Like most expectant mothers, Dr. Sarah Goff got advice from family and friends about prenatal care and childbirth. However, as a pediatrician and internist at Baystate Medical Center in Springfield, MA and an Assistant Professor at Tufts University School of Medicine, her instinct was to research that advice by exploring the scientific literature. Doing so, she was struck by the lack of information about predictors of labor and delivery outcomes for mothers.

As Dr. Goff delved more deeply into the literature, she questioned whether some obstetric healthcare-associated infections may be preventable. She found that while some studies looked at specific infections, it seemed no one had done a risk-adjusted look at infections at the hospital level. This gap in the literature, coupled with her concerns as mother-to-be, inspired her to learn more about maternal infections related to labor and delivery in hospitals across the country.

To enable this research, Dr. Goff sought funding through a Tufts CTSI KL2 Career Development Award, which she received in 2011. This prestigious K Scholar Program provides federal funding to junior faculty to develop their skills and conduct multidisciplinary clinical- and patient-oriented research.

In her study, Dr. Goff used Perspective, a Premier, Inc. database that helps hospitals to analyze the quality and cost of their care. She and her research team reviewed more than a million deliveries that took place at 355 hospitals over a two-year period. What they found was striking: more than 4% of these births were complicated by infection, and young mothers aged 15-19 were 50% more likely to experience infection than those aged 25-29.

Even more importantly, she and her team found that obstetric risk-adjusted infection rates (RAIR) vary significantly from one hospital to the next. Hospitals at the 75th percentile of infection rates had nearly double the rates of infection of hospitals at the 25th percentile. This means there is likely room for improvement at hospitals with higher infection rates. Dr. Goff also found that teaching status, urban setting, and a high number of obstetric beds were associated with higher risk-adjusted infection rates, but that these factors explained only about 15% of the variation found.

Dr. Goff’s study is garnering national attention: the complete results are slated to appear in an upcoming issue of the American Journal of Obstetrics and Gynecology, and she received a Best Poster Award at the Translational Science 2012 meeting in Washington, DC. She hopes to continue her research to find out how some hospitals are able to achieve lower infection rates, and ultimately to improve obstetric care nationwide. Her next project, made possible through an R21 grant from the Agency for Healthcare Research and Quality (AHRQ), will focus on the obstetric patient experience by exploring the use of patient navigators to help low-income pregnant women access publicly-available pediatric quality-of-care data.

“The KL2 award was a fantastic research opportunity, and opened many doors for me,” Dr. Goff says. “The course work I’ve done has honed my study design abilities, and allowed me to work with great mentors at Tufts as well as my primary mentor at Baystate. I hope to use what I’ve learned through this study to develop a national questionnaire for hospitals, to better understand the causes and prevention of maternal infection.”