Do Differences in Accuracy of Vital Records and Hospital Discharge Data Between Physician and Nurse-Midwife Attended Births Matter?

Excerpt

In their recent paper, Bradford et al. [1] report the results of an analysis of differences in reporting validity for clinical data elements by birth attendant type, specifically comparing data quality between deliveries by certified nurse-midwifes (CNMs) and physicians (MDs). More research focusing not only on the strengths and limitations of vital statistics and hospital discharge databases is clearly needed [2, 3]. However, while this paper raises some interesting issues concerning documentation and clinical practice styles of the two types of birth attendants, the entire premise of the study may be flawed by a misunderstanding of the process of administrative record documentation of birth events occurring in hospitals. In most states, birth certificates are completed by clerks who are responsible for collating all necessary data for each birth and fetal death event, regardless of the type of birth attendant involved. While in the State of Washington the practice recommended by the state Center for Health Statistics is for the birth attendant or other person present at the delivery to complete the medical portion of the birth certificate in consultation with the patient chart, this function is often performed by medical record staff, a nurse or a unit clerk (personal communication, Patricia Starzyk, Center for Health Statistics, Washington State Department of Health, November 15, 2007). Hospital discharge summaries (frequently referred to as UB-92s) are coded centrally by medical records coders who perform this function for all inpatient discharges in most hospitals, also without regard to the type of medical provider attending each patient. Given this, any differences observed in birth certificate and/or hospital discharge summary data quality between CNMs and MDs most likely stem from other factors not analyzed or controlled in Bradford et al.’s analysis. While the authors note that “completion of birth certificates and hospital discharge summaries are clerical tasks performed by the same staff at each hospital irrespective of attendant at delivery, and not completed by the birth attendants” (p. 542), the implications of this statement for the utility of the subsequent analyses may have been under-recognized. …