Share this article on:

Validation of The Joint Commission Exclusion Criteria for Elective Early-Term Delivery

Clark, Steven L. MD; Meyers, Janet A. RN; Milton, Celeste G. MPH, RN; Frye, Donna R. RN, BSN; Horner, Stephen RN, BSN; Baker, Allison MS; Perlin, Jonathan B. MD, PhD

doi: 10.1097/AOG.0000000000000059
Contents: Original Research
Journal Club

OBJECTIVE: To evaluate whether current Joint Commission (JC) exclusion criteria for measure PC-01, “Elective Delivery” before 39 weeks of gestation, accurately identify valid, codeable indications for planned early-term delivery.

METHODS: We performed a review and critical analysis of all cases recorded as noncompliant for the measure in a large health care system during the second half of 2012.

RESULTS: During the study period, of 107,145 total deliveries, 205 cases were reported as noncompliant with PC-01. Ten percent of compliance fallouts (ie, cases coded as noncompliant) resulted from valid indications for delivery identifiable by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) coding not included on the JC exclusion list; these were primarily unusual or extreme variations of these conditions. Twenty-five percent of fallouts represented valid indications not represented by an ICD-9-CM code. Eight percent of cases were reported as fallouts as a result of imprecise physician charting; only 2% represented chart abstraction errors. Fifty-five percent of cases involved stated indications for early-term delivery not generally recognized as such by the medical community. Compliance rates of 98% are achievable across a large population using the current ICD-9-CM–based metric for compliance assessment used by the JC (PC-01). The current exclusion list does not appear to be amenable to further improvement by inclusion of more or different ICD-9-CM codes. However, given the low volumes generated using the current PC-01 denominator definition, approximately 60% of facilities would have compliance rates below a 95% benchmark with even a single justified outlier if analyzed on a quarterly basis.

CONCLUSION: Our data validate the current JC exclusion criteria for this measure, which identify the vast majority of valid indications for early-term delivery used by obstetrician–gynecologists and identifiable with ICD-9-CM codes.

LEVEL OF EVIDENCE: III

Current Joint Commission exclusion criteria for measure PC-01, “Elective Delivery” before 39 weeks of gestation, identify the vast majority of valid, codeable indications for planned early-term delivery.

Hospital Corporation of America, Nashville, Tennessee; and The Joint Commission, Oakbrook Terrace, Illinois.

Corresponding author: Steven L. Clark, MD, P.O. Box 404, Twin Bridges, MT 59754; e-mail: Steven.clark1@hcahealthcare.com.

Financial Disclosure Ms. Milton is employed by The Joint Commission. Ms. Meyers and Ms. Frye are HCA employees who own some stock shares. The other authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.