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ePC-07 Severe Obstetric Complications

CBE ID
3687e
Endorsement Status
1.0 New or Maintenance
1.1 Measure Structure
Previous Endorsement Cycle
Is Under Review
No
Next Maintenance Cycle
Spring 2027
E&M Cycle Comments

Effective March 27, 2023, the National Quality Forum (NQF) is no longer the consensus-based entity (CBE) funded through the Centers for Medicare & Medicaid Services (CMS) National Consensus Development and Strategic Planning for Health Care Quality Measurement Contract. Battelle has been selected to oversee the endorsement & maintenance (E&M) of clinical quality and cost/resource use measures. Since the Spring 2023 cycle launched at NQF, measures submitted to this E&M cycle continued along the prior E&M protocols that were in place at time of the Spring 2023 “Intent to Submit.” Battelle took over the E&M work for the Spring 2023 cycle when developers and/or stewards submitted their full measure information, which for CBE #3687e, the most recent measure specifications can be found here: https://p4qm.org/sites/default/files/2023-06/3687e_severe_obstetric_complications.zip

To close out this E&M cycle, Battelle published the Spring 2023 measures for pre-evaluation public commenting, convened the E&M standing committees for their measure evaluation meetings, launched the Spring 2023 post-comment period, convened the E&M committees for the post-comment meeting, convened the CSAC to render a final endorsement decision, and executed the appeals period.

 

1.6 Measure Description

Hospital-level measure scores are calculated as a risk-adjusted proportion of the number of delivery hospitalizations for women who experience a severe obstetric complication, as defined by the numerator, by the total number of delivery hospitalizations in the denominator during the measurement period.

    Measure Specs
      General Information
      1.7 Measure Type
      1.8 Level of Analysis
      1.20 Types of Data Sources
      1.14 Numerator

      Inpatient hospitalizations for patients with severe obstetric complications including severe maternal morbidity diagnoses, severe maternal morbidity procedures, discharge disposition = expired.

      1.15 Denominator

       Inpatient hospitalizations for patients delivering stillborn or live birth with >= 20 weeks, 0 days gestation completed.

      Exclusions

      Patients with confirmed diagnosis of COVID with COVID-related respiratory condition or patients with confirmed diagnosis of COVID with COVID-related respiratory procedure.

      Most Recent Endorsement Activity
      Patient Safety Spring 2023
      Steward Organization
      The Joint Commission
      Steward POC email
      cwalas@jointcommission.org
              Risk Adjustment
                Public Comments