HHS Inpatient Quality Indicators for Childbirth

When hospital data are reported, it is important to look at whether or not hospitals are reporting risk-adjusted data. If a department of health reports on the Agency for Healthcare Research & Quality's Inpatient Quality Indicators, they are presenting data with certain higher-risk deliveries excluded. For example, the cesarean rate is not reflective of all cesarean deliveries; rather, it excludes births with the following complications: abnormal presentation, preterm delivery, fetal death, multiple gestation diagnosis, or breech procedure.



  • Cesarean delivery rate, uncomplicated (IQI 21)
  • Vaginal birth after cesarean (VBAC) delivery rate, uncomplicated (IQI 22)
  • Primary Cesarean delivery rate, uncomplicated (IQI 33)
  • Vaginal birth after Cesarean (VBAC) rate, all (IQI 34)




Cesarean delivery rate, uncomplicated (IQI 21). HHS:005877

Agency for Healthcare Research & Quality (AHRQ)
Measure Steward Agency for Healthcare Research & Quality (AHRQ)
Topic or Condition
Reproductive Health
- Pregnancy
Surgical Procedures
- Obstetrical
Measure Domain Process
Care Setting
Hospital Inpatient
Denominator
Deliveries defined by specific diagnosis-related groups (DRGs) or Medicare severity diagnosis-related groups (MS-DRGs); Excludes deliveries with complications (abnormal presentation, preterm delivery, fetal death, multiple gestation diagnosis, or breech procedure).
Numerator
Number of Cesarean deliveries identified by diagnosis-related groups (DRGs) or Medicare severity diagnosis-related groups (MS-DRGs), or International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes if they are reported without a hysterotomy procedure, among cases meeting the inclusion and exclusion rules for the denominator
Target Population Age Unspecified
Data Source Healthcare Cost and Utilization Project
Purpose Quality improvement, national tracking and trending, comparative reporting



Vaginal birth after cesarean (VBAC) delivery rate, uncomplicated (IQI 22). HHS:002828

Agency for Healthcare Research & Quality (AHRQ)
Topic or Condition
Reproductive Health, Surgical Procedures
Measure Domain
Process
Care Setting
Hospital Inpatient
Denominator
All deliveries with a previous cesarean delivery diagnosis in any diagnosis field
Numerator
Number of vaginal births in women among cases meeting the inclusion and exclusion rules for the denominator
Target Population
Age Unspecified
Data Source
Healthcare Cost and Utilization Project
Purpose
Hospital quality improvement; National tracking and trending



Primary Cesarean delivery rate, uncomplicated (IQI 33). HHS:005884

Agency for Healthcare Research & Quality (AHRQ)
Measure Steward Agency for Healthcare Research & Quality (AHRQ)
Topic or Condition
Reproductive Health
- Pregnancy
Surgical Procedures
- Obstetrical
Measure Domain
Process
Care Setting
Hospital Inpatient
Denominator
Deliveries defined by specific diagnosis-related groups (DRGs) or Medicare severity diagnosis-related groups (MS-DRGs); Excludes deliveries with complications (abnormal presentation, preterm delivery, fatal death, multiple gestation diagnosis, or breech procedure).
Numerator
Number of Cesarean deliveries, identified by diagnosis-related group (DRG) or Medicare severity diagnosis-related group (MS-DRG), or by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes if they are reported without a hysterotomy procedure, among cases meeting the inclusion and exclusion rules for the denominator
Target Population
Age Unspecified
Data Source
Healthcare Cost and Utilization Project
Purpose
Quality improvement, national tracking and trending, comparative reporting




Vaginal birth after Cesarean (VBAC) rate, all (IQI 34). HHS:005886

Agency for Healthcare Research & Quality (AHRQ)
Measure Steward Agency for Healthcare Research & Quality (AHRQ)
Topic or Condition
Reproductive Health
- Pregnancy
Surgical Procedures
- Obstetrical
Measure Domain
Process
Care Setting
Hospital Inpatient
Denominator
All deliveries identified by specific diagnosis-related groups (DRGs) or Medicare severity diagnosis-related groups (MS-DRGs) with International Classification if Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes for previous Cesarean delivery
Numerator
Number of vaginal deliveries identified by specific diagnosis-related groups (DRGs) or Medicare severity diagnosis-related groups (MS-DRGs), among cases meeting the inclusion and exclusion rules for the denominator
Target Population
Age Unspecified
Data Source
Healthcare Cost and Utilization Project
Purpose
Quality improvement, national tracking and trending, comparative reporting


Definitions below retrieved from http://www.qualitymeasures.ahrq.gov/hhs/ on October 20, 2013.