Quality measures, transparency, and quality improvement - these "buzz words" are proliferating in the blogosphere, reflecting increased activity and interest around improving the quality of health care in the United States. How does maternity care fit into this picture? This blog post series contains three parts: Part 1 provides an introduction to the history of the general quality measure landscape. Part 2 deconstructs and demystifies the alphabet soup of indicators, measures and organizations involved and explains their relationship to one another. This week, in Part 3, we review the current National Quality Forum (NQF) perinatal measures and discuss The Joint Commission (TJC) Perinatal Core Measure Set, describe how these measures are being used by various organizations and/or states, and discuss their limitations as well as their potential. We conclude with suggestions on how maternity care advocates can engage with maternal quality improvement efforts on national and local levels.

The Joint Commission Measure Set

In 2007, The Joint Commission (TJC) recommended replacing the previous pregnancy and related conditions measure set. NQF began an extensive process of soliciting measures from experts, vetting measures, and creating a set of high-quality measures related to perinatal care that other quality organizations and state Medicaid programs could then use. In October 2008, NQF unveiled 17 perinatal measures which were endorsed through their expert panel review process. From this set, TJC selected five measures for their new Perinatal Core Measure Set (see Table 1 below). Hospitals had the option to report on these measures as of April 1, 2010

Maternal quality advocates are excited about this new TJC set of perinatal quality measures, because it brings renewed focus to maternity care and it also incorporates a new process measure focusing on a major problem with obstetrical practice: over-utilization of elective induction and elective cesarean section prior to 39 completed weeks gestation (referred to here as the <39 weeks measure). Tomorrow, we will examine this measure in-depth to explain the justification, development, selection process, and actual practices of measuring data at the level of individual hospitals.

[Tomorrow Dr. Morton and Ms. Pine discuss the concept of limiting elective deliveries prior to 39 completed weeks gestation - and how those measures have come about in various U.S. hospital locales in recent years. To read this series from the very beginning, go here.]

Posted by: Christine Morton, PhD (CMQCC) and Kathleen Pine (University of California, Irvine)

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