Unexpected Complications in Term Newborns

This measure assesses the 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.

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.

Measure specifications are in the Public Domain.

LOINC(R) copyright 2004-2019 Regenstrief Institute, Inc. 

This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2019 International Health Terminology Standards Development Organization. All Rights Reserved.

These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.

Stratification 1 - Severe Complications
Stratification 2 - Moderate Complications

None

Aggregate rate generated from count data reported as a rate per 1000 livebirths.

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.

The birth of a baby is the most common reason for hospitalization in the United States and accounts for over half of all hospital admissions. Since childbirth comprises such a large portion of US hospital care, the quality of health care delivered to mothers and their babies should be a focal point for hospitals and health care providers. This hospital level performance metric captures and quantifies neonatal morbidity while accounting for severity of the condition, delivery route (vaginal or cesarean) and neonatal length of stay. There are significant opportunities to improve care for healthy term infants. Labor, birth management and delivery type can lead to birth injuries, trauma, respiratory complications, hypoxia/asphyxia events and neurologic complications. The ability to evaluate trends and risks across the spectrum of term gestation is limited for mortality and morbidity. This measure addresses this gap by capturing and quantifying severe and moderate neonatal morbidities in term infants that could possibly be reduced or prevented by modifying obstetric and neonatal care practices at the hospital level.

Improvement noted as a decrease in the rate

Reference Type: CITATION

Reference Text: 'Martin, J.A., Hamilton, B.E., Ventura, S.J. et al. (2012). Births: final data for 2010. National Vital Statistics Reports, 61(1).'

Reference Type: CITATION

Reference Text: 'Russo, C.A., Andrews, R.M. (2009, June). Potentially avoidable injuries to mothers and newborns during childbirth, 2006. HCUP Statistical Brief Number 74. Rockville, MD. Agency for Healthcare Research and Quality. Retrieved from https://www.hcup-us.ahrq.gov/reports/statsbriefs/sb74.pdf'

Reference Type: CITATION

Reference Text: 'Gregory, K.D., Fridman, M., Shah, S., et al. (2009). Global measures of quality and patient safety-related childbirth outcomes: should we monitor adverse or ideal rates? American Journal of Obstetrics and Gynecology, 200, 681.e1-681.e7.'

Reference Type: CITATION

Reference Text: 'Profit, J. Zupancic, J.A., Gould, J.B., et al. (2007). Implementing pay-for-performance in the neonatal intensive care unit. Pediatrics, 119, 975-982.'

Reference Type: CITATION

Reference Text: 'American College of Obstetricians and Gynecologists. (2000). Operative vaginal delivery. Practice bulletin number 17. Obstetrics and Gynecology, 1-8.'

Reference Type: CITATION

Reference Text: 'American College of Obstetricians and Gynecologists. (2002). Shoulder dystocia. ACOG Practice bulletin number 40. Obstetrics and Gynecology, 100, 1045-1050.'

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. (2010). Prevention of perinatal group b streptococcal disease. Morbidity and Mortality Weekly Report, RR10, 1-36.'

Reference Type: CITATION

Reference Text: 'Wilmink, F.A., Hukkelhoven, C.W., Lunshof, S., et al. (2002). Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry. American Journal of Obstetrics and Gynecology, 250, e1-e8.'

Reference Type: CITATION

Reference Text: 'Tita, A.T., Landon, M.B., Spong, C.Y., et al. (2009). Timing of elective repeat cesarean delivery at term and neonatal outcomes. New England Journal of Medicine, 360(2), 111-120.'

Reference Type: CITATION

Reference Text: 'Hansen, A.K., Wisborg, K., Uldbjerg, N. (2008). Risk of respiratory morbidity in term infants delivered by elective cesarean section: cohort study. British Medical Journal, 336, 85.'

Reference Type: CITATION

Reference Text: 'Spong, C.Y. (2013, June 19). Defining “Term” pregnancy: recommendations from the defining “term” pregnancy workgroup. Journal of the American Medical Association, 309(23), 2445-2446.'

Reference Type: CITATION

Reference Text: 'Zhang, X., Kramer, M.S. (2009). Variations in mortality and morbidity by gestational age among infants born at term. Journal of Pediatrics, 154, 358-362.'

Reference Type: CITATION

Reference Text: 'Fleischman, A.R., Oinuma, M., Clark, S.L. (2010). Rethinking the definition of “Term” pregnancy”. Obstetrics and Gynecology, 116, 136-139.'

Reference Type: CITATION

Reference Text: 'Clark, S.L., Miller, D.D., Belfort, M.A., et al. (2009). Neonatal and maternal outcomes associated with elective term delivery. American Journal of Obstetrics and Gynecology, 200, 156.e1-156.e4.'

Reference Type: CITATION

Reference Text: 'Reddy, U.M., Bettegowda, V.R., Dias, T., et al. (2011). Term pregnancy: a period of heterogeneous risk for infant mortality. Obstetrics and Gynecology, 117, 1279-1287.'

Reference Type: CITATION

Reference Text: 'California Maternal Quality Care Collaborative (CMQCC). (2018). Unexpected complications in term newborns. Retrieved from https://www.cmqcc.org/focus-areas/quality-metrics/unexpected-complication-term-newborns'

None

A discharge to a designated cancer center or children's hospital should be captured as a discharge to an acute care facility.

Data shows that the majority of newborns with gestational age 37 weeks or more have a birth weight 3000 grams or more. Birth weight 3000 grams or more is a proxy to capture term newborns without gestational age recorded in EHR system. Only one birth weight value should be recorded. In cases where there is conflicting data, use the document recording the birth weight closest to the time of delivery. 

This eCQM is an episode-based measure. 

This version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

TBD

Inpatient hospitalization for single newborns who were born in the hospital that ends during the measurement period, and with either of the following conditions:
   - An estimated gestational age at birth of >=37 weeks  
   - Birth weight 3000 grams or more without an estimated gestational age at birth

Initial Population

Inpatient hospitalization for newborns who were born with congenital malformations and genetic diseases, pre-existing fetal conditions, or maternal drug use exposure in-utero.

Inpatient hospitalization for newborns with severe or moderate complications:  

Severe Complications as any of the following conditions - 
   - Discharge status of patient expired or discharged to an acute care facility
   - Severe morbidities diagnoses, including:
  	- Severe birth trauma
       	- Severe hypoxia asphyxia
      	- Severe shock and resuscitation
       	- Neonatal severe respiratory complications
       	- Neonatal severe infection
       	- Neonatal severe neurological complications
   - Severe morbidities procedures, including:
      	- Severe shock and resuscitation procedures
       	- Neonatal severe respiratory procedures
       	- Neonatal severe neurological procedures
   - Severe septicemia with length of stay more than 4 days

Moderate Complications as any of the following conditions - 
   - Moderate complications diagnoses, including:
       	- Moderate birth trauma
       	- Moderate respiratory complications
   - Moderate complications procedures, including:
      	 - Moderate respiratory complications procedures 
   - Vaginal delivery with length of stay more than 2 days OR cesarean birth with length of stay more than 4 days, who have any of the following:
      	- Moderate complications diagnoses, including:
           		- Moderate Birth Trauma
           		- Moderate Respiratory complications
           		- Moderate Infection
       	- Moderate complications procedures, including:
           		- Moderate neurological complications procedures
           		- Moderate respiratory complications procedures
   - Length of stay more than 5 days without jaundice and social indications

None

None

For every patient evaluated by this measure also identify payer, race, ethnicity, and sex

eMeasure Perinatal Care (ePC)