title: The Feasibility of Tracking Elective Deliveries Prior to 39 Gestational Weeks: Lessons From Three California Projects.
abstract: The tracking of elective deliveries (ED) prior to 39 gestational weeks has become a mandatory requirement for all hospitals with ≥1,100 deliveries for accreditation by The Joint Commission (TJC); however, the feasibility and accuracy of monitoring efforts remain problematic for many hospitals. Here, we evaluated the feasibility of three operational approaches to tracking ED. We used mixed methods to evaluate the feasibility of 3 different approaches to tracking ED: (1) using administrative data, (2) using electronic medical record (EMR) data, and (3) using targeted data collection in a county-wide quality improvement (QI) effort. For (1), we analyzed data from the California 2009 linked birth cohort dataset, and calculated hospital rates of ED using TJC technical specifications. For (2), we performed a case study of a project that recruited hospitals to provide EMR data for the TJC measure calculation. For (3), we performed a case study of a project that recruited hospitals to prospectively track elective inductions of labor. For (1), hospital discharge data were insufficient without supplementation from the EMR or birth certificate. For (2), legal and operational issues surrounding data sharing, and non-standardized data elements prohibited hospital participation. For (3), the QI approach successfully established policies and data collection systems yet lacked infrastructure to assure sustainability at a hospital or regional level. In summary, ED tracking required the coordination and support of multiple resources to enable hospitals to satisfactorily report on this measure.
authors: Childbirth Research Associates, North Hollywood, CA, USA.
authors: Lisa M
authors: LM
authors: Korst
authors: AMF Consulting, Los Angeles, CA, USA.
authors: Moshe
authors: M
authors: Fridman
authors: Maternal, Child and Adolescent Health Division, California Department of Public Health, Sacramento, CA, USA.
authors: Melanie
authors: M
authors: Estarziau
authors: Department of Obstetrics and Gynecology, David Geffen School of Medicine and Department of Community Health Sciences, School of Public Health, UCLA, Los Angeles, CA, USA. gregory@cshs.org.|Department of Obstetrics and Gynecology, Burns Allen Research Institute, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 160 West Tower, Los Angeles, CA, 90048, USA. gregory@cshs.org.
authors: Kimberly D
authors: KD
authors: Gregory
authors: Office of Health Equity, California Department of Public Health, Sacramento, CA, USA.
authors: Connie
authors: C
authors: Mitchell
mesh_terms: D002140:California; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends; D036861:Delivery, Obstetric / Q000706:statistics & numerical data* / Q000639:trends; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D005865:Gestational Age; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data* / Q000639:trends; D036801:Parturition; D061214:Patient Safety / Q000592:standards*; D011247:Pregnancy; D058996:Quality Improvement
keywords: Administrative data; Benchmarking; Childbirth; Elective delivery; Pregnancy; Quality indicators
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