(646) Implementation of an Obstetric Co-Morbidity Scoring System during Delivery Admissions to Reduce Maternal Morbidity

Objective: The clinical obstetric co-morbidity index (OB-CMI) quantifies patient co-morbidity burden, enabling efficient risk assessment. We evaluated the impact of implementing OB-CMI calculation into routine L&D care on severe maternal morbidity (SMM) with the hypothesis that enhanced awareness of patient risk may itself improve outcomes.

Study Design: This prospective, type 1 hybrid implementation-effectiveness trial was conducted at a tertiary hospital and examined the rate of SMM (see Table), pre/post implementation of OB-CMI calculation on L&D (2020 v. 2021). Implementation outcomes included fidelity and acceptability. OB-CMI scores were documented at admission and scores ≥ 6 prompted an interdisciplinary huddle to address risk-reduction. Analysis involved multivariable logistic regression as well as time series to assess secular trends. Fidelity and acceptability were assessed through chart review of all admissions and provider survey.

Results: 8197 patients were included (4150 pre, 4047 post) with no differences in demographics, median OB-CMI score (2 v. 3, p = 0.30), or non-transfusion SMM rate (2.0 vs. 2.5%, p = 0.11). In adjusted models, there remained no difference in SMM pre/post OB-CMI implementation regardless of SMM definition utilized (Table). There was no difference in predicted probability of SMM by OB-CMI score between groups (Figure). Documentation of OB-CMI score (fidelity) increased from 35% and plateaued at 65%. 67 providers completed the acceptability survey (61.5% of eligible) with high perceptions of acceptability and feasibility; 82.1% affirmed a meaningful role in improving care through counseling, risk consciousness, and prompting interventions to reduce risk.

Conclusion:

OB-CMI calculation at L&D admission did not reduce SMM in this population, but implementing a real-time co-morbidity scoring system on L&D is feasible and acceptable to obstetric clinicians. While the OB-CMI presents a novel platform for enhancing risk awareness and eliciting risk-appropriate interventions, the impact of enhanced risk awareness alone may be best seen in a lower acuity setting.