Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland.
Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland.
JAMA Netw Open. 2022 Jul 1;5(7):e2222966. doi: 10.1001/jamanetworkopen.2022.22966.
Surveillance of severe maternal morbidity (SMM) is critical for monitoring maternal health and evaluating clinical quality improvement efforts.
To evaluate national and state trends in SMM rates from 2012 to 2019 and potential disruptions associated with the transition to International Classification of Diseases, 10th Revision, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS) in October 2015.
DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional analysis examined delivery hospitalizations from 2012 through 2019 in the Healthcare Cost and Utilization Project's National Inpatient Sample and State Inpatient Databases, an all-payer compendium of hospital discharge records from community, nonrehabilitation hospitals. Trends were evaluated using segmented linear binomial regression models that allowed for discontinuities across the ICD-10-CM/PCS transition. Analyses were completed from April 2021 through March 2022.
Time, ICD-10-CM/PCS coding system, and state.
SMM rates, excluding blood transfusion, per 10 000 delivery hospitalizations, overall and by indicator.
From 2012 to 2019, there were 5 964 315 delivery hospitalizations in the national sample representing a weighted total of 29.8 million deliveries with a mean (SD) maternal age of 28.6 (5.9) years. SMM rates increased from 69.5 per 10 000 in 2012 to 79.7 per 10 000 in 2019 (rate difference [RD], 10.2; 95% CI, 5.8 to 14.6) without a significant change across the ICD-10-CM/PCS transition (RD, -3.2; 95% CI, -6.9 to 0.6). Of 20 SMM indicators, rates for 10 indicators significantly increased while 3 significantly decreased; 5 of these changes were associated with ICD-10-CM/PCS transition. Acute kidney failure had the largest increase, from 6.4 to 15.3 per 10 000 delivery hospitalizations (RD, 8.9; 95% CI, 7.5 to 10.3) with no change associated with ICD transition (RD, -0.1; 95% CI, -1.2 to 1.1). Disseminated intravascular coagulation had the largest decrease from 31.3 to 21.2 per 10 000 (RD, 10.2; 95% CI, -12.8 to -7.5), with a significant drop associated with ICD transition (RD, -7.9; 95% CI, -10.2 to -5.6). State SMM rates significantly decreased for 1 state and significantly increased for 21 states from 2012 to 2019 and associations with ICD transition varied.
In this cross-sectional study, overall US SMM rates increased from 2012 to 2019, which was not associated with the ICD-10-CM/PCS transition. However, data for certain indicators and states may not be comparable across coding systems; efforts are needed to understand SMM increases and state variation.
监测严重产妇发病率（SMM）对于监测产妇健康和评估临床质量改进工作至关重要。
评估 2012 年至 2019 年期间全国和各州 SMM 发生率的趋势，以及 2015 年 10 月向国际疾病分类第 10 次修订版临床修正（ICD-10-CM/PCS）过渡相关的潜在干扰。
设计、设置和参与者：本重复横断面分析检查了 2012 年至 2019 年期间全国住院患者样本和州住院数据库中的分娩住院情况，这是一个来自社区、非康复医院出院记录的所有支付者综合数据库。趋势使用分段线性二项式回归模型进行评估，该模型允许在 ICD-10-CM/PCS 过渡时出现不连续。分析于 2021 年 4 月至 2022 年 3 月完成。
时间、ICD-10-CM/PCS 编码系统和州。
SMM 发生率（不包括输血），每 10000 次分娩住院治疗的比例，整体和按指标。
2012 年至 2019 年期间，全国样本中有 5964315 次分娩住院治疗，代表了 2980 万次分娩的加权总数，产妇平均（标准差）年龄为 28.6（5.9）岁。SMM 发生率从 2012 年的 69.5 增加到 2019 年的 79.7（差异率[RD]，10.2；95%置信区间[CI]，5.8 至 14.6），但在 ICD-10-CM/PCS 过渡期间没有显著变化（RD，-3.2；95%CI，-6.9 至 0.6）。在 20 个 SMM 指标中，10 个指标的发生率显著增加，3 个指标显著下降；其中 5 个变化与 ICD-10-CM/PCS 过渡有关。急性肾衰竭的增幅最大，从每 10000 次分娩住院治疗的 6.4 增加到 15.3（RD，8.9；95%CI，7.5 至 10.3），与 ICD 过渡无关（RD，-0.1；95%CI，-1.2 至 1.1）。弥漫性血管内凝血的降幅最大，从每 10000 次分娩住院治疗的 31.3 降至 21.2（RD，10.2；95%CI，-12.8 至-7.5），与 ICD 过渡显著相关（RD，-7.9；95%CI，-10.2 至-5.6）。从 2012 年到 2019 年，1 个州的州 SMM 率显著下降，21 个州的州 SMM 率显著上升，与 ICD 过渡的相关性各不相同。
在这项横断面研究中，美国整体 SMM 率从 2012 年到 2019 年有所增加，这与 ICD-10-CM/PCS 过渡无关。然而，某些指标和州的数据在不同的编码系统之间可能无法比较；需要努力了解 SMM 的增加和州际差异。
