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For better care we need better data: towards a national obstetrics registry

Published:October 26, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100787

      Abstract

      Unacceptably high rates of severe maternal morbidity and mortality in the United States and stark racial disparities in outcomes are generating efforts to improve both research capacity and quality improvement in obstetrical care. Comprehensive, high-quality datasets on which to build these efforts are crucial to the success of obstetrical quality improvement efforts. However, existing data sources in obstetrics have notable limitations. Other medical and surgical specialties have addressed similar challenges through the creation of national registries, and we argue that obstetrics must take the same approach to improve outcomes. In this article, we summarized the current availability and limitations of large-scale data in obstetrics research and compared the data with registries developed in other specialties. Moreover, we have outlined the guiding principles for the development of a national obstetrics registry and have proposed future directions.

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      References

      1. Tikkanen R, Gunja MZ, Fitzgerald M, Zephyrin L. Maternal mortality and maternity care in the United States compared to 10 other developed countries. The Commonwealth Fund. 2020. Available at: https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries. Accessed 12/1/2021.

        • Howell EA
        • Zeitlin J.
        Quality of care and disparities in obstetrics.
        Obstet Gynecol Clin North Am. 2017; 44: 13-25
        • Gingrey JP.
        Maternal mortality: a US public health crisis.
        Am J Public Health. 2020; 110: 462-464
        • Marill MC.
        Getting to the heart of America's maternal mortality crisis.
        Health Aff (Millwood). 2021; 40: 1824-1829
        • Pettker CM
        • Grobman WA.
        Obstetric safety and quality.
        Obstet Gynecol. 2015; 126: 196-206
      2. The Leapfrog Group. Healthy moms, healthy babies: hospital performance on leapfrog's maternity care standards based on results of the 2020 leapfrog hospital survey. 2021. Available at: https://www.leapfroggroup.org/sites/default/files/Files/2021%20Maternity%20Report_Final_1.pdf. Accessed 12/31/21.

        • Thomas Craig KJ
        • Mckillop MM
        • Huang HT
        • George J
        • Punwani ES
        • Rhee KB.U.S
        hospital performance methodologies: a scoping review to identify opportunities for crossing the quality chasm.
        BMC Health Serv Res. 2020; 20: 640
        • Main EK
        • Chang SC
        • Dhurjati R
        • Cape V
        • Profit J
        • Gould JB.
        Reduction in racial disparities in severe maternal morbidity from hemorrhage in a large-scale quality improvement collaborative.
        Am J Obstet Gynecol. 2020; 223 (123.e1-14)
        • Rosenstein MG
        • Chang SC
        • Sakowski C
        • et al.
        Hospital quality improvement interventions, statewide policy initiatives, and rates of cesarean delivery for nulliparous, term, singleton, vertex births in California.
        JAMA. 2021; 325: 1631-1639
        • Harrington R
        • Washington D
        • Paliani S
        • Thompson K
        • Rouse L
        • Anderson A.
        A new effort to address racial and ethnic disparities in care through quality measurement.
        Health Affairs, 2021 (Available at) (Accessed 12/1/2021)
        • Gold R
        • Bunce A
        • Cowburn S
        • et al.
        Adoption of social determinants of health EHR tools by community health centers.
        Ann Fam Med. 2018; 16: 399-407
      3. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 196: thromboembolism in pregnancy.
        Obstet Gynecol. 2018; (e1–17): 132
        • Federspiel JJ
        • Wein LE
        • Addae-Konadu KL
        • et al.
        Venous thromboembolism incidence among patients recommended for pharmacologic thromboembolism prophylaxis after cesarean delivery in selected guidelines.
        J Thromb Haemost. 2021; 19: 830-838
      4. Hoyert DL. Maternal mortality rates in the United States, 2019. NCHS Health E-Stats. 2021. Available at: https://www.cdc.gov/nchs/data/hestat/maternal-mortality-2021/E-Stat-Maternal-Mortality-Rates-H.pdf. Accessed 12/1/21.

        • Stein PD
        • Henry JW.
        Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy.
        Chest. 1995; 108: 978-981
        • Kaye DK.
        The moral imperative to approve pregnant women's participation in randomized clinical trials for pregnancy and newborn complications.
        Philos Ethics Humanit Med. 2019; 14: 11
      5. HCUP databases. Healthcare Cost and Utilization Project (HCUP). Available at: https://www.hcup-us.ahrq.gov/tech_assist/citations.jsp#. Rockville, MD: Agency for Healthcare Research and Quality.

        • Glance LG
        • Hasley S
        • Glantz JC
        • et al.
        Measuring childbirth outcomes using administrative and birth certificate data.
        Anesthesiology. 2019; 131: 238-253
        • Sarrazin MS
        • Rosenthal GE.
        Finding pure and simple truths with administrative data.
        JAMA. 2012; 307: 1433-1435
        • Snowden JM
        • Lyndon A
        • Kan P
        • El Ayadi A
        • Main E
        • Carmichael SL.
        Severe maternal morbidity: a comparison of definitions and data sources.
        Am J Epidemiol. 2021; 190: 1890-1897
        • Venkatesh KK
        • Strauss RA
        • Grotegut CA
        • et al.
        Machine learning and statistical models to predict postpartum hemorrhage.
        Obstet Gynecol. 2020; 135: 935-944
        • Gianfrancesco MA
        • Goldstein ND.
        A narrative review on the validity of electronic health record-based research in epidemiology.
        BMC Med Res Methodol. 2021; 21: 234
        • Theilen LH
        • Greenland P
        • Varagic J
        • et al.
        Association between aspirin use during pregnancy and cardiovascular risk factors 2-7 years after delivery: the nuMoM2b Heart Health Study.
        Pregnancy Hypertens. 2022; 28: 28-34
      6. American Heart Association. Get With The Guidelines pricing sheet. 2020. Available at: https://www.stroke.org/-/media/files/affiliates/swa/qi-files/2020-get-with-the-guidelines-pricing-sheet.pdf?la=en. Accessed 12/31/21.

        • Xian Y
        • Liang L
        • Smith EE
        • et al.
        Risks of intracranial hemorrhage among patients with acute ischemic stroke receiving warfarin and treated with intravenous tissue plasminogen activator.
        JAMA. 2012; 307: 2600-2608
        • Federspiel JJ
        • Anstrom KJ
        • Xian Y
        • et al.
        Comparing inverse probability of treatment weighting and instrumental variable methods for the evaluation of adenosine diphosphate receptor inhibitors after percutaneous coronary intervention.
        JAMA Cardiol. 2016; 1: 655-665
        • Rao SV
        • Hess CN
        • Barham B
        • et al.
        A registry-based randomized trial comparing radial and femoral approaches in women undergoing percutaneous coronary intervention: the SAFE-PCI for Women (Study of Access Site for Enhancement of PCI for Women) trial.
        JACC Cardiovasc Interv. 2014; 7: 857-867
        • Jay C
        • Schold JD.
        Measuring transplant center performance: the goals are not controversial but the methods and consequences can be.
        Curr Transplant Rep. 2017; 4: 52-58
        • Riley LE.
        mRNA Covid-19 vaccines in pregnant women.
        N Engl J Med. 2021; 384: 2342-2343
        • Afshar Y
        • Gaw SL
        • Flaherman VJ
        • et al.
        Clinical presentation of coronavirus disease 2019 (COVID-19) in pregnant and recently pregnant people.
        Obstet Gynecol. 2020; 136: 1117-1125
        • Menard MK
        • Main EK
        • Currigan SM.
        Executive summary of the reVITALize initiative: standardizing obstetric data definitions.
        Obstet Gynecol. 2014; 124: 150-153