Table 4.

Association between Hospital-level Quality Indicators and Characteristics with Severe Maternal and Neonatal Morbidity

	Severe Maternal Morbidity			Severe Neonatal Morbidity at Term
Hospital Level Variables	Model 1 – Unadjusted	Model 2* – Adjusted for Maternal Characteristics	Model 3 – Adjusted for Maternal and Hospital Characteristics	Model 1 – Unadjusted	Model 2# – Adjusted for Maternal and Neonatal Characteristics	Model 3 – Adjusted for Maternal, Neonatal and Hospital Characteristics
	RR (95% CL)	Adjusted RR (95% CL)	Adjusted RR (95% CL)	RR (95% CL)	Adjusted RR (95% CL)	Adjusted RR (95% CL)
Quality Indicator 1 – Elective Deliveries < 39 weeks (per one percent from mean)	1.00 (0.97–1.03)	1.00 (0.98–1.03)	1.00 (0.98–1.02)	1.00 (0.98–1.03)	1.01 (0.99–1.02)	0.99 (0.97–1.01)
Quality Indicator 2 – Cesarean Delivery for Low Risk Nulliparous Women (per one percent from mean)	0.98 (0.95–1.01)	0.99 (0.96–1.01)	0.99 (0.96–1.01)	1.00 (0.98–1.03)	1.01 (0.99–1.03)	1.01 (0.99–1.03)
Public Hospital (ref=private)			1.36 (0.96–1.76)			1.11 (0.82–1.39)
Teaching Hospital (ref=non-teaching)			1.17 (0.37–1.98)			1.08 (0.52–1.65)
Delivery Volume in Quartiles (ref=very high)
Low			1.41 (0.92–1.89)			1.71 (1.20–2.23)
Medium			1.19 (0.76–1.63)			1.30 (0.87–1.95)
High			0.83 (0.56–1.09)			1.27 (0.86–1.68)
Level II Nursery (ref = Level 3–4)			0.71 (0.47–0.94)			0.65 (0.46–0.84)

^*Maternal characteristics adjusted for in this model include age, race, ethnicity, insurance, parity, education, prenatal visits, multiple births previous cesarean delivery, and comorbidities (e.g. hypertension, diabetes). A full list of comorbidities is included in Table

^#Maternal and neonatal characteristics adjusted for in this model include maternal factors (age, race, ethnicity, insurance, parity, education, prenatal visits, tobacco use, illicit drug use, hypertension or diabetes during pregnancy, previous cesarean delivery, premature rupture of membranes), and infant factors (gestational age, size for gestational age).