title: [Increasing the percentage of vaginal birth in the private sector in Brazil through the redesign of care model].
abstract: OBJECTIVE
  To reduce the percentage of cesareans among pregnant women at UNIMED Jaboticabal by redesigning the care delivery model.
  
  
  METHODS
  Descriptive study conducted at an institution in São Paulo State starting in 2012 to propose the redesign of the care mode based on Continued Improvement Science adapted to the health area. To measure the results of changes we selected nine indicators and their targets.
  
  
  RESULTS
  The percentage of natural births reached the target of 40% after seven months of implementation of the interventions. The percentage of natural births reached 66% among pregnant women in SUS. The perinatal mortality rate decreased by 25% from 2012 to 2014, and the prematurity rate was 3 per 100 live births in 2014. The percentage of pregnant women from UNIMED with six or more prenatal consultations reached 95%. The hospital costs for childbirth care decreased by 27% compared to 2012 and 2013. This reduction was not sustainable and the per capita cost returned to the same level in 2014. The remuneration of all obstetricians increased by 72% from 2012 to 2014. Unimed's costs attributed to the neonatal intensive care unit (NICU) decreased by 61% from 2012 to 2013. The cost was the same for 2013 as it was for 2014 while the admission rate among newborns at UNIMED decreased by 55%. The percentage of pregnant women participating in courses to prepare for birth did not reach the goal set at 80%. The percentage of pregnant women satisfied and very satisfied with care delivery reached 86%.
  
  
  CONCLUSIONS
  This project achieved its objectives by reducing the percentage of C-sections among pregnant women of UNIMED Jaboticabal representing a concrete example of achieving the Triple Aim in health: to improve the experience of care and the health outcomes of populations and individuals and to perform these two tasks at a lower cost.
authors.affiliation: UNIMED do Brasil, São Paulo, SP, Brasil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Borem
authors.affiliation: Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Janise Braga Barros
authors.initials: JB
authors.lastname: Ferreira
authors.affiliation: Hospital e Maternidade Santa Isabel, Jaboticabal, SP, Brasil.
authors.forename: Uyara Januzzi
authors.initials: UJ
authors.lastname: da Silva
authors.affiliation: Hospital e Maternidade Santa Isabel, Jaboticabal, SP, Brasil.
authors.forename: Jeyner
authors.initials: J
authors.lastname: Valério Júnior
authors.affiliation: Hospital e Maternidade Santa Isabel, Jaboticabal, SP, Brasil.
authors.forename: Cristiana Machado Borges
authors.initials: CM
authors.lastname: Orlanda
mesh_terms: D001938:Brazil; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008962:Models, Theoretical; D011247:Pregnancy; D017149:Private Sector