{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T20:10:45Z","timestamp":1777493445446,"version":"3.51.4"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>The Joint Commission Unexpected Complications in Term Newborns measure characterizes newborn morbidity potentially associated with quality of labor and delivery care. Infant exclusions isolate relatively low-risk births, but unexpected newborn complications (UNCs) are not adjusted for maternal factors that may be associated with outcomes independently of hospital quality.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate the association between maternal characteristics and hospital UNC rates.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study was conducted using linked 2016 to 2018 New York City birth and hospital discharge datasets among 254\u202f259 neonates at low risk (singleton, \u226537 weeks, birthweight \u22652500 g, and without preexisting fetal conditions) at 39 hospitals. Logistic regression was used to calculate unadjusted hospital-specific UNC rates and replicated analyses adjusting for maternal covariates. Hospitals were categorized into UNC quintiles; changes in quintile ranking with maternal adjustment were examined. Data analyses were performed from December 2022 to July 2023.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>UNCs were classified according to Joint Commission International Statistical Classification of Diseases and Related Health Problems, Tenth Revision <\/jats:italic>(ICD-10<\/jats:italic>) criteria. Maternal preadmission comorbidities, obstetric factors, social characteristics, and hospital characteristics were ascertained.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 254\u202f259 singleton births at 37 weeks or later who were at low risk (125\u202f245 female [49.3%] and 129\u202f014 male [50.7%]; 71\u202f768 births [28.2%] to Hispanic, 47\u202f226 births [18.7%] to non-Hispanic Asian, 42\u202f682 births [16.8%] to non-Hispanic Black, and 89\u202f845 births [35.3%] to non-Hispanic White mothers and 2738 births [1.0%] to mothers with another race or ethnicity), 148\u202f393 births (58.4%) were covered by Medicaid and 101\u202f633 births (40.0%) were covered by commercial insurance. The 2016 to 2018 cumulative UNC incidence in New York City hospitals was 37.1 UNCs per 1000 births. Infants of mothers with preadmission risk factors had increased UNC risk; for example, among mothers with vs without preeclampsia, there were 104.4 and 35.8 UNCs per 1000 births, respectively. Among hospitals, unadjusted UNC rates ranged from 15.6 to 215.5 UNCs per 1000 births and adjusted UNC rates ranged from 15.6 to 194.0 UNCs per 1000 births (median [IQR] change from adjustment, 1.4 [\u22124.7 to 1.0] UNCs\/1000 births). The median (IQR) change per 1000 births for adjusted vs unadjusted rates showed that hospitals with low (&amp;lt;601 deliveries\/year; \u22122.8 [\u22127.0 to \u22121.6] UNCs) to medium (601 to &amp;lt;954 deliveries\/year; \u22123.9 [\u22127.1 to \u22121.9] UNCs) delivery volume, public ownership (\u22123.6 [\u22126.2 to \u22122.3] UNCs), or high proportions of Medicaid-insured (eg, \u226590.72%; \u22123.7 [\u22125.3 to \u22121.9] UNCs), Black (eg, \u226532.83%; \u22125.3 [\u22129.1 to \u22122.2] UNCs), or Hispanic (eg, \u22656.25%; \u22123.7 [\u22125.3 to \u22121.9] UNCs) patients had significantly decreased UNC rates after adjustment, while rates increased or did not change in hospitals with the highest delivery volume, private ownership, or births to predominantly White or privately insured individuals. Among all 39 hospitals, 7 hospitals (17.9%) shifted 1 quintile comparing risk-adjusted with unadjusted quintile rankings.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this study, adjustment for maternal case mix was associated with small overall changes in hospital UNC rates. These changes were associated with performance assessment for some hospitals, and these results suggest that profiling on this measure should consider the implications of small changes in rates for hospitals with higher-risk obstetric populations.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.11699","type":"journal-article","created":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T15:32:40Z","timestamp":1716219160000},"page":"e2411699","source":"Crossref","is-referenced-by-count":2,"title":["Maternal Characteristics and Rates of Unexpected Complications in Term Newborns by Hospital"],"prefix":"10.1001","volume":"7","author":[{"given":"Kimberly B.","family":"Glazer","sequence":"first","affiliation":[{"name":"Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York"},{"name":"Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York"},{"name":"Blavatnik Family Women\u2019s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Zeitlin","sequence":"additional","affiliation":[{"name":"Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York"},{"name":"Universit\u00e9 Paris Cit\u00e9, Inserm, Centre for Research in Epidemiology and Statistics, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie","family":"Boychuk","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalia N.","family":"Egorova","sequence":"additional","affiliation":[{"name":"Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York"},{"name":"Blavatnik Family Women\u2019s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul L.","family":"Hebert","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Washington, Seattle"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa","family":"Janevic","sequence":"additional","affiliation":[{"name":"Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York"},{"name":"Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth A.","family":"Howell","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2024,5,20]]},"reference":[{"issue":"4","key":"zoi240413r1","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1097\/AOG.0000000000003109","article-title":"Safety assessment of a large-scale improvement collaborative to reduce nulliparous cesarean delivery rates.","volume":"133","author":"Main","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"2","key":"zoi240413r2","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1097\/AOG.0000000000001864","article-title":"Severe maternal morbidity among Hispanic women in New York City: investigation of health disparities.","volume":"129","author":"Howell","year":"2017","journal-title":"Obstet Gynecol"},{"issue":"1","key":"zoi240413r3","doi-asserted-by":"publisher","first-page":"122.e1","DOI":"10.1016\/j.ajog.2015.08.019","article-title":"Black-White differences in severe maternal morbidity and site of care.","volume":"214","author":"Howell","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"zoi240413r4","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1377\/hlthaff.2019.00735","article-title":"Neighborhood racial and economic polarization, hospital of delivery, and severe maternal morbidity.","volume":"39","author":"Janevic","year":"2020","journal-title":"Health Aff (Millwood)"},{"issue":"3","key":"zoi240413r7","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1097\/AOG.0000000000004022","article-title":"An expanded obstetric comorbidity scoring system for predicting severe maternal morbidity.","volume":"136","author":"Leonard","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"4","key":"zoi240413r8","doi-asserted-by":"publisher","first-page":"e7","DOI":"10.1097\/MLR.0b013e31821d2b1d","article-title":"Quality of data in perinatal population health databases: a systematic review.","volume":"50","author":"Lain","year":"2012","journal-title":"Med Care"},{"issue":"2","key":"zoi240413r9","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1097\/EDE.0000000000001311","article-title":"Validation of ICD-10 codes for gestational and pregestational diabetes during pregnancy in a large, public hospital.","volume":"32","author":"Stanhope","year":"2021","journal-title":"Epidemiology"},{"issue":"4","key":"zoi240413r12","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1097\/MLR.0000000000000476","article-title":"The impact of hospital size on CMS hospital profiling.","volume":"54","author":"Sosunov","year":"2016","journal-title":"Med Care"},{"issue":"1","key":"zoi240413r13","doi-asserted-by":"publisher","first-page":"123.e1","DOI":"10.1016\/j.ajog.2015.08.027","article-title":"Hospital variation in cesarean delivery rates: contribution of individual and hospital factors in Florida.","volume":"214","author":"Sebasti\u00e3o","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"zoi240413r14","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.ajog.2016.05.007","article-title":"Site of delivery contribution to Black-White severe maternal morbidity disparity.","volume":"215","author":"Howell","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"3","key":"zoi240413r15","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1001\/jamapediatrics.2017.4402","article-title":"Differences in morbidity and mortality rates in Black, White, and Hispanic very preterm infants among New York City hospitals.","volume":"172","author":"Howell","year":"2018","journal-title":"JAMA Pediatr"},{"issue":"3","key":"zoi240413r16","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-024091","article-title":"Hospital quality of care and racial and ethnic disparities in unexpected newborn complications.","volume":"148","author":"Glazer","year":"2021","journal-title":"Pediatrics"},{"issue":"3","key":"zoi240413r17","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-2364","article-title":"Hospital variations in unexpected complications among term newborns.","volume":"139","author":"Sebasti\u00e3o","year":"2017","journal-title":"Pediatrics"},{"issue":"11","key":"zoi240413r18","first-page":"1046","article-title":"Pregnancy outcomes in women with chronic hypertension: a population-based study.","volume":"52","author":"Gilbert","year":"2007","journal-title":"J Reprod Med"},{"issue":"5","key":"zoi240413r19","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1016\/j.ramb.2013.08.004","article-title":"Fetal and neonatal deaths among cases of maternal near miss.","volume":"59","author":"Oliveira","year":"2013","journal-title":"Rev Assoc Med Bras (1992)"},{"issue":"12","key":"zoi240413r20","doi-asserted-by":"publisher","first-page":"3314","DOI":"10.1002\/art.v67.12","article-title":"Pregnancy outcomes in women with rare autoimmune diseases.","volume":"67","author":"Chen","year":"2015","journal-title":"Arthritis Rheumatol"},{"issue":"3","key":"zoi240413r21","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1097\/AOG.0b013e318229e6de","article-title":"Epidemiology of peripartum cardiomyopathy: incidence, predictors, and outcomes.","volume":"118","author":"Gunderson","year":"2011","journal-title":"Obstet Gynecol"},{"issue":"4","key":"zoi240413r22","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/S1701-2163(16)35214-8","article-title":"Acute disseminated intravascular coagulation in obstetrics: a tertiary centre population review (1980 to 2009).","volume":"34","author":"Rattray","year":"2012","journal-title":"J Obstet Gynaecol Can"},{"issue":"2","key":"zoi240413r23","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1007\/s00404-011-1977-8","article-title":"Trends, risk factors and pregnancy outcome in women with uterine rupture.","volume":"285","author":"Ronel","year":"2012","journal-title":"Arch Gynecol Obstet"},{"issue":"2","key":"zoi240413r24","doi-asserted-by":"publisher","first-page":"e223","DOI":"10.1542\/peds.2006-3629","article-title":"Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk.","volume":"121","author":"Shapiro-Mendoza","year":"2008","journal-title":"Pediatrics"},{"issue":"2","key":"zoi240413r25","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.19498","article-title":"Patient and Hospital factors associated with unexpected newborn complications among term neonates in US hospitals.","volume":"3","author":"Clapp","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"2","key":"zoi240413r26","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2021.100530","article-title":"Obstetric comorbidity scores and disparities in severe maternal morbidity across marginalized groups.","volume":"4","author":"Leonard","year":"2022","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"1","key":"zoi240413r27","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1089\/whr.2021.0046","article-title":"Development and validation of an obstetric comorbidity risk score for clinical use.","volume":"2","author":"Ruppel","year":"2021","journal-title":"Womens Health Rep (New Rochelle)"},{"issue":"4","key":"zoi240413r29","doi-asserted-by":"publisher","DOI":"10.1016\/j.semperi.2021.151410","article-title":"Intertwined disparities: applying the maternal-infant dyad lens to advance perinatal health equity.","volume":"45","author":"Glazer","year":"2021","journal-title":"Semin Perinatol"},{"issue":"6","key":"zoi240413r30","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1007\/s10995-020-02911-9","article-title":"Double disadvantage in delivery hospital for Black and Hispanic women and high-risk infants.","volume":"24","author":"Howell","year":"2020","journal-title":"Matern Child Health J"},{"key":"zoi240413r5","volume-title":"Specifications Manual for the Joint Commission National Quality Care Measures (v2020A2)","author":"The Joint Commission","year":"2019"},{"key":"zoi240413r10","author":"Ash","year":"2012"},{"key":"zoi240413r6","unstructured":"California Maternal Quality Care Collaborative. Unexpected complications in term newborns. Accessed April 19, 2023. https:\/\/www.cmqcc.org\/focus-areas\/quality-metrics\/unexpected-complications-term-newborns"},{"key":"zoi240413r11","unstructured":"Adams? Z, Binger? T, Davis? A, . Methodology: U.S. News & World Report 2022-23 best hospitals for maternity care. U.S. News & World Report. Accessed April 10, 2024. https:\/\/health.usnews.com\/media\/best-hospitals\/Best_Hospitals_for_Maternity_Final_Methodology_2022"},{"key":"zoi240413r28","unstructured":"The Joint Commission. 2022 ORYX performance reporting requirements: hospital accreditation program (HAP) and critical access hospital accreditation (CAH) program. Accessed April 10, 2024. https:\/\/www.jointcommission.org\/-\/media\/tjc\/documents\/measurement\/oryx\/2022-oryx-reporting-requirements--october-19-2021.pdf"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2818860\/glazer_2024_oi_240413_1715804970.91335.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T15:32:55Z","timestamp":1716219175000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2818860"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,20]]},"references-count":30,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.11699","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,20]]}}}