Continuous Improvement and the Expansion of Quality ... - NCQA

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T H E S TAT E o f H E A l T H C A R E Q U A l I T y 2 0 1 1 • H E D I S M E A S U R E S o f C A R E PRENATAl AND PoSTPARTUM CARE & fREQUENCy of oNGoING PRENATAl CARE Among the 4.3 million deliveries in 2008, 94 percent listed some type of pregnancy complication. 1,2 Each year, more than 500,000 pregnant women across the U.S. deliver babies with potentially avoidable complications such as preterm birth, low birthweight and pre-eclampsia. 2 The Prenatal and Postpartum Care and Frequency of Ongoing Prenatal Care measures assess whether women have access to timely and consistent prenatal and postpartum care. • Diabetes, hypertension and postpartum depression are the most commonly reported health conditions among pregnant women. 3 • Prenatal care during the first trimester helps to improve maternal health and survival, and results in improved infant survival by linking women who have highrisk pregnancies to better obstetrical and neonatal care. 3 • Postpartum care encompasses management of the mother and the newborn infant and is aimed at detecting early parenting problems and performing physical exams and postpartum depression screenings. 4 the Case for Improvement • Hospital stays with pregnancy-related complications tended to be longer (2.7–2.9 days) than without complicating conditions (1.9 days). Maternal stays with complicating conditions were also about 50 percent more costly ($8,000) than those without complications ($2,600). In 2008, maternal stays with pregnancy and delivery-related complications accounted 77 for $17.4 billion, or nearly 5 percent of total hospital costs in the U.S. 1 • Women who failed to receive prenatal care were almost three times more likely to have a low-birthweight infant than women who had care, resulting in expected hospital cost savings of more than $1,000 for women who received prenatal care. 5 • Women who receive only the minimal amount of prenatal care are at high risk for pregnancy complication and negative birth outcomes. 8,10 More than 11 percent of pregnant women receive inadequate prenatal care each year. 9 • Early, comprehensive and continuous prenatal and postpartum care can promote healthier pregnancies and reduce the risk of costly, adverse birth outcomes and postpartum depression. 6,7 M E A S U R E S T A R G E T E D A T C H I l D R E N A N D A D o l E S C E N T S
M E A S U R E S T A R G E T E D A T C H I l D R E N A N D A D o l E S C E N T S 78 N AT I o N A l C o M M I T T E E f o R Q U A l I T y A S S U R A N C E HEdIs Measure definition This measure has two indicators related to deliveries of live births between November 6 of the year prior to the measurement year and November 5 of the measurement year. • Timeliness of Prenatal Care: The percentage of deliveries that received a prenatal care visit in the first trimester or within 42 days of enrollment in the health plan. • Postpartum Care: The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery. The Frequency of Ongoing Prenatal Care measure assesses the percentage of Medicaid deliveries between November 6 of the year prior to the measurement year and November 5 of the measure year that received the following number of expected prenatal visits: •
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24 HEDIS MEASURES of CARE about HEd
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128 N AT I o N A l C o M M I T T E
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130 APPENDIx 1: HEDIS EffECTIVENESS
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134 APPENDIx 2: HEDIS EffECTIVENESS
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172 MEASURE N AT I o N A l C o M M
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184 REfERENCES N AT I o N A l C o M
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ACkNoWlEDGMENTS Health Plans The 20
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Continuous Improvement and the Expansion of Quality ... - NCQA

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