[Federal Register Volume 89, Number 22 (Thursday, February 1, 2024)]
[Notices]
[Pages 6525-6526]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-02021]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Inpatient Severe Maternal Morbidity Measure Technical 
Specifications

AGENCY: Agency for Healthcare Research and Quality, U.S. Department of 
Health and Human Services.

ACTION: Notice of Request for Information.

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SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) Center 
for Quality Improvement and Patient Safety (CQuIPS) Division of Quality 
Measurement and Improvement (QMI) invites public comment in response to 
this Request for Information (RFI). The AHRQ Quality Indicators (QI) 
program maintains inpatient quality indicators (https://qualityindicators.ahrq.gov/measures/IQI_TechSpecTechSpec) and patient 
safety indicators (https://qualityindicators.ahrq.gov/measures/PSI_TechSpec), several of which are relevant to maternal health care. 
Specifically, the QI program maintains measures of obstetric trauma, 
birth trauma, and cesarean delivery calculated at the hospital level 
using administrative data. However, severe maternal morbidity during an 
inpatient stay may result from a host of complications, such as sepsis, 
cardiac failure, stroke, respiratory distress, and renal failure. While 
state-level rates of severe maternal morbidity are available from AHRQ 
(https://datatools.ahrq.gov/hcup-fast-stats/?tab=special-emphasis&dash=92), experts have noted some shortcomings of this 
measure. This RFI seeks comments on the usability, feasibility, and 
likely uptake of a measure of severe maternal morbidity to be 
validated, refined, and maintained by the QI program, with the goal of 
providing data for maternal health service improvements. While a 
measure of severe maternal morbidity is currently available from AHRQ 
and the Health Resources and Service Administration (HRSA), several 
experts have suggested that this algorithm could benefit from 
refinements.

DATES: Comments on this notice must be received at the address provided 
below within 30 days of publication of this notice, no later than March 
4, 2024.

ADDRESSES: Interested parties may submit comments electronically to 
<a href="/cdn-cgi/l/email-protection#e8899b8389809a99a889809a99c680809bc68f879e"><span class="__cf_email__" data-cfemail="7a1b09111b12080b3a1b12080b54121209541d150c">[email protected]</span></a>. When submitting comments or requesting 
information, please include the document identifier number and project 
title ``Inpatient Severe Maternal Morbidity Measure Technical 
Specifications'' for reference.

FOR FURTHER INFORMATION CONTACT: Questions may be addressed to Judy 
George, Program Lead for the AHRQ Quality Indicators, 
<a href="/cdn-cgi/l/email-protection#672d12031e4900020815000227060f1516490f0f1449000811"><span class="__cf_email__" data-cfemail="dd97a8b9a4f3bab8b2afbab89dbcb5afacf3b5b5aef3bab2ab">[email protected]</span></a>.

SUPPLEMENTARY INFORMATION: Maternal health, including maternal 
behavioral health, is a national priority in the United States. 
Strengthening data collection and evaluation is part of the first goal 
of the White House Blueprint for Addressing the Maternal Health Crisis 
(https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf), which is to increase access to and coverage of 
comprehensive high-quality maternal health services, including 
behavioral health services. Unexpected complications and outcomes 
around labor and delivery may lead to short- or long-term consequences 
to women's health (https://pubmed.ncbi.nlm.nih.gov/27560600/), which 
have been defined as severe maternal morbidity (https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.htmlhtml). National and state rates of severe 
maternal morbidity are currently available on AHRQ's Healthcare Cost 
and Utilization Project (HCUP) Fast Stats dashboard (https://datatools.ahrq.gov/hcup-fast-stats/?tab=special-emphasis&dash=92). 
However, there are measurement concerns for some of indicators included 
in this measure (eclampsia, disseminated intravascular coagulation, and 
blood transfusions) and additional validation and refinement may be 
warranted.
    In collaboration with federal partners from the Department of 
Health and Human Services, AHRQ is exploring potential refinements to 
this measure of severe maternal morbidity for use at an area level 
(e.g., county, state) using administrative data. AHRQ aims to assess 
the validity and reliability of potential refinements to this severe 
maternal morbidity measure. In addition, AHRQ is considering 
incorporating a measure of severe maternal morbidity into its measure 
portfolio, including the production of technical specifications and the 
dissemination of software to calculate this measure through the AHRQ QI 
program.
    Many users of quality measures, such as state and local 
governments, largely rely on administrative data that lack the robust 
clinical information found in electronic health records (EHRs). For 
example, Centers for Medicaid and Medicare Services (CMS) has developed 
Electronic Clinical Quality Measures (ECQMs) for severe obstetric 
complications which relies upon EHR data. AHRQ aims to provide 
measurement resources that are broadly accessible across organizations, 
including for those lacking access to extensive clinical data.
    To support measurement resources that are broadly accessible across 
organizations, AHRQ requests public comment on the usability, 
feasibility, and likely uptake of an inpatient severe maternal 
morbidity measure, produced through the QI program using administrative 
data, with the intent of promoting maternal health service improvements 
at an area level (e.g., county, state). AHRQ invites stakeholders 
representing consumers, state/regional/local health departments, 
accountable care organizations, community health centers, birthing 
centers, providers/health systems, critical access/rural hospitals, 
professional associations, payers, rural and community health groups, 
community health workers, doulas, maternal health advocacy groups, 
researchers, and other members of the public to comment.
    Specific questions of interest include, but are not limited to:
    1. If you are currently measuring severe maternal morbidity in your 
organization, what measure(s) are you or your organization using? How 
do you use these measures? What data sources are you using? Please 
specify organization type in your answer.
    2. If you or your organization are not currently measuring severe 
maternal morbidity, what quantitative data would you need to make 
maternal health service improvements? Please specify organization type 
in your answer.
    3. At what level--state, county, or some other level--would 
information be

[[Page 6526]]

most helpful for improving maternal health services? In what ways?
    4. The measure currently used by AHRQ for severe maternal morbidity 
uses 21 indicators (https://www.cdc.gov/reproductivehealth/maternalinfanthealth/smm/severe-morbidity-ICD.htm) identified with ICD-
10CM10CM/PCS codes in administrative data. Considering these 
indicators,
    a. What codes might be missing? Are there changes you would you 
recommend?
    b. In what ways would the changes that you propose make a severe 
maternal morbidity measure more useful to your organization?
    c. Would a measure with the refinements you propose be useful for 
surveillance? Population health management? Clinical quality 
improvement? Program evaluation? Research? Public reporting or 
accountability programs? In what ways?
    5. What other measures of maternal health and/or morbidity would 
your organization find useful/effective for improving maternal health 
services, including any potential measures for use in either the 
prenatal or postpartum time periods?
    AHRQ is interested in all of the questions listed above, but 
respondents are welcome to address as many or as few as they choose and 
to address additional areas of interest not listed. It is helpful to 
identify the question to which a particular answer corresponds.
    This RFI is for planning purposes only and should not be construed 
as a policy, solicitation for applications, or as an obligation on the 
part of the Government to provide support for any ideas in response to 
it. AHRQ will use the information submitted in response toto this RFI 
at its discretion and will not provide comments to any respondent's 
submission. However, responses to this RFI may be reflected in future 
solicitation(s) or policies. The information provided will be analyzed 
and may appear in reports.

    Dated: January 29, 2024.
Marquita Cullom,
Associate Director.
[FR Doc. 2024-02021 Filed 1-31-24; 8:45 am]
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