Knowledge Activity: Applied Data Analytics III
Recently, the local paper did an article on the nation’s high rate of cesarean section deliveries. The journalist featured interviews with Shoreline Birth Center doctors and patients who either perform or had undergone cesarean sections. The Birth Center felt that the press would negatively impact their bottom line and were hopeful that an analysis of birth data would show Shoreline does not perform more cesarean section deliveries than the national average.
However, Shoreline’s birth data revealed a cesarean section rate of 34%, 2.1% higher than the national average of 31.9%. The medical director believes that the Birth Center has a higher cesarean section rate because they are the area’s only high-risk birth center. Being a high-risk birth center means that Shoreline receives a higher percentage of high risk births. She believes that Shoreline’s high rate of cesarean section is related to the high-risk births and that cesarean section results in a safer birth experience for these families. Shoreline’s Public Relations officer is happy to hear that Shoreline’s high rate of cesarean may be related to a high rate of high-risk patients, but she feels the public also needs to know that Shoreline is the safest place to give birth. She would like to know the Perioperative mortality rate (POMR) at Shoreline.
You have been asked to research this issue and present your findings to the Shoreline Board.
Read the resources listed below (all attached.
- Measuring Perioperative Mortality Rate (POMR)
- Perioperative mortality rate meta-analysis
- Tracking perioperative mortality and maternal mortality
- What is a high-risk pregnancy
Then answer the questions below.
- What is POMR?
- How is POMR measured?
- How is the POMR rate expressed?
- What is the median POMR for cesarean section in low- to middle-income countries? Refer to the table on page 5 of the Perioperative mortality rate meta-analysis resource that accompanied this activity document under 1: Overview and Resources.
- If high-income counties reported lower POMR rates than low-to-middle income countries, what do you think could account for the different POMR rates?
- What do you think could account for the different POMR rates between low- and high-income countries?
- Why is POMR measurement important?
- What are some of the challenges in getting an accurate POMR around the world?
Review the de-identified EHR that accompanies this activity under 2 and answer the following questions.
- Would this case be counted in Shoreline’s POMR? Why or why not?
- What procedure did this patient have?
- What is the ICD-10 code R99?
- According to the resource What is a high-risk pregnancy, was this patient’s pregnancy considered “high-risk?” Explain.
A report has been generated of all birth outcomes for Shoreline in 2016. Open the resource titled 2016 Shoreline patient data CONFIDENTIAL(attached)
Generate a pivot table to assist with determining the POMR at Shoreline for each type of birth. One approach is to select ‘Birth Outcome’ for the rows, ‘Type of Birth’ for the columns, and ‘Birth Outcome’ for the ∑ Values (count). See screenshot below. Please refer to the pre-requisite activity Orientation to Data Analytics I for a step-by-step refresher on how to create a pivot table.
Use the data in the resulting table to calculate the POMR. You may use a formula function in Excel or calculate it separately.
- Sum the number of the corresponding deceased mothers and divide by the total.
- Use the same data to also determine the infant mortality rates. Sum those with still births and divide by the corresponding totals.
- POMR of all delivery types:
- POMR of cesarean section:
- POMR of vaginal birth:
Use the same data to also determine the infant mortality rates. Sum those with still births for cesarean (include Still Birth and Deceased Mom-Still Birth) and divide by the total cesarean births. Repeat for vaginal births.
- Infant mortality rate of cesarean section:
- Infant mortality rate of vaginal birth:
Continue using the same pivot table data to determine the combined live birth or NICU rates for each type of birth. Sum the live birth and NICU outcomes for cesarean then divide by the total cesarean births. Repeat for vaginal births.
- Cesarean resulting in live birth or NICU:
- Vaginal resulting in live birth or NICU:
Generate another pivot table to assess the cesarean rate by risk type. There are multiple approaches to do so. One option is to select both ‘Risk’ and ‘Type of Birth’ as rows and ‘Type of Birth’ as ∑ Values (count). Use a formula function in Excel or another method to compute the following rates.
- Rate of cesarean for low-risk births:
- Rate of cesarean for high-risk births:
- Rate of high risk births at Shoreline:
- Does the riskiness of the delivery (as indicated by high- versus low-risk) impact the rate of cesarean? Explain.
Generate additional pivot tables to determine if race and/or age impact the rate of cesarean.
- Does race impact the rate of cesarean? Explain.
- Does age impact the rate of cesarean? Explain.
Refer to the resource What is a High-Risk Pregnancyattached and answer the following question.
- Does Shoreline have a higher than average rate of high-risk pregnancies? Explain your answer.