Measure Information Form

**NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE** Measure Set: Perinatal Care (PC) Set Measure ID: PC-06 Set Measure ID Performance Measure Name PC-06.0 Unexpected Complications in Term Newborns – Overall Rate PC-06.1 Unexpected Complications in Term Newborns – Severe Rate PC-06.2 Unexpected Complications in Term Newborns – Moderate Rate Performance Measure Name: Unexpected Complications in Term Newborns Description: Unexpected complications among full term newborns with no preexisting conditions.

Severe complications include neonatal death, transfer to another hospital for higher level of care, severe birth injuries such as intracranial hemorrhage or nerve injury, neurologic damage, severe respiratory and infectious complications such as sepsis.

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Moderate complications include diagnoses or procedures that raise concern but at a lower level than the list for severe e.g. use of CPAP or bone fracture. Examples include less severe respiratory complications e.g. Transient Tachypnea of the Newborn, or infections with a longer length of stay not including sepsis, infants who have a prolonged length of stay of over 5 days.

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Rationale: The most important childbirth outcome for families is bringing home a healthy baby. While there have been measures developed to assess clinical practices and outcomes in preterm infants, there is a lack of metrics that assess the health outcomes of term infants who represent over 90% of all births. This measure addresses this gap and gauges adverse outcomes resulting in severe or moderate morbidity in otherwise healthy term infants without preexisting conditions. This measure also uses length of stay (LOS) modifiers to guard against overcoding and undercoding of diagnoses. Importantly, this metric also serves as a balancing measure for other maternal measures such as NTSV Cesarean rates and early elective delivery rates. The purpose of a balancing measure is to guard against any unanticipated or unintended consequences of quality improvement activities for these measures. Type Of Measure: Outcome Improvement Noted As: Decrease in the rate Risk Adjustment: No. Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Data Accuracy: Variation may exist in the assignment of ICD-10 codes; therefore, coding practices may require evaluation to ensure consistency. Measure Analysis Suggestions: In order to identify areas for improvement, hospitals may want to review results based on specific ICD-10 codes or patient populations. Data could then be analyzed further to determine specific patterns or trends to help reduce unexpected newborn complications. Sampling: No. Data Reported As: Aggregate rate generated from count data reported as a rate per 1000 livebirths. Note: All 3 sub-measures will have the same Final Denominator. Final Denominator = Number of patients in Overall Numerator (PC-06.0=category E) + Number of cases in Overall Denominator (PC-06.0= category of D) Rate Calculation: PC-06.0: Overall rate = ((Number of patients with Severe Complications + Number of patients with Moderate Complications) / Final Denominator) * 1000 PC-06.1: Severe rate = (Number of patients with Severe Complications / Final Denominator) * 1000 PC-06.2: Moderate rate = (Number of patients with Moderate Complications / Final Denominator) * 1000 Selected References:

• Martin JA, Hamilton BE, Ventura SJ et al. Births: Final data for 2010. National vital statistics reports; vol 61 no1. Hyattsville, MD: National Center for health Statistics. 2012
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• Gregory KD, Fridman M, Shah S et al. Global measures of quality and patient safety-related childbirth outcomes: should we monitor adverse or ideal rates? Am J Obstet Gynecol 2009;200:681.e1-681.e7.
• Profit J, Zupancic JA, Gould JB et al. Implementing pay-for-performance in the neonatal intensive care unit. Pediatrics 2007;119:975-82
• Operative Vaginal Delivery. Practice Bulletin No. 17. American College of Obstetricians and Gynecologists. Obstet Gynecol 2000;1-8
• Shoulder dystocia. ACOG Practice Bulletin No. 40. American College of Obstetrician and Gynecologists. Obstet Gynecol 2002;100:1045-50
• Centers for Disease Control and Prevention. Prevention of Perinatal Group B Streptococcal Disease. MMWR 2010;59 (No. RR 10): 1-36 http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf
• Wilmink FA, Hukkelhoven CW, Lunshof, S et al. Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7- year retrospective analysis of a national registry.2010 Am J Obstet Gynecol 2002:250.e1-8
• Tita AT, Landon MB, Spong CY et al. Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes. N Engl J Med 2009;360(2):111-20
• Hansen AK, Wisborg K, Uldbjerg N. Risk of respiratory morbidity in term infants delivered by elective cesarean section: cohort study. BMJ 2008;336:85
• Spong CY. Defining “Term” pregnancy: Recommendations from the defining “term” pregnancy workgroup. JAMA. 2013 Jun 19;309(23):2445-6.
• Zhang X and Kramer MS. Variations in Mortality and Morbidity by Gestational Age among Infants Born at Term. J Pediatr 2009;154:358-62
• Fleischman AR, Oinuma M and Clark SL. Rethinking the Definition of “Term Pregnancy”. Obstet Gynecol 2010;116(1)136-139
• Clark SL, Miller DD, Belfort MA, et al. Neonatal and maternal outcomes associated with elective term delivery. Am J Obstet Gynecol 2009;200:156.e1-156.e4
• Reddy UM, Bettegowda VR, Dias T et al. Term Pregnancy: A period of Heterogeneous Risk for Infant Mortality. Obstet Gynecol 2011;117:1279-1287
• “Unexpected Complications in Term Newborns.” California Maternal Quality Care Collaborative (CMQCC), 2018, www.cmqcc.org/focus-areas/quality-metrics/unexpected-complications-term-newborns.

Original Performance Measure Source / Developer: California Maternal Quality Care Collaborative

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