Accuracy of the Adverse Outcome Index: An Obstetrical Quality Measure

The AOI is highly reliant on accurate coding and provider documentation and requires validation with manual chart review. Concurrent chart review improves the accuracy of the AOI. Caution is advised when using the AOI as an exclusive measure of assessing obstetric quality because it may be heavily influenced by a single outcome measure; perineal laceration rates represented twice the frequency of all ­other outcomes combined. The AOI should be modified to better measure preventable adverse events and include a means of accounting for preexisting conditions.