Hospital Report Cards TM Maternity Care and Women's Health Methodology 2005 3
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calculated for each measure (vaginal or C-section delivery) within each hospital group. To derive the final
ranking, the two percentiles for each measure were added together for each hospital. These summed
percentiles were then reordered and new percentiles were calculated. Low complication rates produced low
percentile rankings.
Complication Rate Patient Choice C-sections
Patient choice C-section was defined as a woman who received a cesarean section with no labor prior to
delivery, who had never had a previous C-section, and who did not have any of the 12 clinical conditions for
a C-section delivery. HealthGrades identified the 12 clinical conditions using Gregory et al.'s methodology
(presented in Health Services Research, October 2002). Women with both single and multiple live-born
deliveries were considered.
Only major complications were considered. Codes for identifying patient choice C-section patients are found
in Exhibit A. Codes for major complications are found in Exhibit B.
To derive a score for this complication rate, HealthGrades calculated complication rates for patient choice
C-section births within each hospital group (NICU and non-NICU hospitals). Percentiles were then
calculated for each hospital group. Hospitals were ranked according to their percentile. Low complication
rates produced low percentile rankings.
Newborn Mortality
HealthGrades identified single live-born newborns who were not transferred in or out of the hospital. Codes
are listed in Exhibit A.
To preserve the integrity of the calculation for newborn mortality, HealthGrades conducted a series of data
quality checks. Based on the results of these checks, HealthGrades excluded a limited number of cases
because they were inappropriate for inclusion. Examples of excluded patient records for newborn mortality
were:
·
Patients over the age of 0 or whose age was unknown (except for California*)
·
Patients who had multiple weights in two or more categories for the same admission
·
Patients who left against medical advice, were still in the hospital, or whose discharge status was
unknown (except for California*)
·
Patients having diagnosis codes indicating congenital defects or other conditions that would be
incompatible with a live birth (See Exhibit C.)
·
Patients who were transferred to another acute care facility or from any facility (except for
California*)
*California data were treated differently due to intentional data masking done by the state.
