How quality measures can decrease cesareans
A new study in The Joint Commission Journal of Quality and Safety led by researchers at Beth Israel Deaconess Medical Center (BIDMC) indicates that hospital-led interventions over the course of 7 years led to significant reductions in the center’s cesarean delivery rate.
From 2008 to 2015, BIDMC adopted a multi-strategy approach which included provider feedback, provider education, and new policies that targeted evidence-based and inferred factors such as the nulliparous term singleton vertex (NTSV) cesarean delivery rates. Administrative claims data and birth certificates supplied data on maternal outcomes, mode of delivery, and neonatal outcomes. The p-trend for categorical and continuous variables were calculated with the help of liner regression and the Cochran-Armitage test.
During the course of the study period there were 51,973 deliveries, of which 15,144 were NTSV. The rate of NTSV cesarean delivery decreased from 34.8% before the study period to 21.2% in 2015 and the overall cesarean delivery rate declined as well from 40.0% to 29.1%. No change in the operative vaginal delivery was seen among NTSV deliveries. Mean gestational age at time of delivery went from 39.3 to 39.6 weeks and average neonatal birth weight declined by roughly 54 g. No change in the incidence of shoulder dystocia was seen and meconium aspiration syndrome saw an increase over the course of the study with an incidence of 0.9% in 2015.
The researchers concluded that instituting quality improvement initiatives can reduce the NTSV cesarean delivery rate. They also urge that any increased incidence of fetal or maternal complications tied to decreased NTSV cesarean delivery must be considered in context with risks and benefits of vaginal delivery.