An Initiative of the Oklahoma State Department of Health and multiple partners aiming to reduce infant mortality and other adverse birth outcomes as well as reduce racial disparities for such outcomes
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4th Quarter 2013 (Oct - Dec 2013) **Comparison is difference between Q1 2011 and Q4 2013. There has been a 94% reduction in the number of scheduled C-Sections and Inductions <39 weeks without a documented indication.
Every Week CountsImproving Oklahoma's Perinatal OutcomesQuality Improvement Collaborative2011
Oklahoma's outcomes for mothers and babies are not what they should be. The prematurity rate in Oklahoma has increased by about 20% over the last two decades. Most of this increase was among late preterm births, those infants born at 34-36 weeks. Oklahoma has seen a rise in the late preterm birth rate of 30% since 1990. Even infants electively delivered between 37 and 38 weeks (early term) have an increased morbidity. Recent studies indicate that changes in the management of labor and delivery care, particularly the increase in induction of labor and cesarean births, have influenced this increase in the rate of late preterm and early term births. While prematurity is a complex issue, the scheduling of elective deliveries after 39 weeks gestation is a proven and influential part of the solution.
The Solution:Each Oklahoma birthing hospital was invited to join a cost-free, statewide collaborative effort to eliminate non-medically indicated (elective) deliveries in women who have not yet reached 39 weeks of gestation.The American College of Obstetrics and Gynecology has long-standing recommendations against this practice, yet recent studies indicate that elective deliveries undertaken at < 39 weeks may account for 10-15% of all births in the U.S. According to a recent survey of birthing hospitals in Oklahoma, 37% do not address gestational age when an elective induction or planned cesarean birth is scheduled. Recent studies also indicate that the first-time cesarean birth rate is rising (approximately 20% in Oklahoma). This rise is largely influenced by the rising induction rate in first-time, low-risk mothers. Early elective deliveries are associated with increased neonatal morbidities with no benefit to the mother or infant. They are also associated with a higher cost to hospitals and insurance providers.
Collaborative Work:This Oklahoma collaborative utilized the March of Dimes Elimination of Non-medically Indicated(Elective) Deliveries Before 39 Weeks Gestational Age Toolkit that includes best practice articles and protocol tools (such as checklists and flowcharts) to educate and train obstetric teams to improve processes of care and outcomes surrounding appropriate scheduling of inductions and cesarean births. Using models based on both the Institute for Healthcare Improvement for collaborative quality improvement and leveraging the March of Dimes Toolkit, participating hospitals will focus on improving practices relative to a baseline assessment, as opposed to comparing practices across participating sites. Each obstetric service unit will examine its practices and share its observations on relevant activities. At the unit level, project teams assessed their individual needs, establish priorities, and work to achieve their own individual goals. Some hospitals may already perform well in this area but are still needed to participate in the collaborative to share successful strategies and support other teams. A panel of experts in quality improvement, obstetrics, neonatology and culture change will provide substantial guidance and support during implementation. Improving practices collaboratively has been proven to be more effective than attempting to improve individually at the unit or hospital level.
Thanks to funding from the March of Dimes and the Oklahoma State Department of Health, there is no cost to join this collaborative. In fact, a stipend of a minimum of $1,000 is being offered to each participating hospital which meets certain requirements. Each participating hospital will also be publicly recognized for its participation.
In kind contributions provided by the Oklahoma Hospital Association and the OUHSC Office of Perinatal Quality Improvement. This collaborative is made possible through funding from the March of Dimes and the Oklahoma State Department of Health.