National Healthcare Disparities Report - LDI Health Economist

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Effectiveness of Care Findings NEW Outcome: Obstetric Trauma Childbirth and reproductive care are the most common reasons for women of childbearing age to use health care services. As there are roughly 11,300 births each day in the United States (Martin, et al., 2011), childbirth is the most common reason for hospital admission among women. Chapter 2 Maternal and Child Health Obstetric trauma involving a severe tear to the vagina or surrounding tissues during delivery is a common complication of childbirth. Higher risks of severe (i.e., 3rd or 4th degree) perineal laceration may be related to the degree of fetal-maternal size disproportion. Adolescents, who often have smaller body sizes because they have not finished growing, may be more likely to experience obstetric trauma than older women. In addition, although any delivery can result in trauma, existing evidence shows that severe perineal trauma can be reduced by restricting the use of episiotomies and forceps (Kudish, et al., 2008). Previous reports used AHRQ Quality Indicators version 3.1 to generate obstetric trauma rates. The 2011 reports use a modified version 4.1 of the software. While the effects of version change are extremely small, these estimates should not be compared with estimates in previous reports. Figure 2.24. Obstetric trauma with 3rd or 4th degree laceration per 1,000 vaginal deliveries without instrument assistance, by race/ethnicity and area income, 2001-2008 75 Total White Black API Hispanic 75 Q1 (Lowest) Q2 Q3 Q4 (Highest) Rate per 1,000 Deliveries 50 25 Rate per 1,000 Deliveries 50 25 2008 Achievable Benchmark: 17 2008 Achievable Benchmark: 17 0 2001 2002 2003 2004 2005 2006 2007 2008 0 2001 2002 2003 2004 2005 2006 2007 2008 Key: API = Asian or Pacific Islander; Q1 represents the lowest income quartile and Q4 represents the highest income quartile based on the median income of a patient’s ZIP Code of residence. Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, State Inpatient Databases disparities analysis file, and AHRQ Quality Indicators, version 4.1. Denominator: All patients hospitalized for vaginal delivery without indication of instrument assistance. Note: For this measure, lower rates are better. Rates are adjusted by age. White, Black, and API groups are non-Hispanic; Hispanic includes all races. 84 National Healthcare Disparities Report, 2011
Effectiveness of Care NEW n From 2004 to 2008, rates of obstetric trauma with 3rd or 4th degree laceration decreased from 36 to 24 per 1,000 vaginal deliveries without instrument assistance (Figure 2.24). Declines were observed in all racial/ethnic and area income groups. n In all years, Black and Hispanic mothers had lower rates of obstetric trauma than White mothers. In addition, residents of the lower three area income quartiles had lower rates than residents of the highest area income quartile. n In all years, API mothers had higher rates than White mothers. n The 2008 top 3 State achievable benchmark was 17 per 1,000 deliveries. xvii Black mothers have already attained the benchmark. At the current annual rate of decrease, this benchmark could be attained overall and by most racial/ethnic and area income groups in about 4 years. Residents of the highest area income quartile would need 5 years while APIs would need more than 13 years to attain the benchmark. Also, in the NHQR: n In all years, mothers ages 18-24 and 35-54 had lower rates of obstetric trauma than mothers ages 25- 34. n In all years, mothers whose payment source was Medicare, Medicaid, or self pay/unininsured/no charge had lower rates of obstetric trauma than mothers whose payment source was private health insurance. Prevention: Receipt of Recommended Immunizations by Young Children Immunizations are important in reducing mortality and morbidity. They protect recipients from illness and protect others in the community who are not vaccinated. Beginning in 2007, recommended vaccines for children that should have been completed by ages 19-35 months included diphtheria-tetanus-pertussis vaccine, polio vaccine, measles-mumps-rubella vaccine, Haemophilus influenzae type B vaccine, hepatitis B vaccine, varicella vaccine, and pneumococcal conjugate vaccine. These vaccines constitute the 4:3:1:3:3:1:4 vaccine series tracked in Healthy People 2020. Chapter 2 Maternal and Child Health xvii The top 3 States contributing to the achievable benchmark are Utah, West Virginia, and Wyoming. National Healthcare Disparities Report, 2011 85
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