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Childbirth


These indicators summarize Cesarean-section (C-section) rates and other data associated with childbirth. Obstetric practices have changed considerably in recent years, so the applicability of these indicators and the accuracy of the national comparative data are unclear. At Norton Healthcare, only Norton Hospital and Norton Suburban Hospital deliver babies. The Norton Healthcare column combines the performance of the two hospitals.

Vaginal deliveries - percent of patients with
Number of instrument-assisted vaginal deliveries per 100 with a laceration (cut or tear). Instrument assistance, such as forceps or vacuum extractors, may be used when the last phase of labor is not progressing and mother and baby are becoming exhausted. Risk-adjusted for age and comorbidity categories. Includes vaginal delivery discharges with a procedure code for instrument-assisted delivery. Laceration is defined as the presence of selected diagnosis or procedure codes.(NQF HC 31 / AHRQ PSI 18) injury/tear - delivery with instrument low     3 15   8   14
Number of vaginal deliveries without instrument assistance per 100 with a laceration (cut or tear). Risk-adjusted for age and comorbidity categories. Includes vaginal delivery discharges. Excludes patients with a procedure code of instrument-assisted delivery. Laceration is defined as the presence of selected diagnosis or procedure codes.(NQF HC 31 / AHRQ PSI 19) injury/tear - delivery without instrument low     1.6 3.4   2.8   2.2
% of vaginal deliveries with episiotomy Denominator includes inpatient discharges assigned to a vaginal delivery DRG 767, 768, 774, or 775, excluding cases with shoulder dystocia defined by ICD-9 660.41 or 660.42. Numerator includes cases from the denominator with an episiotomy procedure defined by ICD-9 codes 72.1, 72.21, 72.31, 72.71, or 73.6.(NQF) incidence of episiotomy low     4.8 11   8.8    
Cesarean deliveries - percent of patients with
C-section rate for low-risk women having their first baby Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean section (calculated using direct standardization)(NQF) low-risk, first birth cesarean deliveries low     38 31   32    
Preventative antibiotics given before C-section Included in the numerator are patients who received prophylactic antibiotics within one hour prior to surgical incision or at the time of delivery. The denominator includes C-section patients. Patients with evidence of prior infection are excluded.(NQF) prophylactic antibiotic given prior to surgery high     81 92   88    
Percent of mothers undergoing cesarean delivery receiving treatment to reduce risk of blood clots (deep vein thrombosis (DVT) prophylaxis) All mothers undergoing cesarean delivery (MSDRG 765 or 766) who receive either fractionated or unfractionated heparin or pneumatic compression devices prior to surgery(HCA/St. Marks Perinatal Center) appropriate DVT prophylaxis given prior to surgery high     66 91   82    
Additional deliveries - percent of patients with
Elective delivery more than one week before due date Babies electively delivered prior to 39 completed weeks gestation. Included in the numerator are elective deliveries >=37 and < 39 weeks completed gestation. The denominator includes all deliveries >=37 weeks, with specified exclusions.(NQF) elective delivery prior to 39 completed weeks gestation low     10 7.8   8.7 10 20
Percent of mothers with preterm delivery at 24-32 weeks gestation receiving antenatal steroids prior to delivering preterm newborns Beginning with 01/01/2013 discharges the requirement for full dose of antenatal steroid changed to initiation of antenatal therapy before delivery.(NQF) appropriate use of antenatal steroids with preterm delivery high     98 98   98   98
Newborns - percent of patients with
Number of newborns per 100 with a birth trauma. Birth trauma is a physical injury to the infant during delivery. Risk-adjusted for infant sex. Includes liveborn births. Excludes infants with a subdural or cerebral hemorrhage and any diagnosis of pre-term infant, and infants with injury to skeleton and any diagnosis of osteogenesis imperfecta.(AHRQ PSI 17) birth trauma or injury low     0.19 0.20   0.20   0.23
Infants who were given only breastmilk during their hospital stay Exclusive breast milk feeding during the newborn's entire hospitalization.(NQF) exclusive breastfeeding during hospitalization high     12 44   33   40
Infants born under 3 lb. 5 oz. whose first temperature was taken within one hour of admission to NICU very low birth weight, admit temp taken w/in 1 hr of NICU admit high       98 98 98    
Infants born under 3 lb. 5 oz. whose first temperature was below 36 degrees Celsius (96.8 degrees F). very low birth weight w/ NICU admit, first temp < 36 degrees low       10 6.4 7.2    
Infants born 11-18 weeks early who were treated with surfactant (a drug given to help prevent the collapse of air sacs in the lungs) within 2hrs of birth premature birth, given surfactant w/in 2hrs of birth high       82 78 79    
Immunization - percent of newborns with
Hepatitis B vaccines given to all newborns prior to discharge hepatitis B vaccine given prior to discharge high     94 100 77 95 77 61
Early (within 12 hours of birth) dose of hepatitis B vaccine and hepatitis immune globulin for newborns of mothers with chronic hepatitis B Included in the numerator are newborns receiving birth doses of hepatitis B vaccine and hepatitis immune globulin within 12 hours of delivery. The denominator includes newborns delivered from mothers who tested positive for hepatitis B during pregnancy.(NQF) appropriate birth dose of hepatitis B vaccine & immune globulin (mother w/ HBV) high     # #   #    
Miscellaneous
Is this hospital a level III or equivalent NICU (infants under 1500g delivered at appropriate site)? Is hospital level III or equal NICU (babies <1500g delivered site appropriate)? high     yes yes yes yes    

The following set of indicators do not have a desired direction.

Vaginal birth after cesarean (VBAC) rates
Number of vaginal deliveries per 100 deliveries with a previous Cesarean delivery (C-section). C-sections are deliveries performed by making an incision (surgical cut) in the mother's abdomen and uterus. NQF considers this a neutral indicator, so it is unclear whether high or low numbers are better. Risk-adjusted for age. Includes all deliveries with a diagnosis of previous C-section.(NQF HC 30 / AHRQ IQI 34) all VBAC deliveries ?     7.6 3.6   5.1   8.6
Number of vaginal deliveries per 100 uncomplicated deliveries among patients with a previous Cesarean delivery (C-section). C-sections are deliveries performed by making an incision (surgical cut) in the mother's abdomen and uterus. NQF considers this a neutral indicator, so it is unclear whether high or low numbers are better. Risk-adjusted for age. Includes all uncomplicated deliveries with a diagnosis of previous C-section. Excludes patients with abnormal presentation, preterm delivery, fetal death, multiple gestation diagnosis codes, and breech procedure codes.(NQF HC 30 / AHRQ IQI 22) uncomplicated VBAC deliveries ?     7.1 3.5   4.7   8.7
Cesarean delivery rates
Number of deliveries per 100 that were Cesarean (C-section) deliveries. C-sections are deliveries performed by making an incision (surgical cut) in the mother's abdomen and uterus. This indicator includes repeat C-section deliveries. NQF considers repeat C-section rate a neutral indicator, so it is unclear whether high or low numbers are better. Risk-adjusted for age. Excludes patients with abnormal presentation, preterm delivery, fetal death, multiple gestation diagnosis codes, and breech procedure codes.(NQF 33 / AHRQ IQI 21) primary and repeat cesarean deliveries ?     37 35   35   30

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