Am J Perinatol 2018; 35(04): 390-396
DOI: 10.1055/s-0037-1607985
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Comparison of the Nulliparous-Term-Singleton-Vertex and Society of Maternal–Fetal Medicine Cesarean Birth Metrics Based on Hospital Size

Laurence E. Shields
1   Department of Obstetrics and Gynecology, Division of Maternal–Fetal Medicine, Marian Regional Medical Center, Santa Maria, California
2   Department of Patient Safety, Dignity Health, San Francisco, California
,
Suzan Walker
3   Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
,
Herman L. Hedriana
2   Department of Patient Safety, Dignity Health, San Francisco, California
4   Department of Obstetrics and Gynecology, University of California Davis, Sacramento, California
,
Suzanne Wiesner
2   Department of Patient Safety, Dignity Health, San Francisco, California
,
Barbara Pelletreau
2   Department of Patient Safety, Dignity Health, San Francisco, California
,
Jane Hitti
3   Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
,
Thomas J. Benedetti
3   Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
› Institutsangaben
Weitere Informationen

Publikationsverlauf

31. Juli 2017

05. Oktober 2017

Publikationsdatum:
03. November 2017 (online)

Abstract

Objective The purpose of this study was to compare the nulliparous-term-singleton-vertex (NTSV) and the Society of Maternal–Fetal Medicine (SMFM) cesarean birth metrics as tools for quality improvement efforts based on hospital size.

Materials and Methods Cesarean birth rates from 275 hospitals from six states were used to evaluate the NTSV metric and 81 hospitals from four states for the SMFM metric. Data were assessed based on delivery volume, their use as an effective tool for ongoing quality improvement programs, and their ability to serve as performance-based payline indicators.

Results The average NTSV and SMFM cesarean birth rates were 25.6 and 13.0%, respectively. The number of deliveries included in the NTSV metric was stable across all hospital sizes (33.1–36.2%). With the SMFM metric, there was a progressive decline in the number of deliveries included, 90.0 versus 69.6%, in relatively small to large facilities. Variability was less and precision increased with the SMFM metric, which reduced the number of hospitals that could be incorrectly categorized when using performance-based predefined cesarean birth rate paylines.

Conclusion The SMFM metric appears to be better suited as a tool for rapid process improvement programs aimed at reducing cesarean birth rates in low-risk patients.

 
  • References

  • 1 Martin JA, Hamilton BE, Osterman MJK. Births in the United States, 2015. NCHS Data Brief 2016; 2016 (258) 1-8
  • 2 American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol 2014; 123 (03) 693-711
  • 3 Caughey AB, Cahill AG, Guise JM, Rouse DJ. ; American College of Obstetricians and Gynecologists (College); Society for Maternal-Fetal Medicine. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014; 210 (03) 179-193
  • 4 The Joint Commission. American's Hospitals: Improving Quality and Safety. The Joint Commission Annual Report 2016. Available at: https://www.jointcommission.org/america's_hospitals_improving_quality_and_safety_the_joint_commission's_annual_report_2016/ . Accessed June 30, 2017
  • 5 Case Study: Maternity Payment and Care Redesign Pilot: Pacific Business Group on Health. 2015. Available at: http://www.pbgh.org/storage/documents/TMC_Case_Study_Oct_2015.pdf . Accessed December 1, 2015
  • 6 Bailit J, Garrett J. Comparison of risk-adjustment methodologies for cesarean delivery rates. Obstet Gynecol 2003; 102 (01) 45-51
  • 7 Bailit JL, Love TE, Dawson NV. Quality of obstetric care and risk-adjusted primary cesarean delivery rates. Am J Obstet Gynecol 2006; 194 (02) 402-407
  • 8 Main EK, Moore D, Farrell B. , et al. Is there a useful cesarean birth measure? Assessment of the nulliparous term singleton vertex cesarean birth rate as a tool for obstetric quality improvement. Am J Obstet Gynecol 2006; 194 (06) 1644-1651 , discussion 1651–1652
  • 9 Armstrong JC, Kozhimannil KB, McDermott P, Saade GR, Srinivas SK. ; Society for Maternal-Fetal Medicine Health Policy Committee. Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures. Am J Obstet Gynecol 2016; 214 (02) 153-163
  • 10 Main EK, Bloomfield L, Hunt G. ; Sutter Health, First Pregnancy and Delivery Clinical Initiative Committee. Development of a large-scale obstetric quality-improvement program that focused on the nulliparous patient at term. Am J Obstet Gynecol 2004; 190 (06) 1747-1756
  • 11 Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 2012; 120 (05) 1181-1193
  • 12 Hitti J, Walker S, Benedetti TJ. Effect of severity of illness on cesarean delivery rates in Washington State. Am J Obstet Gynecol 2017; 217 (04) 474.e1-474.e5
  • 13 Simpson KR. An overview of distribution of births in United States hospitals in 2008 with implications for small volume perinatal units in rural hospitals. J Obstet Gynecol Neonatal Nurs 2011; 40 (04) 432-439
  • 14 Menard MK, Kilpatrick S, Saade G. , et al; American College of Obstetricians and Gynecologists and Society for Maternal–Fetal Medicine. Levels of maternal care. Am J Obstet Gynecol 2015; 212 (03) 259-271
  • 15 Hartmann KE, Andrews JC, Jerome RN. , et al. Strategies to Reduce Cesarean Birth in Low-Risk Women. Rockville, MD: Agency for Healthcare Research and Quality (US); ; October, 2012