Hospital Report Cards TM Maternity Care and Women's Health Methodology 2006 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 or induced
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).
Only major complications were considered. Codes for identifying the 12 conditions for clinically indicated 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 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.
Newborn mortality rates were examined by birth weight and normal newborn categories. Newborn mortality
rates were compared by examining the percentage of newborns who died while in the hospital with the
national percentage of newborns who died while in the hospital for each of six different weight categories.
