Notice2024-02021
Inpatient Severe Maternal Morbidity Measure Technical Specifications
Primary source
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Published
February 1, 2024
Issuing agencies
Health and Human Services DepartmentAgency for Healthcare Research and Quality
Abstract
The Agency for Healthcare Research and Quality (AHRQ) Center for Quality Improvement and Patient Safety (CQuIPS) Division of Quality Measurement and Improvement (QMI) invites public comment in response to this Request for Information (RFI). The AHRQ Quality Indicators (QI) program maintains inpatient quality indicators (https:// qualityindicators.ahrq.gov/measures/IQI_TechSpecTechSpec) and patient safety indicators (https://qualityindicators.ahrq.gov/measures/ PSI_TechSpec), several of which are relevant to maternal health care. Specifically, the QI program maintains measures of obstetric trauma, birth trauma, and cesarean delivery calculated at the hospital level using administrative data. However, severe maternal morbidity during an inpatient stay may result from a host of complications, such as sepsis, cardiac failure, stroke, respiratory distress, and renal failure. While state-level rates of severe maternal morbidity are available from AHRQ (https://datatools.ahrq.gov/hcup-fast-stats/?tab=special- emphasis&dash=92), experts have noted some shortcomings of this measure. This RFI seeks comments on the usability, feasibility, and likely uptake of a measure of severe maternal morbidity to be validated, refined, and maintained by the QI program, with the goal of providing data for maternal health service improvements. While a measure of severe maternal morbidity is currently available from AHRQ and the Health Resources and Service Administration (HRSA), several experts have suggested that this algorithm could benefit from refinements.
Full Text
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<title>Federal Register, Volume 89 Issue 22 (Thursday, February 1, 2024)</title>
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[Federal Register Volume 89, Number 22 (Thursday, February 1, 2024)]
[Notices]
[Pages 6525-6526]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-02021]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Inpatient Severe Maternal Morbidity Measure Technical
Specifications
AGENCY: Agency for Healthcare Research and Quality, U.S. Department of
Health and Human Services.
ACTION: Notice of Request for Information.
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SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) Center
for Quality Improvement and Patient Safety (CQuIPS) Division of Quality
Measurement and Improvement (QMI) invites public comment in response to
this Request for Information (RFI). The AHRQ Quality Indicators (QI)
program maintains inpatient quality indicators (<a href="https://qualityindicators.ahrq.gov/measures/IQI_TechSpecTechSpec">https://qualityindicators.ahrq.gov/measures/IQI_TechSpecTechSpec</a>) and patient
safety indicators (<a href="https://qualityindicators.ahrq.gov/measures/PSI_TechSpec">https://qualityindicators.ahrq.gov/measures/PSI_TechSpec</a>), several of which are relevant to maternal health care.
Specifically, the QI program maintains measures of obstetric trauma,
birth trauma, and cesarean delivery calculated at the hospital level
using administrative data. However, severe maternal morbidity during an
inpatient stay may result from a host of complications, such as sepsis,
cardiac failure, stroke, respiratory distress, and renal failure. While
state-level rates of severe maternal morbidity are available from AHRQ
(<a href="https://datatools.ahrq.gov/hcup-fast-stats/?tab=special-emphasis&dash=92">https://datatools.ahrq.gov/hcup-fast-stats/?tab=special-emphasis&dash=92</a>), experts have noted some shortcomings of this
measure. This RFI seeks comments on the usability, feasibility, and
likely uptake of a measure of severe maternal morbidity to be
validated, refined, and maintained by the QI program, with the goal of
providing data for maternal health service improvements. While a
measure of severe maternal morbidity is currently available from AHRQ
and the Health Resources and Service Administration (HRSA), several
experts have suggested that this algorithm could benefit from
refinements.
DATES: Comments on this notice must be received at the address provided
below within 30 days of publication of this notice, no later than March
4, 2024.
ADDRESSES: Interested parties may submit comments electronically to
<a href="/cdn-cgi/l/email-protection#e8899b8389809a99a889809a99c680809bc68f879e"><span class="__cf_email__" data-cfemail="7a1b09111b12080b3a1b12080b54121209541d150c">[email protected]</span></a>. When submitting comments or requesting
information, please include the document identifier number and project
title ``Inpatient Severe Maternal Morbidity Measure Technical
Specifications'' for reference.
FOR FURTHER INFORMATION CONTACT: Questions may be addressed to Judy
George, Program Lead for the AHRQ Quality Indicators,
<a href="/cdn-cgi/l/email-protection#672d12031e4900020815000227060f1516490f0f1449000811"><span class="__cf_email__" data-cfemail="dd97a8b9a4f3bab8b2afbab89dbcb5afacf3b5b5aef3bab2ab">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION: Maternal health, including maternal
behavioral health, is a national priority in the United States.
Strengthening data collection and evaluation is part of the first goal
of the White House Blueprint for Addressing the Maternal Health Crisis
(<a href="https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf">https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf</a>), which is to increase access to and coverage of
comprehensive high-quality maternal health services, including
behavioral health services. Unexpected complications and outcomes
around labor and delivery may lead to short- or long-term consequences
to women's health (<a href="https://pubmed.ncbi.nlm.nih.gov/27560600/">https://pubmed.ncbi.nlm.nih.gov/27560600/</a>), which
have been defined as severe maternal morbidity (<a href="https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.htmlhtml">https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.htmlhtml</a>). National and state rates of severe
maternal morbidity are currently available on AHRQ's Healthcare Cost
and Utilization Project (HCUP) Fast Stats dashboard (<a href="https://datatools.ahrq.gov/hcup-fast-stats/?tab=special-emphasis&dash=92">https://datatools.ahrq.gov/hcup-fast-stats/?tab=special-emphasis&dash=92</a>).
However, there are measurement concerns for some of indicators included
in this measure (eclampsia, disseminated intravascular coagulation, and
blood transfusions) and additional validation and refinement may be
warranted.
In collaboration with federal partners from the Department of
Health and Human Services, AHRQ is exploring potential refinements to
this measure of severe maternal morbidity for use at an area level
(e.g., county, state) using administrative data. AHRQ aims to assess
the validity and reliability of potential refinements to this severe
maternal morbidity measure. In addition, AHRQ is considering
incorporating a measure of severe maternal morbidity into its measure
portfolio, including the production of technical specifications and the
dissemination of software to calculate this measure through the AHRQ QI
program.
Many users of quality measures, such as state and local
governments, largely rely on administrative data that lack the robust
clinical information found in electronic health records (EHRs). For
example, Centers for Medicaid and Medicare Services (CMS) has developed
Electronic Clinical Quality Measures (ECQMs) for severe obstetric
complications which relies upon EHR data. AHRQ aims to provide
measurement resources that are broadly accessible across organizations,
including for those lacking access to extensive clinical data.
To support measurement resources that are broadly accessible across
organizations, AHRQ requests public comment on the usability,
feasibility, and likely uptake of an inpatient severe maternal
morbidity measure, produced through the QI program using administrative
data, with the intent of promoting maternal health service improvements
at an area level (e.g., county, state). AHRQ invites stakeholders
representing consumers, state/regional/local health departments,
accountable care organizations, community health centers, birthing
centers, providers/health systems, critical access/rural hospitals,
professional associations, payers, rural and community health groups,
community health workers, doulas, maternal health advocacy groups,
researchers, and other members of the public to comment.
Specific questions of interest include, but are not limited to:
1. If you are currently measuring severe maternal morbidity in your
organization, what measure(s) are you or your organization using? How
do you use these measures? What data sources are you using? Please
specify organization type in your answer.
2. If you or your organization are not currently measuring severe
maternal morbidity, what quantitative data would you need to make
maternal health service improvements? Please specify organization type
in your answer.
3. At what level--state, county, or some other level--would
information be
[[Page 6526]]
most helpful for improving maternal health services? In what ways?
4. The measure currently used by AHRQ for severe maternal morbidity
uses 21 indicators (<a href="https://www.cdc.gov/reproductivehealth/maternalinfanthealth/smm/severe-morbidity-ICD.htm">https://www.cdc.gov/reproductivehealth/maternalinfanthealth/smm/severe-morbidity-ICD.htm</a>) identified with ICD-
10CM10CM/PCS codes in administrative data. Considering these
indicators,
a. What codes might be missing? Are there changes you would you
recommend?
b. In what ways would the changes that you propose make a severe
maternal morbidity measure more useful to your organization?
c. Would a measure with the refinements you propose be useful for
surveillance? Population health management? Clinical quality
improvement? Program evaluation? Research? Public reporting or
accountability programs? In what ways?
5. What other measures of maternal health and/or morbidity would
your organization find useful/effective for improving maternal health
services, including any potential measures for use in either the
prenatal or postpartum time periods?
AHRQ is interested in all of the questions listed above, but
respondents are welcome to address as many or as few as they choose and
to address additional areas of interest not listed. It is helpful to
identify the question to which a particular answer corresponds.
This RFI is for planning purposes only and should not be construed
as a policy, solicitation for applications, or as an obligation on the
part of the Government to provide support for any ideas in response to
it. AHRQ will use the information submitted in response toto this RFI
at its discretion and will not provide comments to any respondent's
submission. However, responses to this RFI may be reflected in future
solicitation(s) or policies. The information provided will be analyzed
and may appear in reports.
Dated: January 29, 2024.
Marquita Cullom,
Associate Director.
[FR Doc. 2024-02021 Filed 1-31-24; 8:45 am]
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