Severe Obstetric Complications
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| Measure Information | 2023 Reporting Period | 2024 Reporting Period |
|---|---|---|
| Title | Severe Obstetric Complications | Severe Obstetric Complications |
| CMS eCQM ID | CMS1028v1 | CMS1028v2 |
| Short Name |
PC-07 |
PC-07 |
| CBE ID | Not Applicable | Not Applicable |
| Measure Steward | The Joint Commission | The Joint Commission |
| Description |
Patients with severe obstetric complications which occur during the inpatient delivery hospitalization. |
Patients with severe obstetric complications which occur during the inpatient delivery hospitalization |
| Measure Scoring | Proportion measure | Proportion measure |
| Measure Type | Outcome measure | Outcome measure |
| Stratification | *See CMS1028v1.html |
Stratum1: Delivery hospitalizations with severe obstetric complications excluding hospitalizations where transfusion was the only severe obstetric complication. Additionally, this measure will be stratified by race and ethnicity after measure submission. |
| Risk Adjustment | *See CMS1028v1.html |
The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov). Pre-existing conditions and variables must be present on admission. Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. - Anemia - Asthma - Autoimmune Disease - Bariatric Surgery - Bleeding disorder - Cardiac Disease - Gastrointestinal Disease - Gestational Diabetes - HIV - Housing Instability - Hypertension - Maternal Age (derived from birthdate) - Mental Health Disorder - Morbid Obesity - Multiple Pregnancy - Neuromuscular Disease - Other Pre-eclampsia - Placenta Previa - Placental Abruption - Placental Accreta Spectrum - Pre-existing Diabetes - Preterm Birth - Previous Cesarean - Pulmonary Hypertension - Renal Disease - Severe Pre-eclampsia - Substance Abuse - Thyrotoxicosis - Long-term Anticoagulant Use - Obstetric VTE Lab and Physical Exam Results: Report the first resulted value 24 hours prior to start of encounter and before time of delivery in UCUM units specified: - Heart rate: {beats}/min - Systolic blood pressure: mm[Hg] - White blood cell count: 10*3/uL - Hematocrit: % Note regarding submission of risk variable data: The risk variable definitions are included in the specifications and risk variable data should be sent with eCQM data in the QRDA1 file. Specific risk variable templates are not needed in the QRDA1 files. |
| Rationale | *See CMS1028v1.html |
The United States (US) experiences higher rates of maternal morbidity and mortality than most other developed countries. These rates have continued to trend upward in recent decades (CDC, n.d.). Research indicates that the overall rate of severe maternal morbidity (SMM) increased by almost 200% between 1993 and 2014 to 144 per 10,000 delivery hospitalizations (CDC, n.d.), with more than 25,000 women per year experiencing obstetric complications (U.S. Department of Health and Human Services, 2020). Recent maternal mortality data from 2018 reveal that 658 women in the US died from maternal causes, resulting in a rate of 17.4 deaths per 100,000 live births, with 77% of the deaths attributed to direct obstetric causes like hemorrhage, preeclampsia, obstetric embolism, and other complications (Hoyert & Minino, 2018). 144 per 10,000 women hospitalized for delivery have experienced SMM, including hemorrhage, embolism, hypertension, stroke, and other serious complications (CDC,2020). Racial and ethnic disparities for Black women and Hispanic women are at a significantly higher risk for developing these complications than are Non-Hispanic White women (Leonard et al., 2019). Increasing rates of SMM are resulting in increased healthcare costs, longer hospitalization stays and impacts on a woman's health. There is limited national evaluation of hospitals' performance on maternal morbidity and mortality although SMM is widely used at the population level. SMM is linked to maternal mortality, varies significantly among hospitals, and has significant racial/ethnic and urban/rural disparities. SMM is a cost driver for both Medicaid and commercial plans. This measure is important as it will assist in the discovery and understanding of SMM patterns which can lead to improvements in the safety and quality of maternal care necessary to reduce SMM rates. |
| Clinical Recommendation Statement | *See CMS1028v1.html |
Healthy People 2030 Measure (MICH-05): Reduce severe maternal complications identified during delivery hospitalizations The American College of Obstetricians and Gynecologists (the College) and the Society for Maternal-Fetal Medicine (SMFM) recommend identifying potential cases of severe maternal morbidity for further review, with a focus on outcomes and complications, and consider this an important step toward promoting safe obstetric care. |
| Improvement Notation |
Improvement noted as a decrease in the rate. |
Improvement noted as a decrease in the rate |
| Definition | *See CMS1028v1.html |
For this measure, specifications are modeled after the nationally available and adopted CDC definition for Severe Maternal Morbidity (SMM) with the addition of maternal mortality. At times, we may refer to the CDC indicators of morbidity as SMM, but the outcome of the measure, which includes morbidity and mortality, is referred to as Severe Obstetric Complications (SOC). |
| Guidance |
In the case of multiple births, map the first delivery date/time (Baby A) as the delivery date/time for the encounter. This measure allows for 2 approaches to determine estimated gestational age (EGA) in the following order of precedence: 1. The EGA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.* 2. The EGA is obtained from a discrete field in the electronic health record. This option is only used when the calculated EGA is not available. Wherever gestational age is mentioned, relative to the delivery, the intent is to capture the last estimated gestational age prior to or at the time of delivery.
*ACOG ReVITALize Guidelines for Calculating Gestational Age:
Gestational Age = (280-(EDD minus Reference Date))/7 --Estimated Due Date (EDD): The best obstetrical Estimated Due Date is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (eg, assisted reproductive technology) --Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery. Note however the calculation may yield a non-whole number and gestational age should be rounded off to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
In the case of multiple births, map the first delivery date/time (Baby A) as the delivery date/time for the encounter. This measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence: 1. The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.* 2. The GA is obtained from a discrete field in the electronic health record. This option is only used when the calculated GA is not available. 3. The GA is based on ICD10 or SNOMED codes indicative of weeks gestation. This option is only used when results from items #1 and #2 (see above) are not available. Wherever gestational age is mentioned, relative to the delivery, the intent is to capture the last estimated gestational age prior to or at the time of delivery.
*ACOG ReVITALize Guidelines for Calculating Gestational Age:
Gestational Age = (280-(Estimated Due Date minus Reference Date))/7 --Estimated Due Date (EDD): The best obstetrical EDD is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (e.g., assisted reproductive technology) --Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery. Note however the calculation may yield a non-whole number and gestational age should be rounded off to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
| Initial Population |
Inpatient hospitalizations for patients age >= 8 years and < 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure with a discharge date that ends during the measurement period |
Inpatient hospitalizations for patients age >= 8 years and < 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure with a discharge date that ends during the measurement period |
| Denominator |
Inpatient hospitalizations for patients delivering stillborn or live birth with >= 20 weeks, 0 days gestation completed |
Inpatient hospitalizations for patients delivering stillborn or live birth with >= 20 weeks, 0 days gestation completed |
| Denominator Exclusions |
Inpatient hospitalizations for patients with confirmed diagnosis of COVID with COVID-related respiratory condition or patients with confirmed diagnosis of COVID with COVID-related respiratory procedure |
Inpatient hospitalizations for patients with confirmed diagnosis of COVID with COVID-related respiratory condition or patients with confirmed diagnosis of COVID with COVID-related respiratory procedure |
| Numerator |
Inpatient hospitalizations for patients with severe obstetric complications (not present on admission that occur during the current delivery encounter) including the following: - Severe maternal morbidity diagnoses (see list below) - Severe maternal morbidity procedures (see list below) - Discharge disposition of expired Severe Maternal Morbidity Diagnoses: - Cardiac Acute heart failure Acute myocardial infarction Aortic aneurysm Cardiac arrest/ventricular fibrillation Heart failure/arrest during procedure or surgery - Hemorrhage Disseminated intravascular coagulation Shock - Renal Acute renal failure - Respiratory Adult respiratory distress syndrome Pulmonary edema - Sepsis - Other OB Air and thrombotic embolism Amniotic fluid embolism Eclampsia Severe anesthesia complications - Other Medical Puerperal cerebrovascular disorder Sickle cell disease with crisis Severe Maternal Morbidity Procedures: - Blood transfusion - Conversion of cardiac rhythm - Hysterectomy - Temporary tracheostomy - Ventilation |
Inpatient hospitalizations for patients with severe obstetric complications (not present on admission that occur during the current delivery encounter) including the following: - Severe maternal morbidity diagnoses (see list below) - Severe maternal morbidity procedures (see list below) - Discharge disposition of expired Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data. Severe Maternal Morbidity Diagnoses: - Cardiac Acute heart failure Acute myocardial infarction Aortic aneurysm Cardiac arrest/ventricular fibrillation Heart failure/arrest during procedure or surgery - Hemorrhage Disseminated intravascular coagulation Shock - Renal Acute renal failure - Respiratory Adult respiratory distress syndrome Pulmonary edema - Sepsis - Other OB Air and thrombotic embolism Amniotic fluid embolism Eclampsia Severe anesthesia complications - Other Medical Puerperal cerebrovascular disorder Sickle cell disease with crisis Severe Maternal Morbidity Procedures: - Blood transfusion - Conversion of cardiac rhythm - Hysterectomy - Temporary tracheostomy - Ventilation |
| Numerator Exclusions |
Not applicable |
Not applicable |
| Denominator Exceptions |
None |
None |
| Next Version | No Version Available | |
| Previous Version | No Version Available |
*This is a risk adjusted measure. Risk Adjustment Methodology Report: Severe Obstetric Complications Methodology Report
**There is a known issue on CMS1028v2. See issue EKI-23 on the ONC eCQM Known Issues Dashboard for details.
Header
Updated grammar, wording, and/or formatting to improve readability and consistency.
Measure Section: Description
Source of Change: Annual Update
Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
Added link to the Risk Methodology Report to aid implementation.
Measure Section: Risk Adjustment
Source of Change: Measure Lead
Clarified Lab and Physical Exam Results to improve readability.
Measure Section: Risk Adjustment
Source of Change: Measure Lead
Updated risk adjustment variable description from 'BMI>=40' to 'Morbid Obesity' as ICD-10 coding guidelines indicate BMI codes are not to be assigned for pregnant patients.
Measure Section: Risk Adjustment
Source of Change: Measure Lead
Added guidance to clarify patients may now be qualified for the denominator based on gestational age diagnosis codes when neither calculated or reported gestational age is available.
Measure Section: Guidance
Source of Change: Measure Lead
Added guidance to clarify where present on admission information may be sourced.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Logic
Added logic to denominator criteria to capture patients with specified weeks gestation based on diagnosis codes when neither calculated or reported gestational age is available.
Measure Section: Denominator
Source of Change: Measure Lead
Updated definition name to 'Risk Variable Morbid Obesity' to reflect change in value set as ICD-10 coding guidelines indicate BMI codes are not to be assigned for pregnant patients.
Measure Section: Definitions
Source of Change: Measure Lead
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.
Measure Section: Definitions
Source of Change: Standards/Technical Update
Updated the version number of the PC Maternal Library to v3.0.000.
Measure Section: Definitions
Source of Change: Annual Update
Removed 'Truncate.Time' function and added 'as DateTime' to Estimated Delivery Date result to simplify logic and allow hospitals to submit data as date only or as date/time.
Measure Section: Functions
Source of Change: Measure Lead
Updated the version number of the PC Maternal Library to v3.0.000.
Measure Section: Functions
Source of Change: Annual Update
Value Set
The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.
Added value set 20 to 42 Plus Weeks Gestation (2.16.840.1.113762.1.4.1110.67) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Value set (2.16.840.1.113883.3.117.1.7.1.271): Renamed to Acute or Persistent Asthma based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
Value set Anemia (2.16.840.1.113762.1.4.1029.323): Added 4 ICD-10-CM codes (D59.30, D59.31, D59.32, D59.39) based on terminology update. Deleted 1 ICD-10-CM code (D59.3) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Bleeding Disorder (2.16.840.1.113762.1.4.1029.287): Added 10 ICD-10-CM codes (D68.00, D68.01, D68.020, D68.021, D68.022, D68.023, D68.029, D68.03, D68.04, D68.09) based on terminology update. Deleted 1 ICD-10-CM code (D68.0) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Blood Transfusion (2.16.840.1.113762.1.4.1029.213): Added 19 SNOMED CT codes based on terminology update. Added 20 ICD-10-PCS codes based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Cardiac Disease (2.16.840.1.113762.1.4.1029.341): Added 30 ICD-10-CM codes based on terminology update. Deleted 5 ICD-10-CM codes (I47.2, I31.3, I34.8, Q21.1, Q21.2) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Economic Housing Instability (2.16.840.1.113762.1.4.1029.292): Added 3 ICD-10-CM codes (Z59.82, Z59.86, Z59.87) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Gastrointestinal Disease (2.16.840.1.113762.1.4.1029.338): Added 1 ICD-10-CM code (K76.82) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Hematocrit lab test (2.16.840.1.113762.1.4.1045.114): Added 1 LOINC code (48703-3) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set (2.16.840.1.113762.1.4.1029.272): Renamed to HIV in Pregnancy Childbirth and Puerperium based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
Value set Mental Health Disorder (2.16.840.1.113762.1.4.1029.314): Added 5 ICD-10-CM codes (F32.A, F06.70, F06.71, F43.81, F43.89) based on terminology update. Deleted 1 ICD-10-CM code (F43.8) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set (2.16.840.1.113762.1.4.1029.329): Renamed to Mild or Moderate Preeclampsia based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
Value set (2.16.840.1.113762.1.4.1029.290): Renamed to Morbid or Severe Obesity based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
Value set Neuromuscular Disease (2.16.840.1.113762.1.4.1029.308): Added 2 ICD-10-CM codes (G40.833, G40.834) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Payer (2.16.840.1.114222.4.11.3591): Added 5 SOP codes (1111, 1112, 142, 344, 141) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Previous Cesarean (2.16.840.1.113762.1.4.1029.278): Added 1 ICD-10-CM code (O34.218) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Renal Disease (2.16.840.1.113762.1.4.1029.335): Added 7 ICD-10-CM codes (N03.A, N04.A, N05.A, N07.A, N18.30, N18.31, N18.32) based on terminology update. Deleted 1 ICD-10-CM code (N18.3) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Respiratory Support Procedures Related to COVID 19 (2.16.840.1.113762.1.4.1029.379): Deleted 1 ICD-10-PCS code (5A0522C) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Severe Maternal Morbidity Diagnoses (2.16.840.1.113762.1.4.1029.255): Added 44 ICD-10-CM codes based on terminology update. Deleted 1 ICD-10-CM code (O72.3) based on review by technical experts, SMEs, and/or public feedback. Deleted 8 ICD-10-CM codes (I71.1, I71.5, I63.8, I71.01, I71.2, I71.3, I71.4, I71.6) based on terminology update.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Severe Maternal Morbidity Procedures (2.16.840.1.113762.1.4.1029.256): Added 61 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Substance Abuse (2.16.840.1.113762.1.4.1029.320): Added 21 ICD-10-CM codes based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set (2.16.840.1.113762.1.4.1029.363): Renamed to Venous Thromboembolism in Pregnancy based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
Value set White blood cells count lab test (2.16.840.1.113762.1.4.1045.129): Added 2 LOINC codes (12227-5, 92635-2) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead