Delivery of <1500g Infants at a Non-Level III Facility

NQF Measure Title: Under 1500g Infant Not Delivered at Appropriate Level of Care

Brief Description of the Measure

The number (per 1,000 live births) of <1500g infants delivered at hospitals not appropriate for that size infant.

Denominator Statement

All live births over 24 weeks gestation at the given birth hospital.  NICU Level III status is defined by the State Department of Health or similar body typically using American Academy of Pediatrics Criteria.

Denominator Details

All live births at the hospital>=24weeks gestation.  This is easily calculated from Vital Stats (Birth Certificate) data.  The field used is the Best Obstetric Estimate of Gestational Age.  The only exclusions are: Stillbirths and live births <24 weeks gestation.

Numerator Statement

All live births over 24 weeks gestation and under 1500g born at the given birth hospital. 

Numerator Detail

Birthweight and Best Obstetric Estimate of Gestational Age are standard data fields on the Birth Certificate with extremely high rates of completion (>99%).

Risk Model

As this is a simple rate of a condition that simply should not occur (except for women who  present in advanced labor without time to transport to a higher level of care), there is no risk model.

Calculation Algorithm

For each hospital, first the total live births with Gestational age >=24 weeks is calculated.  Then from among these cases, those that are <1500g birth weight are counted.  Missing data for birth weight and gestational age is rare in the states vital records data that have been examined (<1%).  However, if the birth weight is <1500g but >=600g and the gestational age is missing, the case would be counted in both the denominator and numerator (as it is likely to be >24 weeks) but if it is <600gm and the gestational age is missing it is excluded. This is because the GA is more likely to be missing than usual in very early gestational ages.

For more information, see the NQF #0477 Measure Submission and Evaluation Worksheet