Frequently Asked Questions - UNC

Now that we have several years of results with over a million patients, we can address some common FAQs:

Typically over 80% of a hospital's births are covered with 15‐18% meeting one or another of the exclusion criteria.

The median hospital rate for Total Unexpected Newborn Complications in 2016 in California is 27.4 per 1,000 births (19.2 for the first quartile and 37.7 for the third quartile). (Severe Complications: median=15.9, Q1=10.2, Q3=23.6 per 1,000 births;  Moderate Complications: median=9.6, Q1=4.9, Q3=14.6 per 1,000 births).

The codes from both Severe and Moderate Complications can be combined into 6 categories for further analysis. In 2016, the most frequent category in California is Respiratory (10.9 per 1,000 births), followed by Transfer to another hospital (8.0 per 1,000), Infection (6.2 per 1,000), Neurologic/Birth Injury (3.9 per 1,000), Long Length of Stay without clear diagnosis (0.9 per 1,000), and lastly by Shock/Resuscitation (0.3 per 1,000). Examining hospitals with high rates, we find significant variation among diagnostic categories. Some hospitals have high rates of infection while others have high rates of respiratory issues suggesting improvement opportunities.

We have noted that there is significant variation within low and high volume hospitals; within hospitals with high‐level Neonatal Intensive Care Units and within hospitals with basic‐level facilities; and among Public/County facilities and among Private facilities. No one grouping as a whole is favored over another.

While we originally envisioned this measure to be a balancing measure for Obstetric services, on further analysis we have found it very helpful for driving quality improvement. The key is to provide the sub‐analyses of the diagnostic categories described in question (3) above.  Being able to identify that you have a high rate overall and that your issues are with infection or respiratory issues provides good direction.