The Relationship between Various Measures of Perinatal Quality

Objective  This study aimed to examine the correlations between pairs of maternal, infant, and maternal-infant dyad quality measures to provide a comprehensive assessment of perinatal care. Study Design  In a retrospective cohort study using birth and fetal death certificates linked to hospital discharge data from Michigan, Oregon, Pennsylvania, and South Carolina (2016-2018), we examined correlations between pairs of maternal, infant, and maternal-infant dyad quality measures. Maternal quality measures included nulliparous term singleton vertex (NTSV) cesarean birth, nontransfusion severe maternal morbidity (SMM), and a composite maternal outcome. Infant quality was assessed with a composite outcome measure, whereas the dyad measure combined maternal and infant outcomes. Results  Among 955,904 dyads across 266 hospitals, 25.9% had NTSV, 0.7% had nontransfusion SMM, 12.3% had the composite infant measure, and 19.3% had the dyad measure. The correlation between nontransfusion SMM and the dyad measure was 0.12, whereas the correlation between the composite infant measure and the dyad measure was 0.86, which was higher than the correlation between the composite maternal measure and the dyad measure (0.47). Conclusion  We observed minimal correlations among these perinatal quality measures, especially when aggregated beyond individual outcomes. Key Points There are minimal correlations among different perinatal quality measures. Quality is multifaceted, and hospitals vary in the level of quality they achieve. Assessing hospital care for pregnant patients and infants requires multiple quality measures.