Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
Am J Obstet Gynecol. 2010 Oct;203(4):336.e1-7. doi: 10.1016/j.ajog.2010.05.024.
The purpose of this study was to assess the Adverse Outcome Index perinatal quality indicator system that was derived from administrative data.
Adverse events were identified for 10 component measures; the Adverse Outcome Index was calculated by the National Perinatal Information Center from 42 months of administrative data. After retrospective chart review, we estimated positive predictive value for 10 measures that were obtained by corrected calculations of Adverse Outcome Index.
Positive predictive values were 86-100% in 7 indicators, with lower values in 3 indicators: neonatal death, 0/2 fetuses; inborn birth trauma, 22/33 infants (67%); and maternal return to the operating room, 16/33 women (48.5%). In term admission to the neonatal intensive care unit, 107 false negatives were identified, with a negative predictive value of 45%.
Indicator positive predictive value was variable. Performance can be strengthened by methods to identify both false-positive and false-negative adverse events that would include chart review and some measure specification revisions to improve alignment with original indicator intent. Interhospital comparison application requires further study.
本研究旨在评估源于行政数据的不良结局指数围产质量指标体系。
为 10 个组成部分的措施确定了不良事件；国家围产期信息中心从 42 个月的行政数据中计算出不良结局指数。经过回顾性图表审查，我们估计了通过不良结局指数校正计算得出的 10 个指标的阳性预测值。
7 个指标的阳性预测值为 86%-100%，3 个指标的阳性预测值较低：新生儿死亡，0/2 胎儿；先天性出生创伤，33 名婴儿中的 22 名（67%）；产妇返回手术室，33 名妇女中的 16 名（48.5%）。在足月入住新生儿重症监护病房的情况下，发现 107 个假阴性，阴性预测值为 45%。
指标阳性预测值是可变的。通过识别假阳性和假阴性不良事件的方法可以提高性能，包括图表审查和一些措施规范修订，以更好地与原始指标意图保持一致。医院间的比较应用需要进一步研究。
