A Statewide Quality Improvement Initiative to Reduce Non-Medically Indicated Scheduled Deliveries
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A Statewide Quality Improvement Initiative to Reduce NonMedically Indicated Scheduled Deliveries Marilyn A. Kacica1,2 · J. Christopher Glantz3 · Kuangnan Xiong1 · Eileen P. Shields1 · Peter H. Cherouny4
© Springer Science+Business Media New York 2016
Abstract Objectives To evaluate a large two-phase, statewide quality improvement (QI) collaborative to decrease non-medically indicated (N-MI) deliveries scheduled between 36 and 38 weeks gestation (early). Methods The New York State Department of Health (NYSDOH) convened a Perinatal Quality Collaborative to devise a twophase QI initiative using a rapid cycle incremental learning model. Phase 1 included Regional Perinatal Centers (RPCs), and Phase 2 added their ailiated perinatal hospitals. Maternal demographics, delivery characteristics, medical indications, and stillbirths were collected on scheduled inductions and cesarean section (CS) deliveries between 36 and 38 weeks. Results There were 35,091 scheduled 36–38 week deliveries reported during the collaborative’s 4 years. The percentage of early N-MI scheduled deliveries decreased 41-fold in RPCs (Phase 1 and Phase 2), and 17-fold in ailiates (Phase 2). There was a signiicant statewide increase in deliveries at ≥39 weeks (P < 0.001), with an estimated 23,732 early deliveries averted. Stillbirths did not increase over time (P = 0.42), although reporting was incomplete. Conclusions A two-phase, statewide QI collaborative in a large state with regionalized perinatal * Marilyn A. Kacica [email protected] 1
Division of Family Health, New York State Department of Health, Empire State Plaza, Corning Tower Rm 984, Albany, NY 12237, USA
2
State University of New York, University at Albany School of Public Health, Rensselaer, NY, USA
3
University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
4
University of Vermont College of Medicine, Burlington, VT, USA
care efectively lowered the number of N-MI deliveries scheduled between 36 and 38 weeks gestation. Associated improvements in neonatal and early childhood developmental outcomes should translate to signiicant cost savings. This model can efectively be used for similar as well as other obstetrical QI. Keywords Non-medically indicated deliveries · Inductions · Cesarean deliveries · 36–38 weeks gestation · New York State
Signiicance Reductions in non-medically indicated scheduled deliveries have been previously reported in Ohio and North Carolina through state initiatives, involving 20 and 33 hospitals respectively. In this statewide quality improvement collaborative involving 96 New York State birthing hospitals, a two-phased approach helped efectively lower the number of non-medically indicated deliveries scheduled between 36 and 38 weeks gestation.
Introduction The American College of Obstetricians and Gynecologists has published and updated guidelines for >30 years advising against scheduled non-medically indicated (N-MI) delivery before 39 weeks gestational age (GA) (ACOG Practice Bulletin No. 107 2009; ACOG educational bulleti
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