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Case mix adjustment of health outcomes, resource use and process indicators in childbirth care : A register-based study

Mesterton, Johan; Lindgren, Peter; Ekenberg Abreu, Anna; Ladfors, Lars; Lilja, Monica LU ; Saltvedt, Sissel and Amer-Wåhlin, Isis LU (2016) In BMC Pregnancy and Childbirth 16(1).
Abstract

Background: Unwarranted variation in care practice and outcomes has gained attention and inter-hospital comparisons are increasingly being used to highlight and understand differences between hospitals. Adjustment for case mix is a prerequisite for meaningful comparisons between hospitals with different patient populations. The objective of this study was to identify and quantify maternal characteristics that impact a set of important indicators of health outcomes, resource use and care process and which could be used for case mix adjustment of comparisons between hospitals. Methods: In this register-based study, 139 756 deliveries in 2011 and 2012 were identified in regional administrative systems from seven Swedish regions, which... (More)

Background: Unwarranted variation in care practice and outcomes has gained attention and inter-hospital comparisons are increasingly being used to highlight and understand differences between hospitals. Adjustment for case mix is a prerequisite for meaningful comparisons between hospitals with different patient populations. The objective of this study was to identify and quantify maternal characteristics that impact a set of important indicators of health outcomes, resource use and care process and which could be used for case mix adjustment of comparisons between hospitals. Methods: In this register-based study, 139 756 deliveries in 2011 and 2012 were identified in regional administrative systems from seven Swedish regions, which together cover 67 % of all deliveries in Sweden. Data were linked to the Medical birth register and Statistics Sweden's population data. A number of important indicators in childbirth care were studied: Caesarean section (CS), induction of labour, length of stay, perineal tears, haemorrhage > 1000 ml and post-partum infections. Sociodemographic and clinical characteristics deemed relevant for case mix adjustment of outcomes and resource use were identified based on previous literature and based on clinical expertise. Adjustment using logistic and ordinary least squares regression analysis was performed to quantify the impact of these characteristics on the studied indicators. Results: Almost all case mix factors analysed had an impact on CS rate, induction rate and length of stay and the effect was highly statistically significant for most factors. Maternal age, parity, fetal presentation and multiple birth were strong predictors of all these indicators but a number of additional factors such as born outside the EU, body mass index (BMI) and several complications during pregnancy were also important risk factors. A number of maternal characteristics had a noticeable impact on risk of perineal tears, while the impact of case mix factors was less pronounced for risk of haemorrhage > 1000 ml and post-partum infections. Conclusions: Maternal characteristics have a large impact on care process, resource use and outcomes in childbirth care. For meaningful comparisons between hospitals and benchmarking, a broad spectrum of sociodemographic and clinical maternal characteristics should be accounted for.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Caesarean section, Case mix adjustment, Childbirth, Length of stay, Outcomes, Value-based health care
in
BMC Pregnancy and Childbirth
volume
16
issue
1
publisher
BioMed Central
external identifiers
  • Scopus:84971510699
ISSN
1471-2393
DOI
10.1186/s12884-016-0921-0
language
English
LU publication?
yes
id
b7abac44-3fa3-4786-bb80-ae26813d7d76
date added to LUP
2016-06-17 11:24:15
date last changed
2016-11-17 12:18:53
@misc{b7abac44-3fa3-4786-bb80-ae26813d7d76,
  abstract     = {<p>Background: Unwarranted variation in care practice and outcomes has gained attention and inter-hospital comparisons are increasingly being used to highlight and understand differences between hospitals. Adjustment for case mix is a prerequisite for meaningful comparisons between hospitals with different patient populations. The objective of this study was to identify and quantify maternal characteristics that impact a set of important indicators of health outcomes, resource use and care process and which could be used for case mix adjustment of comparisons between hospitals. Methods: In this register-based study, 139 756 deliveries in 2011 and 2012 were identified in regional administrative systems from seven Swedish regions, which together cover 67 % of all deliveries in Sweden. Data were linked to the Medical birth register and Statistics Sweden's population data. A number of important indicators in childbirth care were studied: Caesarean section (CS), induction of labour, length of stay, perineal tears, haemorrhage &gt; 1000 ml and post-partum infections. Sociodemographic and clinical characteristics deemed relevant for case mix adjustment of outcomes and resource use were identified based on previous literature and based on clinical expertise. Adjustment using logistic and ordinary least squares regression analysis was performed to quantify the impact of these characteristics on the studied indicators. Results: Almost all case mix factors analysed had an impact on CS rate, induction rate and length of stay and the effect was highly statistically significant for most factors. Maternal age, parity, fetal presentation and multiple birth were strong predictors of all these indicators but a number of additional factors such as born outside the EU, body mass index (BMI) and several complications during pregnancy were also important risk factors. A number of maternal characteristics had a noticeable impact on risk of perineal tears, while the impact of case mix factors was less pronounced for risk of haemorrhage &gt; 1000 ml and post-partum infections. Conclusions: Maternal characteristics have a large impact on care process, resource use and outcomes in childbirth care. For meaningful comparisons between hospitals and benchmarking, a broad spectrum of sociodemographic and clinical maternal characteristics should be accounted for.</p>},
  author       = {Mesterton, Johan and Lindgren, Peter and Ekenberg Abreu, Anna and Ladfors, Lars and Lilja, Monica and Saltvedt, Sissel and Amer-Wåhlin, Isis},
  issn         = {1471-2393},
  keyword      = {Caesarean section,Case mix adjustment,Childbirth,Length of stay,Outcomes,Value-based health care},
  language     = {eng},
  month        = {05},
  number       = {1},
  publisher    = {ARRAY(0xc5b6d68)},
  series       = {BMC Pregnancy and Childbirth},
  title        = {Case mix adjustment of health outcomes, resource use and process indicators in childbirth care : A register-based study},
  url          = {http://dx.doi.org/10.1186/s12884-016-0921-0},
  volume       = {16},
  year         = {2016},
}