NR 717 Week 3 Epidemiologic Profile Example

Epidemiologic Profile of Hypertensive Disorders of Pregnancy at Riverbend Health, Converted Step by Step Into Expected Cases, Visits and Dollars

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College of Nursing, Chamberlain University

NR 717: Concepts in Population Health Outcomes & Health Policy

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Month Day, Year

Epidemiologic Profile of Hypertensive Disorders of Pregnancy at Riverbend Health, Converted Step by Step Into Expected Cases, Visits and Dollars

The Cohort and the Single Denominator

Every measure in this profile uses the same cohort: 4,180 delivery hospitalizations at Riverbend Health in the most recent complete fiscal year. Where a measure applies to a subgroup, such as the 502 patients discharged with a hypertensive disorder of pregnancy, the subgroup is named and its size given, so a reader can always trace a figure back to the 4,180. Delivery hospitalizations are used rather than live births because they count each pregnancy once and come from the same discharge records as the numerators (Centers for Disease Control and Prevention, 2024).

The Measures, With Working Shown

Cumulative incidence of hypertensive disorders of pregnancy = 502 patients with the diagnosis at discharge divided by 4,180 delivery hospitalizations, times 100 = 12.0 per 100 deliveries. In plain terms, about one delivering patient in eight left the hospital with a pregnancy-related blood pressure disorder.

Prevalence of chronic hypertension at delivery = 209 patients with hypertension recorded before pregnancy divided by 4,180, times 100 = 5.0 per 100 deliveries. This is prevalence, not incidence, because the condition existed before the pregnancy began; it describes how many patients arrived already carrying it.

Incidence of readmission for hypertension within 42 days, among patients with a hypertensive disorder = 27 readmissions divided by 502 patients, times 100 = 5.4 per 100. Roughly one patient in nineteen with the diagnosis came back to the hospital for blood pressure within six weeks.

Incidence of emergency department visits within 42 days, among the same patients = 77 visits divided by 502, times 100 = 15.3 visits per 100 patients.

Severe Maternal Morbidity by Hypertensive Status

Excluding transfusion-only cases, severe maternal morbidity occurred in 14 of the 502 patients with a hypertensive disorder, 278.9 per 10,000, and in 15 of the 3,678 without one, 40.8 per 10,000. The rate ratio is 6.8: patients with a hypertensive disorder were nearly seven times as likely to experience severe morbidity during the delivery admission. The reference group is named, patients without a hypertensive disorder in the same cohort, because a rate ratio means nothing without one.

How Firm the Numbers Are

The small counts limit what can be said. The 27 hypertension readmissions give an exact 95% interval of about 18 to 39 events, so the true readmission rate in this population could plausibly lie between about 3.5 and 7.8 per 100. The 14 severe morbidity cases among patients with a hypertensive disorder are fewer still, and the rate ratio of 6.8 should be read as large rather than as precise. One year of data from one system cannot support claims to a decimal place, and the figures below carry ranges for that reason. For counts this small, an exact Poisson interval is the appropriate way to express uncertainty, since the usual normal approximation becomes unreliable when events number in the tens (Celentano & Szklo, 2019). In practice this means a year in which readmissions fall from 27 to 20 would not, on its own, show that anything had changed; it would sit comfortably inside the range this year's figure already allows. Any program evaluated against these numbers needs either more than one year of data or an outcome with more events, such as the blood pressure check itself.

The Conversion, Step by Labeled Step

Each step below converts one quantity into the next, and each is labeled as an observed figure, a forecast or an assumption.

Step 1, forecast: the system expects 4,250 deliveries next year. At the observed incidence of 12.0 per 100, that is about 510 patients with a hypertensive disorder.

Step 2, observed share: 60.0% of patients with a hypertensive disorder last year, 301 of 502, were Medicaid-financed. Applied to 510, that is about 306 Medicaid-financed patients.

Step 3, observed rates: at 5.4 readmissions and 15.3 emergency visits per 100 patients, the 306 would be expected to have about 16.5 hypertension readmissions and 47 emergency visits within 42 days.

Step 4, observed payments: at the plans' average payments of $9,450 per readmission and $780 per emergency visit, that is about $155,900 for readmissions and $36,700 for emergency visits, roughly $192,600 a year in Medicaid spending on the short-term consequences of postpartum hypertension in this one system.

Step 5, range: using the interval from the readmission rate, 3.5 to 7.8 per 100, readmission spending could lie between about $101,000 and $226,000.

Table 1

Converting the Profile Into Expected Medicaid Spending, Next Fiscal Year

Note. Note. Steps 2 to 4 use last year's observed shares, rates and average payments; step 1 uses the system's delivery forecast.

Limits Tied to These Numbers

The readmission and emergency counts include only Riverbend's own facilities, so patients who went elsewhere are missing and the true burden is higher. The diagnosis codes for hypertensive disorders depend on documentation at discharge, and a patient who developed postpartum preeclampsia after an uncomplicated delivery is counted in the readmissions but not in the 502, which slightly inflates the readmission rate among diagnosed patients. And the average payments are for the system's two largest plans; a third, smaller plan pays about 8% less per readmission.

Where a Dollar Goes Furthest

At about $160 per patient, remote blood pressure monitoring for all 510 expected patients would cost about $81,600. The guidance it would deliver, a blood pressure check in the first ten days for patients with a hypertensive disorder, is already the recommended standard (American College of Obstetricians and Gynecologists, 2018). On the conversion above, the program would need to prevent roughly half of the expected Medicaid hypertension readmissions to pay for itself on readmissions alone, which is a stated assumption, not a finding. The cleaner argument is that the money currently spent arrives after the harm, in the emergency department and on the ward, while the same money spent in the first ten days could reach every patient at risk.

References

American College of Obstetricians and Gynecologists. (2018). ACOG Committee Opinion No. 736: Optimizing postpartum care. Obstetrics & Gynecology, 131(5), e140-e150. https://doi.org/10.1097/AOG.0000000000002633

Celentano, D. D., & Szklo, M. (2019). Gordis epidemiology (6th ed.). Elsevier.

Centers for Disease Control and Prevention. (2024). Severe maternal morbidity in the United States. U.S. Department of Health and Human Services. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html