title: A Statewide Quality Improvement Initiative to Reduce Non-Medically Indicated Scheduled Deliveries.
abstract: Objectives To evaluate a large two-phase, statewide quality improvement (QI) collaborative to decrease non-medically indicated (N-MI) deliveries scheduled between 36 and 38 weeks gestation (early). Methods The New York State Department of Health (NYSDOH) convened a Perinatal Quality Collaborative to devise a two-phase QI initiative using a rapid cycle incremental learning model. Phase 1 included Regional Perinatal Centers (RPCs), and Phase 2 added their affiliated perinatal hospitals. Maternal demographics, delivery characteristics, medical indications, and stillbirths were collected on scheduled inductions and cesarean section (CS) deliveries between 36 and 38 weeks. Results There were 35,091 scheduled 36-38 week deliveries reported during the collaborative's 4 years. The percentage of early N-MI scheduled deliveries decreased 41-fold in RPCs (Phase 1 and Phase 2), and 17-fold in affiliates (Phase 2). There was a significant statewide increase in deliveries at ≥39 weeks (P < 0.001), with an estimated 23,732 early deliveries averted. Stillbirths did not increase over time (P = 0.42), although reporting was incomplete. Conclusions A two-phase, statewide QI collaborative in a large state with regionalized perinatal care effectively lowered the number of N-MI deliveries scheduled between 36 and 38 weeks gestation. Associated improvements in neonatal and early childhood developmental outcomes should translate to significant cost savings. This model can effectively be used for similar as well as other obstetrical QI.
authors.affiliation: Division of Family Health, New York State Department of Health, Empire State Plaza, Corning Tower Rm 984, Albany, NY, 12237, USA. Marilyn.Kacica@health.ny.gov.|State University of New York, University at Albany School of Public Health, Rensselaer, NY, USA. Marilyn.Kacica@health.ny.gov.
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Kacica
authors.affiliation: University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: J Christopher
authors.initials: JC
authors.lastname: Glantz
authors.affiliation: Division of Family Health, New York State Department of Health, Empire State Plaza, Corning Tower Rm 984, Albany, NY, 12237, USA.
authors.forename: Kuangnan
authors.initials: K
authors.lastname: Xiong
authors.affiliation: Division of Family Health, New York State Department of Health, Empire State Plaza, Corning Tower Rm 984, Albany, NY, 12237, USA.
authors.forename: Eileen P
authors.initials: EP
authors.lastname: Shields
authors.affiliation: University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Cherouny
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006801:Humans; D009518:New York; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D058996:Quality Improvement / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*
keywords: 36–38 weeks gestation; Cesarean deliveries; Inductions; New York State; Non-medically indicated deliveries