The Joint Commission's Perinatal Care Measure Set Overview

Abstract

Overview

In November 2007, the Joint Commission's Board of Commissioners recommended retiring the pregnancy and related conditions (PR) core measure set. The Board made a further recommendation to replace the PR measures with an expanded set of measures based on current scientific evidence. The new set of measures, known as the perinatal care (PC) core measure set, was adapted from the national PC measures endorsed in October 2008 by the National Quality Forum (NQF).

A PC Technical Advisory Panel (TAP) was appointed December 2008. The TAP comprised 10 clinicians representing the following professional organizations: American College of Obstetricians and Gynecologists (ACOG); American Academy of Pediatrics (AAP); Society for Maternal-Fetal Medicine; American College of Nurse-Midwives, Association of Women's Health, Obstetric and Neonatal Nurses; America's Health Insurance Plans; National Perinatal Information Center; NQF; and Centers for Disease Control and Prevention (CDC). The PC TAP meeting was held February 2009, and five measures were selected from the 17 NQF-endorsed PC measures.

Measure specifications work began February 2009, during which time the measures were fully specified in a standardized manner similar to the existing core measure sets. Numerator and denominator populations were defined, a data dictionary was built, algorithms were developed, and codes tables were constructed to identify included and excluded populations. The Specifications Manual for Joint Commission National Quality Core Measures Version 2010A, posted in October 2009, contains the PC measure set. Version 2010A1 of the manual was posted in December 2009, and Version 2010A2 was posted in January 2010 with some minor enhancements to the measures. PC measure data collection began with April 1, 2010 discharges and replaced the PR measure set at that time. Version 2010B of the manual was posted April 2010 and will be effective with October 1, 2010 discharges.

PC Measure Set

PC-01 Elective Delivery. Patients with elective vaginal deliveries or elective cesarean sections at ≥37 and <39 weeks of gestation completed

PC-02 Cesarean Section. Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean section

PC-03 Antenatal Steroids. Patients at risk of preterm delivery at 24–32 weeks of gestation receiving antenatal steroids prior to delivering preterm newborns

PC-04 Healthcare-Associated Bloodstream Infections in Newborns. Staphylococcal and Gram-negative septicemias or bacteremias in high-risk newborns

PC-05 Exclusive Breastmilk Feeding. Exclusive breastmilk feeding during the newborn's entire hospitalization

As the rationale for PC-05, exclusive breastmilk feeding for the first 6 months of neonatal life has long been the expressed goal of the World Health Organization, U.S. Department of Health and Human Services, AAP, and ACOG. ACOG has recently reiterated its position.¹ A recent Cochrane review substantiates the benefits.² Much evidence has now focused on the prenatal and intrapartum period as critical for the success of exclusive (or any) breastfeeding.³ Exclusive breastmilk feeding rate during birth hospital stay has been calculated by the California Department of Public Health for the last several years using newborn genetic disease testing data. The Healthy People 2010 initiative and the CDC have also been active in promoting this goal.

Footnotes

Disclosure Statement

No competing financial interests exist.

References

Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists. ACOG Committee Opinion 361: Breastfeeding: Maternal and infant aspects. Obstet Gynecol, 2007; 109:479–480.

Kramer

, Kakuma

. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev, 2002; 1CD003517.

Centers for Disease Control and Prevention. Breastfeeding trends and updated national health objectives for exclusive breastfeeding—United States birth years 2000–2004. MMWR Morbid Mortal Wkly Rep, 2007; 56:760–763.