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Release Notes:
Measure Information Form
Version 2010B


Measure Information Form

Measure Set: Pregnancy and Related Conditions (PR)

Set Measure ID: PR-1

Performance Measure Name: VBAC

Description: Prenatal patient evaluation, management, and treatment selection concerning vaginal deliveries in patients who have a history of previous cesarean section.

Rationale: A trial of labor may be offered to women who have had a previous cesarean section. Although trial of labor is usually successful and is relatively safe, major maternal complications can occur. The rate of vaginal birth after cesarean section (VBAC) along with other performance measures such as primary cesarean section, repeat cesarean section, and neonatal complications will assist organizations in understanding whether an increase or a decrease in the rate of VBAC is desirable.

Type of Measure: Outcome

Improvement Noted As: Either an increase or decrease in the rate depending on the context of the measure

Numerator Statement: Patients with VBAC
Included Populations: Not applicable

Excluded Populations: Discharges with:

  • An ICD-9-CM Principal Procedure Code for cesarean section as defined in Appendix A, Table 4.07

Data Elements:

Denominator Statement: All patients who delivered with a history of previous cesarean section

Included Populations: Discharges with:
  • An ICD-9-CM Principal Diagnosis Code or ICD-9-CM Other Diagnosis Codes for pregnancy with delivery as defined in Appendix A, Tables 4.01, 4.02, 4.03, and 4.04
  • An ICD-9-CM Principal Diagnosis Code or ICD-9-CM Other Diagnosis Code 654.21 (previous cesarean section)

Excluded Populations:

  • Patients less than 8 years of age
  • Patients greater than or equal to 65 years of age
  • Patients who have a Length of Stay >120 days
  • Patients enrolled in clinical trials
  • Patients with an ICD-9-CM Principal Diagnosis Code or ICD-9-CM Other Diagnosis Code for abortion as defined in Appendix A, Table 4.06

Data Elements:

Risk Adjustment: Yes. This section has been moved to the ORYX Risk Adjustment Guide. This guide is available to the public on the Joint Commission’s website and, in addition, it is available to performance measurement systems via the Joint Commission’s extranet site for measurement systems (PET).

Data Elements:

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records.

Data Accuracy: * Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency

  • This measure is solely derived from ICD-9-CM codes, therefore accurate and thorough coding of all conditions is essential for reporting of this measure
  • Clinical Trial data element:
    • For Pregnancy and Related Conditions measures ONLY it is appropriate for the Performance Measurement System to default the data element to "No" unless the ICD-9-CM diagnosis code of V70.7, “Examination of participant in a clinical trial” is present. If this code is present, or the organization knows via some other electronic method that the patient is participating in a clinical trial, default the data element to "Yes".
    • Hospital abstractors may change defaulted value of “No” based on hospital participation in clinical trial.

Measure Analysis Suggestions: None

Sampling: Yes. For additional information see the Sampling Section.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:

  • American College of Obstetricians and Gynecologists (ACOG). Vaginal birth after previous cesarean delivery. Practice Bulletin No.5, July 1999:3.
  • Centers for Disease Control and Prevention. National Vital Statistics Reports. 1999:Vol. 47, No.18:13.
  • Healthy people 2010. Centers for Disease Control and Prevention, Health Resources and Services Administration. Vol. 2:16.
  • McMahon, MJ, Luther, ER, Watson, Bowes Jr, WA, Olshan, AF Comparison of a trial of labor with an elective second cesarean section. The New England Journal of Medicine. 1996: Vol. 335, No. 10:689-695.
  • Rates of Cesarean delivery-United States, 1993:Morbidity and Mortality Weekly Report, v.44, n.15, 1995:303(5).

Measure Algorithm:

Attach file

Related Topics

Measure Information Form PR-1
Specifications Manual for Joint Commission National Quality Core Measures (2010B)
Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11)