A perinatal care quality and safety initiative: Are there financial rewards for improved quality?

Katy B. Kozhimannil, Samantha A. Sommerness, Phillip Rauk, Rebecca Gams, Charles Hirt, Stanley Davis, Kristi K. Miller, Daniel V. Landers

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: Although costs of providing care may decrease with hospital initiatives to improve obstetric and neonatal outcomes, the accompanying reduced adverse outcomes may negatively affect hospital revenues. Methods: In 2008 a Minnesota-based hospital system (Fairview Health Services) launched the Zero Birth Injury (ZBI) initiative, which used evidence-based care bundles to guide management of obstetric services. A pre-post analysis of financial impacts of ZBI was conducted by using hospital administrative records to measure costs and revenues associated with changes in maternal and neonatal birth injuries before (2008) and after (2009-2011) the initiative. Results: For the Fairview Health Services hospitals, after adjusting for relevant covariates, implementation of ZBI was associated with a mean 11% decrease in the rate of maternal and neonatal adverse outcomes between 2008 and 2011 (adjusted odds ratio [AOR] = 0.89, p = .076). As a result of the adverse events avoided, the hospital system saved $284,985 in costs but earned $324,333 less revenue, which produced a net financial decrease of $39,348 (or a $305 net financial loss per adverse event avoided) in 2011, compared with 2008. Conclusions: Adoption of a perinatal quality and safety initiative that reduced birth injuries had little net financial impact on the hospital. ZBI produced better clinical results at a lower cost, which represents potential savings for payers, but the hospital system offering improved quality reaped no clear financial rewards. These results highlight the important role for shared-savings collaborations (among patients, providers, government and third-party payers, and employers) to incentivize QI. Widespread adoption of perinatal safety initiatives combined with innovative payment models may contribute to better health at reduced cost. Copyright 2013

Original languageEnglish (US)
Pages (from-to)339-348
Number of pages10
JournalJoint Commission Journal on Quality and Patient Safety
Issue number8
StatePublished - Aug 2013

Bibliographical note

Funding Information:
Dr. Kozhimannil’s work was supported by the Building Interdisciplinary Research Careers in Women’s Health Grant ( # K12HD055887 ) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Institutes of Health (NIH) Office of Research on Women’s Health and administered by the University of Minnesota Deborah E. Powell Center for Women’s Health.


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