The perinatal quality collaborative of North Carolina's 39 weeks project: a quality improvement program to decrease elective deliveries before 39 weeks of gestation.
BACKGROUND
Despite long-standing guidelines from the American College of Obstetricians and Gynecologists that call for avoiding elective births prior to 39 weeks of gestation, elective deliveries make up almost one-third of US births occurring in weeks 36-38. Poor outcomes are more likely for infants born electively before 39 weeks than for those born at 39 weeks. The Perinatal Quality Collaborative of North Carolina (PQCNC) undertook the 39 Weeks Project in 2009-2010 with the aim of reducing the number of early-term elective deliveries in North Carolina hospitals.


METHODS
Participating hospitals (N = 33) provided retrospective data on all early-term deliveries and created new policies, or amended or enforced existing policies, to accomplish the project's goals. Project activities included in-person learning sessions, regional meetings, webinars, electronic newsletters, a secure extranet Web site where participating hospitals could share relevant materials, and individual leadership consultations with hospital teams. Hospitals submitted monthly data to PQCNC, which provided ongoing training and data analysis.


RESULTS
Elective deliveries before 39 weeks of gestation decreased 45% over the project period, from 2% to 1.1% of all deliveries. The proportion of elective deliveries among all scheduled early-term deliveries also decreased, from 23.63% to 16.19%. There was an increase in the proportion of patients with documented evidence of medical indications for early delivery, from 62.4% to 88.2%.


CONCLUSIONS
No data were collected to determine whether outcomes changed for patients whose deliveries were deferred. The project also depended on each hospital to code its own data.


CONCLUSIONS
The PQCNC's 39 Weeks Project successfully decreased the rate of early-term elective deliveries in participating hospitals.
Perinatal Quality Collaborative of North Carolina, Chapel Hill, NC, USA; Community Care of North Carolina, Raleigh, NC, USA.
Kate
K
Berrien
Perinatal Quality Collaborative of North Carolina, Chapel Hill, NC, USA; Brody School of Medicine, East Carolina University, Greenville, NC, USA.
James
J
Devente
Perinatal Quality Collaborative of North Carolina, Chapel Hill, NC, USA; Prenatal Diagnostic Center, Duke University Health System, Durham, NC, USA.
Amanda
A
French
Perinatal Quality Collaborative of North Carolina, Chapel Hill, NC, USA.
Keith M
KM
Cochran
Perinatal Quality Collaborative of North Carolina; Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Marty
M
McCaffrey
Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Bethany J
BJ
Horton
Perinatal Quality Collaborative of North Carolina; Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. cheschei@med.unc.edu.
Nancy
N
Chescheir
D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends*; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data* / Q000639:trends*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D019983:Guideline Adherence / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000706:statistics & numerical data* / Q000639:trends*; D009657:North Carolina; D011247:Pregnancy; D058996:Quality Improvement / Q000458:organization & administration* / Q000639:trends*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data / Q000639:trends