A validation study of the Australian Maternity Care Classification System.

BACKGROUND: The Maternity Care Classification System is a novel system developed in Australia to classify models of maternity care based on their characteristics. It will enable large-scale evaluations of maternal and perinatal outcomes under different models of care independently of the model's name. AIM: To assess the accuracy, repeatability and reproducibility of the Maternity Care Classification System. METHOD: All 70 public maternity services in New South Wales, Australia, were invited to classify three randomly allocated model case-studies using a web-based survey tool and repeat their classifications 4-6 weeks later. Accuracy of classifications was assessed against the correct values for the case-studies; repeatability (intra-rater reliability) was analysed by percent agreement and McNemar's test between the same participants in both surveys; and reproducibility (inter-rater reliability) was assessed by percent agreement amongst raters of the same case-study combined with Krippendorff's alpha coefficient for a subset of characteristics. RESULTS: The accuracy of the Maternity Care Classification System was high with 90.8% of responses correctly classified; was repeatable, with no statistically significant change in the responses between the two survey instances (mean agreement 91.5%, p>0.05 for all but one variable); and was reproducible with a mean percent agreement across 9 characteristics of 83.6% and moderate to substantial agreement as assessed by a Krippendorff's alpha coefficient of 0.4-0.8. CONCLUSION: The results indicate the Maternity Care Classification System is a valid system for classifying models of care in Australia, and will enable the legitimate evaluation of outcomes by different models of care.

More than a name: Heterogeneity in characteristics of models of maternity care reported from the Australian Maternity Care Classification System validation study.

BACKGROUND: Without a standard terminology to classify models of maternity care, it is problematic to compare and evaluate clinical outcomes across different models. The Maternity Care Classification System is a novel system developed in Australia to classify models of maternity care based on their characteristics and an overarching broad model descriptor (Major Model Category). AIM: This study aimed to assess the extent of variability in the defining characteristics of models of care grouped to the same Major Model Category, using the Maternity Care Classification System. METHOD: All public hospital maternity services in New South Wales, Australia, were invited to complete a web-based survey classifying two local models of care using the Maternity Care Classification System. A descriptive analysis of the variation in 15 attributes of models of care was conducted to evaluate the level of heterogeneity within and across Major Model Categories. RESULTS: Sixty-nine out of seventy hospitals responded, classifying 129 models of care. There was wide variation in a number of important attributes of models classified to the same Major Model Category. The category of 'Public hospital maternity care' contained the most variation across all characteristics. CONCLUSION: This study demonstrated that although models of care can be grouped into a distinct set of Major Model Categories, there are significant variations in models of the same type. This could result in seemingly 'like' models of care being incorrectly compared if grouped only by the Major Model Category.

Medical Devices; Obstetrical and Gynecological Devices; Classification of the Pressure Wedge for the Reduction of Cesarean Delivery. Final order.

The Food and Drug Administration (FDA or we) is classifying the pressure wedge for the reduction of cesarean delivery into class II (special controls). The special controls that apply to the device type are identified in this order and will be part of the codified language for the pressure wedge for the reduction of cesarean delivery's classification. We are taking this action because we have determined that classifying the device into class II (special controls) will provide a reasonable assurance of safety and effectiveness of the device. We believe this action will also enhance patients' access to beneficial innovative devices, in part by reducing regulatory burdens.

Can we communicate gravidity and parity better?

Communication of gravidity and parity is a typical part of any written or oral presentation related to an obstetric or gynecologic patient. The ostensible purpose of including this information at the beginning of a discussion of a woman's care is to provide a quick context of the patient from a reproductive standpoint. Unfortunately, the systems in use for describing gravidity, parity, and reproductive outcomes are without clear epidemiologic, biologic, or clinical basis. In description of parous events, births and abortions easily can be confused in the gray zone of 20 to 24 weeks, and terminology used often fails to take into account the clinical context. In this article, we discuss the pitfalls of current systems used for describing a woman's reproductive history and recommend new and simple nomenclature to enhance our ability to communicate properly.

An evaluation of the quality of obstetric morbidity coding using an objective assessment tool, the Performance Indicators For Coding Quality (PICQ).

The Performance Indicators for Coding Quality (PICQ) is a data quality assessment tool developed by Australia's National Centre for Classification in Health (NCCH). PICQ consists of a number of indicators covering all ICD-10-AM disease chapters, some procedure chapters from the Australian Classification of Health Intervention (ACHI) and some Australian Coding Standards (ACS). The indicators can be used to assess the coding quality of hospital morbidity data by monitoring compliance of coding conventions and ACS; this enables the identification of particular records that may be incorrectly coded, thus providing a measure of data quality. There are 31 obstetric indicators available for the ICD-10-AM Fourth Edition. Twenty of these 31 indicators were classified as Fatal, nine as Warning and two Relative. These indicators were used to examine coding quality of obstetric records in the 2004-2005 financial year Australian national hospital morbidity dataset. Records with obstetric disease or procedure codes listed anywhere in the code string were extracted and exported from the SPSS source file. Data were then imported into a Microsoft Access database table as per PICQ instructions, and run against all Fatal and Warning and Relative (N=31) obstetric PICQ 2006 Fourth Edition Indicators v.5 for the ICD-10- AM Fourth Edition. There were 689,905 gynaecological and obstetric records in the 2004-2005 financial year, of which 1.14% were found to have triggered Fatal degree errors, 3.78% Warning degree errors and 8.35% Relative degree errors. The types of errors include completeness, redundancy, specificity and sequencing problems. It was found that PICQ is a useful initial screening tool for the assessment of ICD-10-AM/ACHI coding quality. The overall quality of codes assigned to obstetric records in the 2004- 2005 Australian national morbidity dataset is of fair quality.

Exploratory analysis of medical coding practices: the relevance of reported data quality in obstetrics-gynaecology.

We aimed at identifying a suitable data analysis approach to investigate potential patterns in the current medical coding in obstetrics and perinatal care. We processed the data reported for 2006 in DRG files from three Romanian university clinics of obstetrics-gynaecology and found substantial differences in the coding practices. Based on the evidence we found with a poor usage of the coding instruments, we concluded that using objective methods and quantifiable measures in analyzing the medical coding could help putting things into the right perspective and bring support for the need for formal education of medical record administrators and coders where such programmes do not exist, e.g. in Romania.

Are entering obstetrics/gynecology residents more similar to the entering primary care or surgery resident workforce?

OBJECTIVE: We compared demographic characteristics of first-year residents entering obstetrics/gynecology with those entering primary care and surgery. STUDY DESIGN: We analyzed first-year residents from the 1997-2004 National Graduate Medical Education Census. Multivariable logistic regression models identified independent associations between obstetrics/gynecology residency (compared with primary care and surgery) and demographic predictor variables. RESULTS: More than 90% of studied programs completed the National Graduate Medical Education Census for 146,174 first-year residents. Graduates of US allopathic medical schools, women, African Americans, and entering residents in 2003 and 2004 were more likely to enter obstetrics/gynecology than primary care; Asians were less likely to enter obstetrics/gynecology than primary care. Women, African Americans, and Hispanics were more likely to enter obstetrics/gynecology than surgery; trainees who were Asian, "other" race/ethnicity, and entered residency from 1999-2004 were less likely to enter obstetrics/gynecology than surgery. CONCLUSION: Demographic characteristics of incoming obstetrics/gynecology-residents differed significantly from both primary care and surgery residents. Obstetrics/gynecology should be a unique category in physician workforce studies.

Should obstetrics and gynaecology be separate specialities? A survey of Yorkshire trainees.

A questionnaire was given to trainees attending the Yorkshire Modular training programme to determine their views on separating obstetrics and gynaecology. A total of 73 questionnaires were collected; 34% of participants were junior grade (SHO), 65% were middle grade (SpR, LAT, SSHO) and 30% of participants were male. A total of 42% of participants wanted to work in gynaecology only; 28% of participants wanted to work in obstetrics only; and only 23% wanted a combined practice. The primary reasons to prefer gynaecology was more job satisfaction than in obstetrics and better social hours of work (100%). All of the 28% of participants who wanted to work in obstetrics only, thought it is more rewarding and 100% enjoyed the challenge. In conclusion, perhaps separating obstetrics and gynaecology will make both specialties more attractive, as individuals would not be compelled to practice both. There is a possibility that this might result in better recruitment and retention in both specialities.

Obstetric and gynecology devices; effective date of requirement for premarket approval for glans sheath devices. Final rule.

The Food and Drug Administration (FDA) is issuing a final rule to require the filing of a premarket approval application (PMA) or a notice of completion of product development protocol (PDP) for glans sheath medical devices. The agency has previously published its findings regarding the degree of risk of illness or injury designed to be eliminated or reduced by requiring the devices to meet the statute's approval requirements and the benefits to the public from the use of the devices.

Frecuencia de bacteriurea asintomática en embarazadas de la consulta prenatal ambulatorio urbano Tipo III Cabudare marzo-junio 1996 / Frecuency of asintomatic bacteriurea in pregnancy of prenatal consult urban Ambulatory Type II Cabudare marz-june 1996

Se realizó un estudio descriptivo transversal con el objeto de determinar la frecuencia de Bacteriurea Asintomática en las embarazadas que acudieron a la consulta prenatal del Ambulatorio de Cabudare en el lapso Marzo-Junio de 1996. Se estudiaron cuarenta y cinco (45) pacientes gestantes entre 9 y 37 semanas de embarazo, asintomáticas desde el punto de vista urinario. Se evaluaron los antecedentes obstétricos, examen funcional y físico de las gestantes. Entre los resultados más relevantes se destacan que el 28 por ciento de las pacientes que presenteron Bacteriurea Asintomática se ubicaron en el grupo etáreo entre 14 y 24 años de edad igualmente las primeras relaciones sexuales se encontraron a predominio en este grupo. Todas las pacientes de Bacteriurea Asintomática eran procedentes del área urbana y en el mayor porcentaje (19 por ciento) realizaron oficios del hogar. Respecto a la paridad se evidenció una mayor participación (28 por ciento) las primigestas, mientras que las multíparas fue 15 por ciento. Los resultados de este estudio permitirán al médico en la primera consulta la detección precoz de esta patología estableciendo pautas de tratamiento adecuados

Cesarean section rates by type of maternity unit and level of obstetric care: an area-based study in central Italy.

BACKGROUND: The rate of cesarean section in the Lazio region of Italy is one of the highest in the Western world, 26.5%. In order to evaluate the effects of nonmedical factors on cesarean section, we examined its relationship to the characteristics of maternity units in the region. METHODS: We collected data from the birth certificates of 91,557 infants born to women residing in Lazio in 1988-1989 and classified all maternity units in the region by method of financing (public, semiprivate with arrangements with the national health service, and completely private) and level of obstetric care (unclassified and levels I,II, and III). The rates of cesarean section were examined for primiparous and multiparous women, taking into account birthweight, gestational age, fetal presentation, maternal age, and day of delivery. RESULTS: The adjusted odds ratio for cesarean section (with public units of level I taken as reference) was 1.06 (primiparous) and 1.22 (multiparous) for semiprivate maternity units and 1.59 (primiparous) and 1.52 (multiparous) for private units; it increased to 1.59 (primiparous) and 1.61 (multiparous) for unclassified semiprivate units and to 2.06 (primiparous) and 1.87 (multiparous) for unclassified private units. CONCLUSIONS: The rate of cesarean section was associated in the Lazio region with private payment for hospital care and with inadequate level of obstetric care. The latter factor is of particular concern and should be investigated elsewhere.