Severe maternal morbidity and related hospital quality measures in Maryland

objective to determine hospital characteristics and quality metrics associated with severe maternal morbidity (smm) in maryland.study designa population-based observational study of 364,113 statewide delivery hospitalizations during 2010–2015 linked with socio-economic community measures and hospital characteristics and quality measures. multivariable logistic regression models with generalized estimating equations estimated smm adjusting for individual, community, and hospital-level factors and clustering within hospitals and residence zip codes. results the smm prevalence was 197 per 10,000 deliveries. adjusted smm risk ratios were higher for younger (<20 years), older (35+ years), non-white non-hispanic, unmarried, multiple substance users, women with multiple gestations, and chronic medical and mental health conditions than their counterparts. communities with greater socio-economic disadvantage and hospitals with poorer patient experience and clinical care quality had higher rates of smm. conclusion addressing socio-economic disparities and improving quality of care in delivery hospitals are key to reducing the smm burden in maryland.