| eCQM Title | Elective Delivery |
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|---|---|---|---|
| CMS ID | 113 | eCQM Version Number | 14.0.000 |
| CBE Number | Not Applicable | GUID | fd7ca18d-b56d-4bca-af35-71ce36b15246 |
| Measurement Period | January 1, 2026 through December 31, 2026 | ||
| Measure Steward | The Joint Commission | ||
| Measure Developer | The Joint Commission | ||
| Endorsed By | None | ||
| Description |
Patients with elective vaginal deliveries or elective cesarean births at >= 37 and < 39 weeks of gestation completed |
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| Copyright |
Measure specifications are in the Public Domain LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved. |
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| Disclaimer |
These performance measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. |
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| Measure Scoring | Proportion | ||
| Measure Type | Process | ||
| Stratification |
None |
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| Risk Adjustment |
None |
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| Rate Aggregation |
None |
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| Rationale |
For almost 3 decades, the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) have had in place a standard requiring 39 completed weeks gestation prior to ELECTIVE delivery, either vaginal or operative (ACOG Committee Opinion, 2021). A survey conducted in 2007 of almost 20,000 births in Hospital Corporation of America (HCA) hospitals throughout the U.S. carried out in conjunction with the March of Dimes at the request of ACOG revealed that almost 1/3 of all babies delivered in the United States are electively delivered with 5% of all deliveries in the U.S. delivered in a manner violating ACOG/AAP guidelines. Most of these are for convenience and result in significant short term neonatal morbidity (neonatal intensive care unit admission rates of 13- 21%) (Clark et al., 2009). An infant born prior to 39 weeks faces a 20% greater risk of significant medical consequences than those born after 39 weeks. Mortality rates are also higher among infants delivered in the early-term period compared with those born after 39 weeks, now called full-term births (Sengupta et al., 2013). According to Glantz (2005), compared to spontaneous labor, elective inductions result in more cesarean births and longer maternal length of stay. Interventions that decrease the chance of a cesarean delivery include avoiding non-medically indicated induction of labor prior to 39 weeks gestation (Quinlan and Murphy, 2015). Repeat elective cesarean births before 39 weeks gestation also result in higher rates of adverse respiratory outcomes, mechanical ventilation, sepsis and hypoglycemia for the newborns (Tita et al., 2009). |
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| Clinical Recommendation Statement |
Guidelines from the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics do not support non-medically indicated elective deliveries at <39 weeks gestation. Evidence suggests that early term deliveries result in significant short term neonatal morbidity. Therefore, it is recommended that elective deliveries should not be performed at <39 weeks gestation unless medically indicated. |
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| Improvement Notation |
Decreased score indicates improvement |
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| Reference |
Reference Type: CITATION Reference Text: 'ACOG Committee Opinion, No. 765: Avoidance of nonmedically indicated early-term deliveries and associated neonatal morbidities. (2019). Obstetrics and Gynecology, 133(2), e156–e163. https://doi.org/10.1097/AOG.0000000000003076' |
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| Reference |
Reference Type: CITATION Reference Text: 'ACOG Committee Opinion, No. 831: Medically indicated late-preterm and early-term deliveries. (2021, July). Obstetrics and Gynecology, 138(1), e35-e39. https://doi.org/10.1097/AOG.0000000000004447' |
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| Reference |
Reference Type: CITATION Reference Text: 'American College of Obstetricians and Gynecologists. (2014). Revitalize: Obstetrics Data Definitions Version 1.0. American College of Obstetricians and Gynecologists. Revitalize: Obstetrics Data Definitions Version 1.0-Search (bing.com)' |
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| Reference |
Reference Type: CITATION Reference Text: 'Clark, S. L., Miller, D. D., Belfort, M. A., Dildy, G. A., Frye, D. K., & Meyers, J. A. (2009). Neonatal and maternal outcomes associated with elective term delivery. American Journal of Obstetrics and Gynecology, 200(2), 156.e1- 156.e1564. https://doi.org/10.1016/j.ajog.2008.08.068' |
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| Reference |
Reference Type: CITATION Reference Text: 'Glantz, J.C. (2005, April). Elective induction vs. spontaneous labor associations and outcomes. Journal of Reproductive Medicine, 50(4), 235-240.' |
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| Reference |
Reference Type: CITATION Reference Text: 'Kilpatrick, S. J., Papile, L., Macones, G. A., & Watterberg, K. L. (Eds.). (2017). Guidelines for perinatal care (8th ed.). Washington, DC: American Academy of Pediatrics.' |
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| Reference |
Reference Type: CITATION Reference Text: 'Quinlan, J. D., & Murphy, N. J. (2015). Cesarean delivery: Counseling issues and complication management. American Family Physician, 91(3), 178–184.' |
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| Reference |
Reference Type: CITATION Reference Text: 'Sengupta, S., Carrion, V., Shelton, J., Wynn, R. J., Ryan, R. M., Singhal, K., & Lakshminrusimha, S. (2013). Adverse neonatal outcomes associated with early-term birth. JAMA pediatrics, 167(11), 1053–1059. https://doi.org/10.1001/jamapediatrics.2013.2581' |
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| Reference |
Reference Type: CITATION Reference Text: 'Tita, A. T. N., Landon, M. B., Spong, C. Y, Lai, Y., Leveno, K. J., Varner, M. W., . . . Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network (2009). Timing of elective repeat cesarean delivery at term and neonatal outcomes. The New England Journal of Medicine, 360(2), 111-120. https://doi.org/10.1056/NEJMoa0803267' |
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| Definition |
None |
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| Guidance |
Stillbirth: The chart-abstracted measure (PC-01 Elective Delivery) contains a denominator exclusion data element for Stillbirth. The eCQM Denominator Exclusion value set entitled "Conditions Possibly Justifying Elective Delivery" includes SNOMED CT and ICD-10-CM concepts representing Stillbirth and History of Stillbirth.
This measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence:
1. The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.*
2. When the calculated GA is not available, the GA is obtained from a discrete field in the electronic health record. The intent is to capture the last estimated GA in the interval starting 24 hours or less prior to delivery and ending before midnight on the same day of delivery.
3. The GA is based on ICD10 or SNOMED codes indicative of weeks gestation. This option is only used when results from items #1 and #2 (see above) are not available.
*ACOG ReVITALize Guidelines for Calculating Gestational Age:
Gestational Age = (280-(EDD minus Reference Date))/7
--Estimated Due Date (EDD): The best obstetrical Estimated Due Date is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (e.g., assisted reproductive technology).
--Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery.
Note however, the calculation may yield a non-whole number, and gestational age should be rounded off to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks.
This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.
This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
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| Transmission Format |
TBD |
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| Initial Population |
Inpatient hospitalizations for patients age >= 8 years and < 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure with a discharge date that ends during the measurement period. |
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| Denominator |
Inpatient hospitalizations for patients delivering newborns with >= 37 and < 39 weeks of gestation completed |
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| Denominator Exclusions |
Inpatient hospitalizations for patients with conditions possibly justifying elective delivery prior to 39 weeks gestation |
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| Numerator |
Inpatient hospitalizations for patients with elective deliveries by either:
- Medical induction of labor while not in labor prior to the procedure
- Cesarean birth while not in labor and with no history of a prior uterine surgery
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| Numerator Exclusions |
None |
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| Denominator Exceptions |
None |
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| Supplemental Data Elements |
For every patient evaluated by this measure also identify payer, race, ethnicity, sex and variable calculated gestational age |
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PCMaternal."Delivery Encounter With Age Range"
"Delivery Encounter Near Term"
"Delivery Encounter With Conditions Justifying Elective Delivery"
"Delivery Encounter With Medical Induction Started While Not In Labor"
union "Delivery Encounter With Cesarean Birth Without Labor Or History Of Uterine Surgery"
None
None
None
from
"Delivery Encounter Near Term" NearTermEncounter,
["Procedure, Performed": "Cesarean Birth"] CSection
let FirstLaborTime: Global."EarliestOf" ( "FirstLabor"(NearTermEncounter).relevantDatetime, "FirstLabor"(NearTermEncounter).relevantPeriod )
where( not ( FirstLaborTime 24 hours or less before start of Global."NormalizeInterval" ( CSection.relevantDatetime, CSection.relevantPeriod ) )
and Global."NormalizeInterval" ( CSection.relevantDatetime, CSection.relevantPeriod ) starts during PCMaternal."HospitalizationWithEDOBTriageObservation" ( NearTermEncounter ))
or (FirstLaborTime is null
and Global."NormalizeInterval" ( CSection.relevantDatetime, CSection.relevantPeriod ) starts during PCMaternal."HospitalizationWithEDOBTriageObservation" ( NearTermEncounter ))
return NearTermEncounter
"Delivery Encounter With Calculated Gestational Age Greater Than Or Equal To 37 Weeks And Less Than 39 Weeks"
union "Delivery Encounter With Estimated Gestational Age Greater Than Or Equal To 37 Weeks And Less Than 39 Weeks"
union "Delivery Encounter With Gestational Age Greater Than Or Equal To 37 Weeks And Less Than 39 Weeks Based On Coding"
PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
where PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ) >= 37
and PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ) < 39
"Cesarean Birth Procedure While Not In Labor" CSectionNoLabor
without "Uterine Surgery Procedure" UterineProcedure
such that Global."NormalizeInterval" ( UterineProcedure.relevantDatetime, UterineProcedure.relevantPeriod ) starts before start of PCMaternal."HospitalizationWithEDOBTriageObservation" ( CSectionNoLabor )
without "Uterine Surgery Diagnosis" UterineDiagnosis
such that UterineDiagnosis.prevalencePeriod starts before start of PCMaternal."HospitalizationWithEDOBTriageObservation" ( CSectionNoLabor )
( "Delivery Encounter Near Term" NearTermEncounter
with ["Diagnosis": "Conditions Possibly Justifying Elective Delivery Prior to 39 Weeks Gestation"] DiagnosisElectiveDelivery
such that DiagnosisElectiveDelivery.prevalencePeriod overlaps PCMaternal."HospitalizationWithEDOBTriageObservation" ( NearTermEncounter )
)
union ( "Delivery Encounter Near Term" NearTermEncounter
where exists ( NearTermEncounter.diagnoses EncounterDiagnoses
where EncounterDiagnoses.code in "Conditions Possibly Justifying Elective Delivery Prior to 39 Weeks Gestation"
)
)
PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
where PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ) is null
and ( PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter ) >= 37 weeks
and PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter ) < 39 weeks
)
PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
let CGA: PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ),
EGA: PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter )
where CGA is null
and EGA is null
and exists ( DeliveryEncounter.diagnoses EncounterDiagnoses
where EncounterDiagnoses.code in "37 to 38 Weeks Gestation"
)
from
"Delivery Encounter Near Term" NearTermEncounter,
"Medical Induction" Induction
let FirstLaborTime: Global."EarliestOf" ( "FirstLabor"(NearTermEncounter).relevantDatetime, "FirstLabor"(NearTermEncounter).relevantPeriod )
where Global."NormalizeInterval" ( Induction.relevantDatetime, Induction.relevantPeriod ) starts 24 hours or less before FirstLaborTime
return NearTermEncounter
"Delivery Encounter Near Term"
"Delivery Encounter With Conditions Justifying Elective Delivery"
["Encounter, Performed": "Encounter Inpatient"] EncounterInpatient
where EncounterInpatient.relevantPeriod ends during day of "Measurement Period"
PCMaternal."Delivery Encounter With Age Range"
["Medication, Administered": "Oxytocin"]
union ["Medication, Administered": "Dinoprostone"]
union ["Procedure, Performed": "Medical Induction of Labor"]
"Delivery Encounter With Medical Induction Started While Not In Labor"
union "Delivery Encounter With Cesarean Birth Without Labor Or History Of Uterine Surgery"
"Encounter With Age Range" EncounterWithAge
with ["Procedure, Performed": "Delivery Procedures"] DeliveryProcedure
such that Global."NormalizeInterval" ( DeliveryProcedure.relevantDatetime, DeliveryProcedure.relevantPeriod ) starts during "HospitalizationWithEDOBTriageObservation"(EncounterWithAge)
Global."Inpatient Encounter" InpatientEncounter
where AgeInYearsAt(date from start of InpatientEncounter.relevantPeriod) >= 8
and AgeInYearsAt(date from start of InpatientEncounter.relevantPeriod) < 65
//This definition establishes a variable of CGA (Calculated Gestational Age). CGA is a supplemental data element to store the calculated gestational age result from the "CalculatedGestationalAge" function. The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition.
"Delivery Encounter With Age Range" DeliveryEncounter
let CGA: "CalculatedGestationalAge"(DeliveryEncounter)
return { DeliveryEncounter, CGA }
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer Type"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "Federal Administrative Sex"]
PCMaternal."Variable Calculated Gestational Age"
["Diagnosis": "Perforation of Uterus"]
union ["Diagnosis": "Uterine Window"]
union ["Diagnosis": "Uterine Rupture"]
union ["Diagnosis": "Cornual Ectopic Pregnancy"]
["Procedure, Performed": "Classical Cesarean Birth"]
union ["Procedure, Performed": "Myomectomy"]
union ["Procedure, Performed": "Transabdominal Cerclage"]
union ["Procedure, Performed": "Metroplasty"]
union ["Procedure, Performed": "Uterine Horn"]
First(["Assessment, Performed": "Labor"] LaborAssessed
where Global."EarliestOf"(LaborAssessed.relevantDatetime, LaborAssessed.relevantPeriod) during PCMaternal."HospitalizationWithEDOBTriageObservation"(Encounter)
sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
)
if ( HasStart(period)) then start of period
else
end of period
Earliest(NormalizeInterval(pointInTime, period))
not ( start of period is null
or start of period = minimum DateTime
)
if pointInTime is not null then Interval[pointInTime, pointInTime]
else if period is not null then period
else null as Interval<DateTime>
// Age = (280-(Estimated Delivery Date minus Reference Date/Delivery Date))/7 ( 280 - ( difference in days between "LastTimeOfDelivery"(Encounter) and "LastEstimatedDeliveryDate"(Encounter) ) ) div 7
//HospitalizationWithEDOBTriageObservation returns the total interval from the start of any immediately prior emergency department visit or OB Triage visit through the observation visit to the discharge of the given encounter.
Encounter Visit
let ObsVisit: Last(["Encounter, Performed": "Observation Services"] LastObs
where LastObs.relevantPeriod ends 1 hour or less on or before start of Visit.relevantPeriod
sort by
end of relevantPeriod
),
VisitStart: Coalesce(start of ObsVisit.relevantPeriod, start of Visit.relevantPeriod),
EDOBTriageVisit: Last(["Encounter, Performed": "ED Visit and OB Triage"] LastEDOBTriage
where LastEDOBTriage.relevantPeriod ends 1 hour or less on or before VisitStart
sort by
end of relevantPeriod
)
return Interval[Coalesce(start of EDOBTriageVisit.relevantPeriod, VisitStart),
end of Visit.relevantPeriod]
//This function identifies the last time the Estimated Delivery Date was assessed 42 weeks or less prior to or on delivery and stores the result of that assessment.
Last(["Assessment, Performed": "Delivery date Estimated"] EstimatedDateOfDelivery
where Global."EarliestOf"(EstimatedDateOfDelivery.relevantDatetime, EstimatedDateOfDelivery.relevantPeriod)42 weeks or less before or on "LastTimeOfDelivery"(Encounter)
and EstimatedDateOfDelivery.result is not null
sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as DateTime
Last(["Assessment, Performed": "Estimated Gestational Age at Delivery"] EstimatedGestationalAge
let EGATiming: Global."EarliestOf"(EstimatedGestationalAge.relevantDatetime, EstimatedGestationalAge.relevantPeriod)
where(EGATiming 24 hours or less before or on "LastTimeOfDelivery"(Encounter)
and EstimatedGestationalAge.result is not null
)
or(EGATiming same day as "LastTimeOfDelivery"(Encounter)
and EGATiming during "HospitalizationWithEDOBTriageObservation"(Encounter)
and EstimatedGestationalAge.result is not null
)
sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity
Last(["Assessment, Performed": "Date and time of obstetric delivery"] TimeOfDelivery
where Global."EarliestOf"(TimeOfDelivery.relevantDatetime, TimeOfDelivery.relevantPeriod) during "HospitalizationWithEDOBTriageObservation"(Encounter)
and TimeOfDelivery.result as DateTime during "HospitalizationWithEDOBTriageObservation"(Encounter)
sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as DateTime
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer Type"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "Federal Administrative Sex"]
PCMaternal."Variable Calculated Gestational Age"
| Measure Set |
eMeasure Perinatal Care (ePC) |
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|---|---|---|---|