Poster Session 3
Rajesh Reddy, MD
Fellow
Dell Medical School
Austin, Texas, United States
Justin A. Drake, PhD
University of Texas at Austin
Austin, Texas, United States
Corwin Zigler, PhD
University of Texas at Austin
Austin, Texas, United States
Jeny Ghartey, DO, MS
Maternal Medical Director
University of Texas at Austin
Austin, Texas, United States
.jpg "Alison G. Cahill, MD, MSCI photo")
Alison G. Cahill, MD, MSCI
Associate Dean of Translational Research,
Professor of Women's Health
The University of Texas at Austin
Austin, Texas, United States
Lorie M. Harper, MD, MSCI (she/her/hers)
Associate Professor
Dell Medical School
Austin, Texas, United States
Seeking to curb severe maternal morbidity (SMM) and mortality, Texas adopted statutory levels of maternal care rules. We evaluated if the state-mandated maternal level of care designation law decreased SMM.
Study Design:
Retrospective cross-sectional analysis of all delivery hospitalizations in Texas from 2016-2023 using quarterly discharge data in the Texas Inpatient Public Use Data File. Out of 221 designated hospitals, we included the 215 that reported deliveries in the study period (32 Level IV, 43 Level III, 86 Level II, 54 Level I). As 99% of facilities received their requested designation level, we assumed the same pre-mandate level. Deliveries at sites that were not designated maternal facilities (89 total) were categorized Undesignated. We organized comorbidities by minimum recommended level of care (highest Level IV, lowest ‘No risk’) using criteria in the Texas Administrative Code, ACOG/SMFM Consensus, and literature. We chose a baseline of 2016(Q1) to 2018(Q4) due to (Q4)2015 introduction of ICD-10 and 2018 Texas rule adoption, then a post-intervention of 2021(Q4) to 2023(Q3) based on the September 2021 implementation deadline. We used the CDC’s definition of SMM and ICD-10 codes to calculate SMM rates. We categorized patients into minimum level of care by their highest risk comorbidity and used a z-test for two proportions to compare the SMM rates for each risk group by delivery at appropriate or inappropriate level of care.
Results:
SMM rates increased overall during the study period. SMM decreased among patients with maternal risk levels II-IV regardless of appropriate level of care, except for a stable rate in risk level IV patients at inappropriate level facilities (Figure 1). Maternal risk level I patients and those with no risks experienced increases in SMM (Table 1).
Conclusion:
SMM decreased for high-risk patients, particularly when delivered at appropriate level facilities, while SMM increased for low-risk patients and overall. As low-risk patients constitute the overwhelming share of births, this cohort may benefit from targeted policies.
