Quality improvement initiative cuts early elective deliveries

(HealthDay)—A statewide quality improvement initiative can reduce early elective deliveries, according to a study published in the April issue of Obstetrics & Gynecology.

Heather C. Kaplan, M.D., from the Cincinnati Children's Hospital Medical Center, and colleagues examined the success of a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation. The initiative was designed as a learning collaborative model and included individual quality improvement coaching. A stepped-wedge design was implemented, with hospitals divided into three waves participating sequentially in the initiative.

Ninety-seven percent of 72 eligible hospitals participated. The researchers found that with implementation, non-medically indicated inductions at less than 39 weeks of gestation decreased in all groups (6.2 to 3.2 percent, 4.2 to 2.5 percent, and 6.8 to 3.7 percent, respectively, for waves 1, 2, and 3). Significant decreases in rates of early elective deliveries were seen when waves 1 and 2 were participating in the initiative compared with wave 3. Significant improvement was seen in birth registry accuracy in all waves (80 to 90 percent, 80 to 100 percent, and 75 to 100 percent, respectively, for waves 1, 2, and 3).

"A quality improvement initiative enabled statewide spread of change strategies to decrease early elective deliveries and improve birth registry accuracy over 14 months and could be used for rapid dissemination of other evidence-based obstetric care practices across states or hospital systems," the authors write.

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