major surgery and surgery for patent ductus arteriosus or necrotizing enterocolitis were accurately identified with PPVs over 92%. Transient tachypnea of the newborn and drainage of an air leak had the lowest PPVs, 70.9% and 83.6% respectively.

CONCLUSION

Although under-ascertained, routinely collected hospital discharge data had high PPVs for most validated items and would be suitable for risk factor analyses of neonatal morbidity. Procedures tended to be more accurately recorded than diagnoses.

The Washington State Intergenerational Study of Birth Outcomes: methodology and some comparisons of maternal birthweight and infant birthweight and gestation in four ethnic groups

A statewide database of vital records and hospital discharge summaries of obstetric and neonatal admissions for Washington State in 1987-95 was linked to the birth certificates of mothers born in the state. A total of 46,000 births to mothers of four racial/ethnic groups were studied: Whites, African-Americans, Native Americans and Hispanics. For all four groups inverse associations were found between maternal birthweight and infant low birthweight and preterm birth. The birthweight distribution of African-American mothers was displaced markedly downwards compared with the Whites; this difference in maternal birthweight is offered as a partial explanation of the greater prevalence of suboptimal pregnancy outcomes in the former. In contrast, the maternal birthweight distributions of Whites, Native Americans and Hispanics are similar; differences in pregnancy outcomes are probably more related to maternal preconceptional and postnatal factors in these groups as well as differences in pregnancy-related factors. Mothers' birthweight may have clinical value in identifying high-risk pregnancies.

Building the information infrastructure required for managed care

PURPOSE

To describe the information used by health care purchasers, policymakers, and administrators when making the decisions required in a managed-care environment and what the profession must do to develop an information infrastructure to demonstrate its contribution to patient outcomes.

SCOPE

Managed care has created a competitive environment for all health care organizations in which they must offer the best value for their dollar. The purchasing processes germane to managed care rely heavily on information for the selection of cost-effective providers and the provision of efficient care. Information used in these processes is derived from transaction systems that largely describe physician and other health care worker's services, but not nursing care. Data analysis by computers requires that data be obtained using a standardized language. Currently, nursing lacks a unified approach to the use of a standardized nursing language.

CONCLUSIONS

Individual nurses, nurse managers, executives, and educators should strive to develop an information infrastructure that will overcome barriers. Nurses should both adopt a unified approach to a standardized language, and develop a nationwide information infrastructure that will demonstrate nursing's contribution to patient outcomes.

What do women want to know after childbirth?

BACKGROUND

Postpartum women have demonstrated a variety of health care concerns. This study, conducted in Washington state in 1991, investigated predictors of primiparas' and multiparas' desire to receive more information about 18 self-care and baby care topics at 7 weeks postpartum in relation to prenatal class attendance, short postpartum hospital stay, and other variables.

METHODS

Data from 1161 women who completed a survey were analyzed. Percentages of women desiring more information on each topic were calculated stratified by parity; mean numbers of chosen health topics were calculated in relation to prenatal education, length of postpartum hospitalization, maternal age, education, social support, and type of delivery; and association between desire for more information on specific topics and length of postpartum hospitalization, maternal age, maternal education, and social support were calculated.

RESULTS

Over three-fourths of women wanted more information on at least one topic, and the highest percentage wanted more information on exercise, diet, and nutrition; getting along with their other children; and recognizing infant illness. Primiparas and multiparas who desired more information were under 25 years of age and had low levels of social support; in addition, multiparas with unmet information needs had low education and short postpartum stays. Prenatal education was unrelated to postpartum desire for more information.

CONCLUSION

Most postpartum women want self-care and baby care information, a need that is not completely met by prenatal or postpartum education. Postpartum follow-up programs with a strong educational component and special targeting of high-risk women may enable health caregivers to better address this need.