Why do VHHA and VDH Listed EED Rates Differ?

VHHA was recently approached by the Virginia Department of Health (VDH) regarding concerns about high early elective delivery (EED) rates in Virginia. EEDs are a public health concern because data indicate that delivery prior to 39 weeks puts infants at risk for serious health complications because vital organs such as the brain, lungs, and liver are not fully developed. Since 2013, VHHA’s data show the EED rate dropping from 4 percent to 0.42 percent. VDH’s most recent data was for 2013. It showed a rate of approximately 7.8 percent, or about twice what VHHA found. Why the difference? It’s all in the details of definition, data source and statistics. VHHA members identify EEDs by using The Joint Commission (TJC) and the Centers for Medicare & Medicaid Services (CMS) Core Definition developed by the National Quality Forum. TJC validates the rates by sampling medical records when they are on-site to certify hospitals as providing quality care. VDH uses a different definition and data source. They do not have access to hospital medical records so they use a data source available to them – birth records stored in the Department of Vital Statistics. Its algorithm was developed by the Association of State and Territorial Health Officials (ASTHO) and TJC for the EED team in HRSA’s Collaborative Improvement and Innovation Network on Infant Mortality. It excludes conditions that can be included in the TJC and CMS Core Definition such as medical indications for early delivery that are present prior to delivery or during pregnancy. Some examples are multiple births and preeclampsia. The gestational age of the infant is determined by the last menstrual period recorded in the medical record when the mother is admitted for delivery. This gestational age is put on the birth certificate. By excluding cases, the algorithm reduces the denominator number. This changes the calculation dynamics. A smaller denominator means the numerator has a bigger influence. Under the two systems, the number of infants delivered prior to 39 weeks could be the same but the rates would appear greater using the ASTHO definition because the denominators are smaller. (7/12/2015)