DeJoy Susan, Pekow Penelope, Bertone-Johnson Elizabeth, Chasan-Taber Lisa
J Midwifery Womens Health. 2014 Jul-Aug;59(4):438-46. doi: 10.1111/jmwh.12107. Epub 2014 May 29.
Certified nurse-midwives (CNMs) and certified midwives (CMs) attend 11% of US vaginal births, and CNM/CM databases include a rich source of information on the birth outcomes of women not generally available through obstetric electronic health records (oEHRs). Although CNM databases are in wide use, studies on their validity are sparse. We examined the validity of a practice-specific CNM birth database compared with an oEHR in a large tertiary-care facility.
The study population consisted of all 3133 births in a large CNM practice that were entered into a practice-specific electronic birth database from 2001 to 2008. We assessed agreement with the oEHR overall and according to individual maternal demographic characteristics; obstetric, medical, and social risk factors; labor and birth information; and newborn characteristics. We also evaluated whether there were differences in agreement according to early versus later study periods and by years of CNM clinical experience.
Overall agreement between the CNM birth database and the oEHR was 92.4%. Agreement between the CNM birth database and the oEHR was greater than 90% for maternal age, race/ethnicity, route and type of birth, major genital tract trauma, newborn weight, and primary clinician attending the birth. Lower agreement rates for smoking, total weight gain in pregnancy, beginning of pregnancy body mass index, and anesthesia for birth were due, in part, to missing information in the oEHR. Agreement did not vary significantly by early versus late study periods or by years of CNM clinical experience.
Findings indicate that a CNM/CM birth database is a valid data source for quality monitoring and outcomes research and may contain more complete information for some variables than the oEHR.
认证护士助产士（CNM）和认证助产士（CM）接生了美国11%的阴道分娩，并且CNM/CM数据库包含了丰富的信息来源，这些信息是关于那些通常无法通过产科电子健康记录（oEHR）获取的女性分娩结局。尽管CNM数据库被广泛使用，但关于其有效性的研究却很少。我们在一家大型三级医疗机构中，将特定实践的CNM分娩数据库与oEHR进行比较，以检验其有效性。
研究人群包括2001年至2008年在一家大型CNM实践中登记到特定实践电子分娩数据库中的所有3133例分娩。我们评估了与oEHR在总体上以及根据个体产妇人口统计学特征、产科、医学和社会风险因素、分娩信息和新生儿特征方面的一致性。我们还评估了根据早期与晚期研究阶段以及CNM临床经验年限，一致性是否存在差异。
CNM分娩数据库与oEHR之间的总体一致性为92.4%。CNM分娩数据库与oEHR在产妇年龄、种族/族裔、分娩途径和类型、主要生殖道创伤、新生儿体重以及接生的主要临床医生方面的一致性大于90%。吸烟、孕期总体重增加、妊娠开始时的体重指数以及分娩时的麻醉方面的一致性较低，部分原因是oEHR中存在缺失信息。一致性在早期与晚期研究阶段或CNM临床经验年限方面没有显著差异。
研究结果表明，CNM/CM分娩数据库是用于质量监测和结局研究的有效数据源，并且对于某些变量可能比oEHR包含更完整的信息。
