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Saturday, December 21, 2013

Trailers (69): Validation of criteria for early term delivery

Clark, et al. Validation of the Joint Commission exclusion criteria for elective early term delivery

Why should you read about this topic?

Elective early term (prior to 39 weeks) delivery has become an important quality measure on most L&D units

What were the authors trying to do?

Determine whether the Joint Commission exclusion criteria for “elective delivery” prior to 39 weeks (PC-01) effectively identifies indications for planned delivery

Who participated and in what setting?

Deliveries (N=205) in July-December, 2012, at HCA-affiliated hospitals judged to be non-compliant with indications for elective early term delivery

What was the study design?

Retrospective analysis of an administrative database

What were the main outcome measures?

Documented recognized indications for planned early term delivery

What were the results?

Of those judged non-compliant, 35% had recognized indications for early term delivery, mostly due to either an extreme variation of a non-excluded condition or a valid condition that has no ICD-9 code.  Also, because of the low number of elective early term deliveries most institutions would have a compliance rate of <95% if analyzed on a quarterly basis, even if all deliveries had valid indications.

What is the most interesting image in the paper?

Table 1

What were the study strengths and weaknesses?

Strengths: large, relevant database; Weaknesses: highly scrutinized data, not typical for standard quality metrics reporting

What does the study contribute for your practice?

Although PC-01 identifies most of the indicated deliveries with the exclusion criteria, most institutions will have <95% compliance due to a single justified fallout when analyzed quarterly.