Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

The Adverse Outcome Index

Putting Quality Into an Outcome Measure

Atallah, Fouad, MD; Bernstein, Peter S., MD, MPH; Diaz, Danilo Acosta, MD; Minkoff, Howard, MD

doi: 10.1097/AOG.0000000000002791
Contents: Current Commentary

The Adverse Outcome Index, originally designed to provide an objective inventory of adverse outcomes, is often promoted as a tool for assessing the quality of inpatient obstetric care. Although the Adverse Outcome Index is well described, and its outcomes are easy to collect, it has notable drawbacks such as “paradoxical measures” (eg, blood transfusions are counted as adverse measures even when they are used appropriately) and the dominance of certain measures within the Adverse Outcome Index that can drive scores (eg, neonatal intensive care unit admissions). In this article, we argue that in addition to the limitations noted, the Adverse Outcome Index, although providing a reasonable measure of inpatient obstetric acuity, fails to be a reliable measure of quality. This is particularly important because many organizations are seeking quality measures and the Adverse Outcome Index may become a candidate tool. We believe that introducing an adjudication process to the Adverse Outcome Index would greatly enhance its role as a quality indicator. Until newly proposed quality measures are perfected and adopted, a quality-adjusted Adverse Outcome Index will allow this widely used measure to provide a more reliable determination of those adverse events potentially amenable to performance improvement.

The Adverse Outcome Index can become a better quality measurement tool if adjudication of each case is added to the process.

Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, the Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, and the State University of New York Downstate, Brooklyn, New York.

Corresponding author: Fouad Atallah, MD, Department of Obstetrics and Gynecology, Maimonides Medical Center, 967 48th Street, 1st Floor, Brooklyn, NY 11219; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he has met the journal's requirements for authorship.

Received March 30, 2018

Received in revised form May 17, 2018

Accepted June 12, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.