The Opportunity

This project seeks to identify and endorse performance measures for accountability and quality improvement that specifically address conditions, treatments, interventions, or procedures relating to reproductive health, pregnancy planning and contraception, pregnancy, childbirth, and post-partum and neonatal care. As part of this project, twenty-four (24) NQF-endorsed measures that are due for maintenance of endorsement review will be re-evaluated against the most recent NQF measure evaluation criteria. Specific conditions and topics addressed by these endorsed measures include: cesarean section rates, early elective deliveries, maternal and newborn infection rates, access to prenatal and postpartum care, screening measures, and breastfeeding measures.

Despite the fact that the US spends more on perinatal healthcare than any other health sector ($111 billion in 2010)¹ the US is ranked 61st in the world for maternal health². In 2014, there were nearly 4 million births in the United States³ and more than half of all hospital stays were a result of premature birth, low birth weight, or inadequate fetal growth⁴. Pregnancy- and childbirth-related procedures accounted for four out of the five most common procedures for individuals ages 18-44 in 2011⁵. The two most common conditions billed to Medicaid as the primary payer in 2010 were pregnancy and childbirth (24%) and newborns (23%), which together comprised 47% of discharges billed to Medicaid⁶. For the 61 million women of reproductive age in the US access to high-quality care before and between pregnancies, including pregnancy planning, contraception and preconception care, can reduce the risk of pregnancy-related complications, including maternal and infant mortality.⁷

Disparities in access to quality reproductive and perinatal care and in outcomes among different racial and ethnic groups in the US, as well as sociodemographic disparities, are major topics of interest for quality measurement.⁸ Deaths during pregnancy and childbirth have doubled for all US women in the past 20 years. Figures compiled by the Centers for Disease Control and Prevention show that black women are nearly four times more likely to die from pregnancy-related causes than white women⁹. Moreover, numerous studies have documented persistent racial, ethnic, and socioeconomic disparities in maternal morbidity and mortality, preterm births, low birthweight infants, access to contraception and reproductive healthcare, and other adverse outcomes.

Research suggests that morbidity and mortality associated with pregnancy and childbirth are to a large extent preventable through adherence to existing evidence-based guidelines. Lower quality care during pregnancy, labor and delivery, and the postpartum period can translate into unnecessary complications, prolonged lengths of stay, costly neonatal intensive care unit (NICU) admissions, and anxiety and suffering for patients and families. However, without appropriate information about performance at a national level, perinatal quality improvement efforts will be unfocused and incentives for improvement limited.

About the Project

The Perinatal and Reproductive Healthcare project launched on October 16, 2015. As part of this endorsement maintenance project, NQF will solicit measures applicable to any healthcare setting and utilize any data sources. Measures that are harmonized with similar measures are preferred.  NQF is particularly seeking composite and outcome measures and measures that are sensitive to the needs of vulnerable populations, including racial/ethnic minorities and Medicaid populations. Endorsement maintenance provides the opportunity to harmonize specifications as well.

A multi-stakeholder Standing Committee will be established to evaluate newly submitted measures and make recommendations for which measures should be endorsed as consensus standards. This Committee will work to identify and endorse new performance measures for accountability and quality improvement that specifically address conditions, treatments, interventions, or procedures relating to perinatal and reproductive healthcare. Additionally, the Committee will evaluate consensus standards previously endorsed by NQF under the maintenance process.

Objectives

This project seeks to identify and endorse additional measures for public reporting and quality improvement that specifically address:

• reproductive health; 
• pregnancy planning and contraception; 
• pregnancy; 
• childbirth; and  
• post-partum and neonatal care;  

NQF Process

Measures will be considered for NQF endorsement as national voluntary consensus standards. Consensus on the recommendations developed through NQF’s formal Consensus Development Process (CDP, Version 1.9). This project involves the active participation of representatives from across the spectrum of healthcare stakeholders and will be guided by a Standing Committee.

Funding

This project is supported under a contract provided by the Department of Health and Human Services.

For information about the availability of auxiliary aids and services for NQF’s federally funded projects, please visit: http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html.

Related NQF Work

• Perinatal and Reproductive Healthcare Endorsement Maintenance Project 2011
• National Voluntary Consensus Standards for Perinatal Care 2008

Contact Information

For further information, contact Nadine Allen at 202-783-1300 or via email at perinatal@qualityforum.org.

Footnotes

1. National Partnership for Women & Families. United States Maternity Care Facts and Figures Website. Available at http://transform.childbirthconnection.org/resources/datacenter/factsandfigures/. Last accessed October 2015.
2. Save the Children. State of the World’s Mothers 2015 Report: The Urban Disadvantage. Available at http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/SOWM_2015.PDF. Last accessed October 2015.
3. Hamilton BE, Martin JA, Osterman MJK, Curtin SC. Births: Preliminary data for 2014. National vital statistics reports. Hyattsville, MD: National Center for Health Statistics 2015; 64(6). Available at http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_06.pdf Last accessed October 2015
4. Pfuntner A, Wier LM , Stocks C . Most Frequent Conditions in U.S. Hospitals, 2010. HCUP Statistical Brief #148. Rockville, MD: Agency for Healthcare Research and Quality 2013. Available at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb148.pdf Last accessed October 2015
5. Pfuntner A, Wier LM , Stocks C . Most Frequent Procedures Performed in U.S. Hospitals, 2011. HCUP Statistical Brief #165. Rockville, MD: Agency for Healthcare Research and Quality 2013.Available at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb165.pdf. Last accessed October 2015
6. National Partnership for Women & Families. United States Maternity Care Facts and Figures Website. Available at http://transform.childbirthconnection.org/resources/datacenter/factsandfigures/ Last accessed October 2015
7. Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry (ATSDR). Recommendations to improve preconception health and health care—United States: A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. Atlanta: CDC; 2006. 23 p. (MMWR Recomm Rep. 2006;55[RR-06]).
8. Dehlendorf C, Rodriguez MI, Levy K, Borrero S, Steinauer J.  Disparities in family planning. AJOG 202(3):214-220. March 2010. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835625/. Last accessed October 2015
9. CDC. Pregancy Mortality Surveillance System Website. Available at http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html. Last accessed October 2015.