QI programs help reduce early elective deliveries

Multi-state, hospital-based quality improvement programs can be effective at reducing early elective deliveries of babies, according to a study.

The rate of elective early-term deliveries at a group of 25 participating hospitals fell from 27.8% to 4.8% during the one-year project period, representing an 83% decline.

The March of Dimes, which partially funded the study, noted that babies delivered before full-term face an increased risk of serious health problems and death in their first year of life.

“This quality improvement program demonstrates that we can create a change in medical culture to prevent unneeded early deliveries and give many more babies a healthy start in life,” the study’s lead author, Bryan T. Oshiro, MD, of Loma Linda (Calif.) University School of Medicine, said in a news release.

The initiative, results of which were published April 5 on the website of the journal Obstetrics & Gynecology, focused on implementation of a toolkit called “Elimination of Non-medically Indicated (Elective) Deliveries before 39 Weeks Gestational Age,” to guide changes in early-term delivery practices.

The toolkit was developed in partnership with March of Dimes, the California Maternal Quality Care Collaborative and the California Maternal Child and Adolescent Division within the California Department of Public Health. It includes a comprehensive literature review about the importance of eliminating elective deliveries before 39 weeks; a step-by-step guide to assist hospital leaders with implementation efforts; a guide for measuring and tracking quality improvement effectiveness over time; and educational tools for clinicians and staff about consequences of early elective delivery. (The toolkit is available at www.prematurityprevention.org; a log-in is required.)

This was the first project of a collaborative of perinatal quality improvement advocates from state health departments, academic health centers, public and private hospitals, and March of Dimes chapters from the five most populous states in the country: California, Texas, New York, Florida and Illinois. These five states account for an estimated 38% of all births in the United States.

“Reducing unnecessary early deliveries to less than 5% in these hospitals means that more babies stayed in the womb longer, which is so important for their growth and development,” Edward R.B. McCabe, MD, medical director of the March of Dimes, said in the news release.

McCabe said the proportion of babies born at 37 and 38 weeks decreased at participating hospitals during the one-year study period, with the proportion born at 39 to 41 weeks correspondingly increasing. “Additional studies, perhaps over a longer period of time, could clarify whether such quality improvement programs can also bring down a hospital’s overall preterm birth rate.”

The March of Dimes urges hospitals, healthcare providers, and patients to follow American College of Obstetricians and Gynecologists guidelines to wait for labor to begin on its own if a pregnancy is healthy. The final weeks of pregnancy are crucial to a baby’s health because many vital organs, including the brain and lungs, still are developing.

The study is available at http://journals.lww.com/greenjournal/Fulltext/2013/05000/A_Multistate_Quality_Improvement_Program_to.17.aspx.

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