These two documents reflect IHI's evolving strategy for measuring the safety of perinatal care. The measurement strategy is still being refined and tested.

1) Perinatal Innovation Community Measurement Strategy(February 2005-June 2006)
[see document entitled "Perinatal Innovation Community Measurement Strategy Feb05-Jun06"]

The IHI Perinatal Innovation Community, in sponsorship with Ascension Health and Premier, Inc., met from February 2005 until June 2006. During this time the Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ PSIs) were used as a measure to determine if the patient safety work the teams were adopting would affect birth trauma outcomes. Our goal was to reduce the national birth trauma rate by 50% at participating organizations. The experience of the majority of teams in collecting this data was that it was often difficult to determine if the results were supportable. Many organizations found it necessary to undertake improvements in the coding process in order to ensure their data was reliable. Two recently published articles also support the difficulty in outcome measurements in the perinatal setting, and whether these indicators are effective in measuring patient safety.

• Grobman WA, Feinglass J, Murthy S. Are the Agency for Healthcare Research and Quality obstetric trauma indicators valid measures of hospital safety? Am J Obstet Gynecol. 2006 Sep;195(3):868-874.
• Simpson KR. Measuring patient safety: Review of current methods. J Obstet Gynecol Neonatal Nurs. 2006 May-Jun;35(3):432-42.

2) IHI's IMPACT Learning and Innovation Community on Improving Perinatal Care Measurement Strategy (June 2006-present)
[see document entitled "IMPACT Improving Perinatal Care Measurement Strategy Jun06"]

As IHI's perinatal work developed into the IMPACT Improving Perinatal Care Learning and Innovation Community, which began in June 2006, IHI faculty decided to use the Perinatal Trigger Tool as the foundation for the measurement strategy for this work. From the Perinatal Trigger Tool: "The object of the review is to identify harm – not whether the event was preventable. In our experience, the discussion about the preventability of an adverse event is often a barrier to determining the cause of an adverse event. The Perinatal Trigger Tool defines an adverse event as any physical harm to the infant or mother. The tool limits the definition of adverse events to physical rather than emotional harm."

The IHI faculty involved in the Improving Perinatal Care Innovation Community continue to recommend that organizations may collect the data for both measures: the AHRQ PSIs or the Perinatal Trigger Tool. This is an individual organization decision. We will report our results as the Community moves forward.