Reduce severe maternal complications identified during delivery hospitalizations — MICH‑05 Data Methodology and Measurement

This measure originally followed the CDC-developed definition of severe maternal morbidity identified from hospital discharge procedure and diagnosis codes that indicate a potentially life-threatening condition or maternal complication (Callaghan et al, 2012). Specific ICD-9-CM diagnosis and procedure codes had been reduced to 21 indicators (18 if 3 are collapsed) in preparation for the transition to ICD-10-CM and described in detail by the National Center for Chronic Disease Prevention and Health Promotion, CDC. The transition from ICD-9-CM to ICD-10-CM/PCS coding of hospital discharge information required a re-alignment of the SMM algorithm. CDC, HRSA and AHRQ collaborated to produce the revised definition used for Healthy People 2030.

With the exception of hospitalizations with in-hospital mortality, transfer, or severe complications identified by procedure codes (e.g., hysterectomy, blood transfusion, ventilation), cases of severe maternal morbidity identified by diagnostic codes were reclassified as hospitalizations without severe maternal morbidity if they had an implausibly short length of stay (≤ 3 days for vaginal,<4 days for primary cesarean, and < 5 days for repeat cesarean deliveries). Delivery hospitalizations were identified by diagnosis codes for an outcome of delivery, diagnosis-related group delivery codes, and procedure codes for selected delivery-related procedures (Kuklina et al, 2008).

Although blood transfusions are significant maternal health events and can be an indicator of SMM, they may not always reflect SMM in the absence of other indicators. As a result of this and changes in data reporting, SMM estimates provided here do not include those who only received blood transfusions.

The HCUP-NIS data represent 97% of inpatient discharges from community hospitals and do not include all states.