Development of a large-scale obstetric quality-improvement program that focused on the nulliparous patient at term.
OBJECTIVE
The purpose of this study was to identify an appropriate population and a balanced set of maternal and neonatal measures to drive a hospital network obstetric quality improvement program.


METHODS
Sutter Health, a large Northern California health care system with>40,000 births annually, served as the site for this project. We chose to focus on the standardized nulliparous patients: term, singleton, and vertex. A multidisciplinary task force evaluated and selected perinatal outcome and process measures. Data from every hospital were collected prospectively electronically and analyzed centrally.


RESULTS
Outcome measures that were selected included term, singleton, and vertex rates of 3rd/4th-degree laceration, cesarean birth, 5-minute Apgar score of <7, and patient satisfaction. The process measures included episiotomy, induction (37-41 weeks), and admittance with cervical dilation of > or =3 cm. Data collection completeness improved each quarter; by the end of 2002, the data collection completeness rate had reached 99.7%. Every measure demonstrated a large variation among our hospitals, which indicates opportunities for improvement.


CONCLUSIONS
This balanced set of measures for term, singleton, and vertex patients has been straightforward to collect over a large and diverse hospital system and has engaged all participants successfully.
Division of Clinical Integration, Sutter Health, Sacramento, CA, USA.
Elliott K
EK
Main
Lori
L
Bloomfield
Gordon
G
Hunt
D002140:California / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007743:Labor, Obstetric; D008427:Maternal Health Services / Q000592:standards*; D008428:Maternal Mortality / Q000639:trends; D009774:Obstetrics / Q000592:standards*; D017063:Outcome Assessment, Health Care; D010298:Parity; D018743:Perinatal Care / Q000592:standards*; D011247:Pregnancy; D016730:Program Development; D015397:Program Evaluation; D017749:Total Quality Management