eMeasure Title

Healthy Term Newborn

eMeasure Identifier (Measure Authoring Tool) 185 eMeasure Version number 5.1.000
NQF Number 0716 GUID ff796fd9-f99d-41fd-b8c2-57d0a59a5d8d
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward Centers for Medicare & Medicaid Services (CMS)
Measure Developer Centers for Medicare & Medicaid Services (CMS)
Endorsed By National Quality Forum
Description
Percent of term singleton live births (excluding those with diagnoses originating in the fetal period) who DO NOT have significant complications during birth or the nursery care
Copyright
Measure specifications are in the Public Domain

CPT(R) is a trademark of the American Medical Association. Current Procedural Terminology. (CPT) is copyright 2015 American Medical Association. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

LOINC(R) is a registered trademark of the Regenstrief Institute.

This material contains SNOMED Clinical Terms (R) (SNOMED CT[C]) copyright 2004-2015 International Health Terminology Standards Development Organization. All rights reserved.
Disclaimer
These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. CMS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.

CMS suggests eligible hospitals participating in the Medicare & Medicaid EHR Incentive Programs not select CMS185/NQF0716: Healthy Term Newborn as one of their additional electronic clinical quality measures (eCQMs) for meaningful use. The measure steward is making substantial changes to this measure and is working with NQF on endorsement of the revised measure. CMS will review the changes to this measure and assess its feasibility for future implementation.
Measure Scoring Proportion
Measure Type Process
Measure Item Count
Encounter, Performed: Encounter Inpatient
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
The current set of Perinatal measures has no metrics for general term neonatal outcomes which is the most important outcome for most families having babies.  This measure sums up the outcomes for term babies that present to Labor and Delivery without underlying fetal conditions so expectations are high.  It serves as a balancing measure for other maternal process and outcome measures such as the low-risk first-birth Cesarean rate.  An ideal OB unit would have both good baby outcomes and an average or better Cesarean rate.
Clinical Recommendation Statement
This measure is an outcome measure; therefore clinical guidelines are not directly applicable as they are for process measures. There are a number of obstetric guidelines that direct elements of maternal care that in turn affect the newborn.  An example is ACOG Practice Bulletin on Labor Induction (#107) which states that elective deliveries should not occur prior to 39 weeks. This guideline directly affects neonatal outcomes, as measured in this metric, as early term births lead to increased neonatal morbidity and longer neonatal length of stay.
Improvement Notation
Improvement noted as an increase in rate
Reference
Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2007. National vital statistics reports, Web release; vol 57 no 12.
Reference
Hyattsville, MD: National Center for Health Statistics. Released March 18, 2009.
Reference
Gregory KD, Fridman M, Shah S, Korst LM. Global measures of quality- and patient safety-related childbirth outcomes: should we monitor adverse or ideal rates? Am J Obstet Gynecol. 2009 Jun;200(6):681.e1-7.
Reference
van Handel M, Swaab H, de Vries LS, Jongmans MJ. Long-term cognitive and behavioral consequences of neonatal encephalopathy following perinatal asphyxia: a review. Eur J Pediatr. 2007 Jul;166(7):645-54. Epub 2007 Apr 11.
Reference
Bailit JL, Garrett JM, Miller WC, McMahon MJ, Cefalo RC. Hospital primary cesarean delivery rates and the risk of poor neonatal outcomes. Am J Obstet Gynecol. 2002 Sep;187(3):721-7.
Reference
Bailit JL, Love TE, Dawson NV. Quality of obstetric care and risk-adjusted primary cesarean delivery rates. Am J Obstet Gynecol. 2006
Reference
Clark SL, Miller DD, Belfort MA, Dildy GA, Frye DK, Meyers JA. Neonatal and maternal outcomes associated with elective term delivery. Am J Obstet Gynecol. 2009 Feb;200(2):156.e1-4. Epub 2008 Dec 25
Reference
Clark SL, Simpson KR, Knox GE, Garite TJ. Oxytocin: new perspectives on an old drug. Am J Obstet Gynecol. 2009 Jan;200(1):35.e1-6. Epub 2008 Jul 29
Reference
Dunne C, Da Silva O, Schmidt G, Natale R. Outcomes of elective labour induction and elective caesarean section in low-risk pregnancies between 37 and 41 weeks' gestation. J Obstet Gynaecol Can. 2009 Dec;31(12):1124-30.
Reference
Fisch JM, Labor induction process improvement: A patient quality-of-care initiative. Obset Gynecol 2009;113:797-803.
Reference
Gould JB, Danielsen B, Korst LM, Phibbs R, Chance K, Main E, Wirtschafter DD, Stevenson DK. Cesarean delivery rates and neonatal morbidity in a low-risk population. Obstet Gynecol. 2004 Jul;104(1):11-9.
Reference
Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Elective caesarean section and respiratory morbidity in the term and near-term neonate. Acta Obstet Gynecol Scand 2007;86:389-94.
Reference
Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study. BMJ. 2008 336:85-7.
Reference
Oshiro BT, Henry E, Wilson J, et al. Decreasing elective deliveries before 39 weeks of gestation in an integrated health care system. Obstet Gynecol 2009;113:840-811.
Reference
Robertson CM, Finer NN. Long-term follow-up of term neonates with perinatal asphyxia. Clin Perinatol. 1993 Jun;20(2):483-500.
Reference
Russo CA, Andrews RM. Potentially Avoidable Injuries to Mothers and Newborns During Childbirth, 2006. HCUP Statistical Brief #74. June 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb74.pdf.
Reference
Tita ATN, Landon MB, Spong CY, et al. Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes. New Engl J Med 360:111, 2009
Reference
ACOG. Induction of labor. ACOG Practice Bulletin No. 107. Obstet Gynecol 2009; 114: 386-97
Reference
There are a number of obstetric guidelines that direct elements of the care that in turn affect the newborn. An example is the ACOG Practice bulletin on labor induction (#107): which states that elective deliveries should not occur prior to 39 weeks. This is covered in NQF #0469, Elective delivery prior to 39 completed weeks gestation, but does not have a corresponding measure of neonatal outcomes.
Definition
Among babies who had no known complications prior to Labor and Delivery (normally grown, no anomalies or other fetal diagnoses) how many left the hospital with their mother without a significant complication
Guidance
CMS suggests eligible hospitals participating in the Medicare & Medicaid EHR Incentive Programs not select CMS185/NQF0716: Healthy Term Newborn as one of their additional electronic clinical quality measures (eCQMs) for meaningful use. The measure steward is making substantial changes to this measure and is working with NQF on endorsement of the revised measure. CMS will review the changes to this measure and assess its feasibility for future implementation.

The very first step for this measure, identifying all term singleton infants can be surprisingly challenging.  Some hospitals do not do a good job of using the proper v-codes or DRGs so that clinical information such as birthweight and gestational age need to be used in the first step.

The logic phrase AND: "Occurrence A of Encounter, Performed: Inpatient Encounter (reason: 'Birth')" intends to capture admission type of newborn for the encounter. Where this information is available in existing EHR structured fields (eg data that is fed to UB-04, field location 14), it can be used to map the criterion specified in the logic.

The logic phrase AND: "Diagnosis, Active: Liveborn Born In Hospital" starts during "Occurrence A of Encounter, Performed: Inpatient Encounter" intends to capture the point of origin for the inpatient admission. Where this information is available in existing EHR structured fields (eg data that is fed to UB-04, field location 15), it can be used to map the criterion specified in the logic.
Transmission Format
TBD
Initial Population
All patients who are single liveborn term newborns born in a hospital
Denominator
The denominator is composed of singleton, term (>=37 weeks), inborn, livebirths in their birth admission. The denominator further has eliminated fetal conditions likely to be present before labor. Maternal and obstetrical conditions (eg hypertension, prior cesarean, malpresentation) are not excluded unless evidence of fetal effect prior to labor (eg IUGR/SGA).
Denominator Exclusions
Denominator exclusions: multiple gestations, preterm, congenital anomalies or fetuses affected by selected maternal conditions
Numerator
The absence of conditions or procedures reflecting morbidity that happened during birth and nursery care to an otherwise normal infant
Numerator Exclusions
Not Applicable
Denominator Exceptions
None
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Table of Contents


Population Criteria

Data Criteria (QDM Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables


Measure Set
None