Heather C Kaplan1, Eileen King, Beth E White, Susan E Ford, Sandra Fuller, Michael A Krew, Michael P Marcotte, Jay D Iams, Jennifer L Bailit, Jo M Bouchard, Kelly Friar, Carole M Lannon. 1. Perinatal Institute, the James M. Anderson Center for Health Systems Excellence, and the Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, the Ohio Beacon Council and the Ohio Colleges of Medicine Government Resource Center, Columbus, the Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Aultman Hospital, Canton, the Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Good Samaritan Hospital, Cincinnati, the Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, The Ohio State University Wexner Medical Center, Columbus, the Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, and the Bureaus of Child & Family Health Services and Vital Statistics, Ohio Department of Health, Columbus, Ohio; and the American Board of Pediatrics, Chapel Hill, North Carolina.
Abstract
OBJECTIVE: To evaluate the success of a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation and improve birth registry data accuracy rapidly and at scale in Ohio. METHODS: Between February 2013 and March 2014, participating hospitals were involved in a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation and improve birth registry data. This initiative was designed as a learning collaborative model (group webinars and a single face-to-face meeting) and included individual quality improvement coaching. It was implemented using a stepped wedge design with hospitals divided into three balanced groups (waves) participating in the initiative sequentially. Birth registry data were used to assess hospital rates of nonmedically indicated inductions at less than 39 weeks of gestation. Comparisons were made between groups participating and those not participating in the initiative at two time points. To measure birth registry accuracy, hospitals conducted monthly audits comparing birth registry data with the medical record. Associations were assessed using generalized linear repeated measures models accounting for time effects. RESULTS: Seventy of 72 (97%) eligible hospitals participated. Based on birth registry data, nonmedically indicated inductions at less than 39 weeks of gestation declined in all groups with implementation (wave 1: 6.2-3.2%, P<.001; wave 2: 4.2-2.5%, P=.04; wave 3: 6.8-3.7%, P=.002). When waves 1 and 2 were participating in the initiative, they saw significant decreases in rates of early elective deliveries as compared with wave 3 (control; P=.018). All waves had significant improvement in birth registry accuracy (wave 1: 80-90%, P=.017; wave 2: 80-100%, P=.002; wave 3: 75-100%, P<.001). CONCLUSIONS: A quality improvement initiative enabled statewide spread of change strategies to decrease early elective deliveries and improve birth registry accuracy over 14 months and could be used for rapid dissemination of other evidence-based obstetric care practices across states or hospital systems.
OBJECTIVE: To evaluate the success of a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation and improve birth registry data accuracy rapidly and at scale in Ohio. METHODS: Between February 2013 and March 2014, participating hospitals were involved in a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation and improve birth registry data. This initiative was designed as a learning collaborative model (group webinars and a single face-to-face meeting) and included individual quality improvement coaching. It was implemented using a stepped wedge design with hospitals divided into three balanced groups (waves) participating in the initiative sequentially. Birth registry data were used to assess hospital rates of nonmedically indicated inductions at less than 39 weeks of gestation. Comparisons were made between groups participating and those not participating in the initiative at two time points. To measure birth registry accuracy, hospitals conducted monthly audits comparing birth registry data with the medical record. Associations were assessed using generalized linear repeated measures models accounting for time effects. RESULTS: Seventy of 72 (97%) eligible hospitals participated. Based on birth registry data, nonmedically indicated inductions at less than 39 weeks of gestation declined in all groups with implementation (wave 1: 6.2-3.2%, P<.001; wave 2: 4.2-2.5%, P=.04; wave 3: 6.8-3.7%, P=.002). When waves 1 and 2 were participating in the initiative, they saw significant decreases in rates of early elective deliveries as compared with wave 3 (control; P=.018). All waves had significant improvement in birth registry accuracy (wave 1: 80-90%, P=.017; wave 2: 80-100%, P=.002; wave 3: 75-100%, P<.001). CONCLUSIONS: A quality improvement initiative enabled statewide spread of change strategies to decrease early elective deliveries and improve birth registry accuracy over 14 months and could be used for rapid dissemination of other evidence-based obstetric care practices across states or hospital systems.
Authors: Shari D Bolen; Elizabeth A Beverly; Shireen Khoury; Saundra Regan; Jackson T Wright; Siran Koroukian; Randell Wexler; Goutham Rao; Daniel Hargraves; Dean Bricker; Glen D Solomon; Michael Holliday; Stacey Gardner-Buckshaw; Lance Dworkin; Adam T Perzynski; Elizabeth Littman; Ann Nevar; Shannon M Swiatkowski; Mary Applegate; Michael W Konstan Journal: Cureus Date: 2022-08-25