New Healthcare Quality Indicator from AHRQ Aimed at Addressing Maternal Morbidities

The U.S. has one of the highest maternal mortality rates in the world among wealthy nations, with an estimated 60,000 women affected each year by serious pregnancy-related complications. In response to this crisis, the United States has made improving maternal health-including maternal behavioral health-a national priority.

The crisis is particularly acute for Black women, Native women, and women in rural communities who experience the highest rates of deaths and illness from complications of labor or delivery, such as renal failure, eclampsia, heart failure, problems with anesthesia, sepsis, aneurysms, and more.

Whitney Schott, Ph.D.

To successfully address these urgent challenges, healthcare organizations must have the ability to measure maternal morbidities and use their data for epidemiological surveillance, population health improvement, and research. State health departments, health insurance companies, policymakers, and others need reliable information about which complications are occurring, and how often.

With that need in mind, AHRQ is pleased to highlight Maternal Health Indicators (MHI), a new set of quality indicators available for analyzing trends in severe maternal morbidity. The tool from AHRQ's Quality Indicators program allows state organizations, payers, healthcare providers, and others to track maternal morbidity trends and develop population health improvement strategies and conduct epidemiological or research studies using administrative (claims) data-an especially important option for groups that may lack access to detailed clinical data.

Collaborating with Federal Partners

The MHI software, now in its testing phase, is an important example of what can be accomplished when federal agencies and external stakeholders work together.

In 2021-2022, AHRQ collaborated with the Health Services and Resource Administration (HRSA) and the Centers for Disease Control (CDC) to make publicly available a state-level measure of severe maternal morbidity. The Fast Stats dashboard, available through AHRQ's Healthcare Cost and Utilization Project's (HCUP) website, was an important step forward. However, this work also revealed some inconsistencies in how healthcare systems record health conditions.

Judy George, Ph.D.

With the goal of improving the severe maternal morbidity measure, earlier this year AHRQ issued a Request for Information seeking input from the public and stakeholders. Feedback was robust: 51 entities-local and state health officials, healthcare system leaders, hospital associations, researchers, professional organizations, and others-provided valuable insights about how to improve a claims-based measure of severe maternal morbidity.

Using administrative data from HCUP, AHRQ assessed several refinements to definitions of maternal health complications during labor and delivery, such as coagulopathy and renal failure. A Federal interagency workgroup, including subject matter experts from CDC, HRSA, and the Office of Women's Health, provided further feedback. AHRQ also coordinated efforts with the Centers for Medicare & Medicaid Services Center for Clinical Safety & Quality.

Launching a Tool to Measure Maternal Health Indicators

AHRQ's new beta software to examine Maternal Health Indicators, launched in September, is intended to provide an easily accessible tool to construct area-level measures of severe maternal morbidity using readily available administrative claims data. The software is not intended for use in value-based payment programs or for comparisons across hospitals. The measure builds on the algorithm previously used by the CDC.

Moving Maternal Health Measurement Forward

Going forward, AHRQ will collect feedback from MHI software users and continue to test new refinements in collaboration with federal agencies. Future updates to the software may include measures of post-discharge outcomes, such as extending the surveillance period for health conditions over 3, 6, and 12 months. AHRQ also plans to explore measures of mental health and substance abuse in prenatal and postnatal periods.

AHRQ is proud to contribute to ongoing federal efforts to improve maternal health. Among recent contributions are data and research tools: a maternal health chartbook that describes trends in delivery-related hospital stays, as well as a statistical brief on severe maternal morbidity complications by patient characteristics. AHRQ's Toolkit for Improving Perinatal Safety, meanwhile, supports efforts by labor and delivery units to reduce preventable errors.

We encourage you to learn more about the MHI software as well as additional software modules and measures offered by AHRQ's Quality Indicators program. AHRQ welcomes your feedback at [email protected].

Dr. Schott is the health statistician and Dr. George is program lead for the AHRQ Quality Indicators Program in AHRQ's Center for Quality Improvement and Patient Safety.

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