Indicator: First-birth Cesarean Birth Rate – Nulliparous Term Singleton Vertex (NTSV)
Description: The C-section rate among low-risk first-time mothers; i.e. the cesarean delivery rate among births that are nulliparous (first births), term (> 37 weeks gestational age), singleton (not twins or triplets) and vertex (not breech). Over the last 15 years, the C-section rate has risen from 21% to 33% with no observed improvements in maternal or newborn health outcomes. C-sections in the NTSV population account for 60% of increase in the overall primary C-section rate in the last decade and represent 90% of the variation in hospital performance. The indicator is calculated from hospital patient discharge data linked to birth certificate data–both of which are submitted by hospitals to state agencies.
The Payer categories in the bar chart are defined as follows from the source data:
c) Other public: Includes “Medicare”, “County Indigent”, “Other government”, “Other indigent”
d) Uninsured: “Self-Pay” in data source
“Worker’s Comp” and “Other” have not been included from the source data. The data source also has two Hispanic categories (US and foreign born), which have been combined into one Hispanic category in the chart.
Data Limitations: The NTSV C-section rate is the C-section measure utilized by the Joint Commission in its Perinatal Care measure set (required for accreditation among hospitals that perform > 1100 deliveries annually) and has been endorsed by the National Quality Forum. The NTSV C-section rate does differ from the C-section rates promulgated by the Agency for HealthCare Research and Quality (AHRQ); the definitions of the Joint Commission and AHRQ versions differ in ways that lead to C-section rate differences of up to ten percentage points.
Indicator Source: Original source of data is from hospitals, who send data to OSHPD(establish) and Vital Records. CMQCC(establish) originally developed the measure specifications and calculates the measure on all California hospitals for the full eligible measure population (100% sample) based on statewide data from OSHPD and Vital Records. The current measure steward is the Joint Commission, and some hospitals directly submit their rates to the Joint Commission, but is usually based on a 20% sample and does not represent all California hospitals.
Data Sharing Agreement: CMQCC has data use agreements with OSHPD and the California Department of Public Health-Vital Records to utilize patient discharge data(PDD) and birth certificate data to link the data and calculate the measure.
Indicator Calculation Methodology:
Data Collection Methodology: California hospitals are required to submit PDD to OSHPD, and to submit birth certificate data to the California Department of Public Health-Vital Records. After undergoing Institution Review Board and other approval processes, CMQCC received permission to receive and utilize these statewide data sets to calculate perinatal measures. The NTSV rate is calculated based on the full population of births in California.
Program URL Link: http://www.cmqcc.org