Quality Measures for Prenatal CareA Comparison of Care in Six Health Care Plans
Paul J. Murata, MD;
Elizabeth A. McGlynn, PhD;
Albert L. Siu, MD, MSPH;
Kristiana Raube, PhD;
Marjorie J. Sherwood, MD;
Carol P. Roth, RN, MPH;
Laurie McDonald;
Ahmar Iqbal, MD;
Hal Morgenstern, PhD;
Robert H. Brook, MD, ScD
Arch Fam Med. 1994;3(1):41-49.
Abstract
Objective
To develop a method for comparing the quality of prenatal care provided in different health care plans and making the results publicly available.
Design
Retrospective cohort study.
Setting
Six health maintenance organizations.
Patients
Random sample of all deliveries in the six managed care organizations during a 1-year interval. Patients not continuously enrolled in the managed care Organization for the year prior to delivery were excluded.
Main Outcome Measure
Adherence to explicit, externally determined prenatal care process criteria that were grouped into three scales.
Results
Adherence to most of the process criteria was over 75% to 80% in the six organizations. Significant differences in adherence rates among managed care organizations were found. For example, at the criterion level, rates at which cervical gonorrhea cultures were obtained at the first visit varied from 7% of patients in one plan to 96% of patients in another. The three process scales that group the individual criteria to facilitate comparisons of overall adherence confirmed significant variations in the quality of prenatal care among the health plans. For example, scores on the 100-point scale measuring use of routine screening tests ranged from 64 to 93. These results were not affected by adjustments for differences in age, race, and parity among pregnant women enrolled in the organizations.
Conclusions
Although in general the quality of prenatal care at the six managed care organizations was quite good, there are significant variations in specific aspects of quality. This information could be useful to purchasers when they consider which plans to offer their employees.
Author Affiliations
for the HMO Quality of Care Consortium
From the Schools of Medicine (Drs Murata, Siu, and Brook) and Public Health (Drs Morgenstern and Brook) of UCLA, Los Angeles, Calif, and the RAND Health Sciences Program (Drs McGlynn, Siu, Raube, and Brook and Ms McDonald) and Value Health Sciences (Drs Sherwood and Iqbal and Ms Roth), Santa Monica, Calif. A list of the names of the members of the HMO Quality of Care Consortium appears at the end of the article.
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