Last night, the March of Dimes sent out a press release regarding the new study – “A Multistate Quality Improvement Program to Decrease Elective Deliveries Before 39 Weeks” – published in the latest online edition of Obstetrics and Gynecology. The study looked at non-medically indicated scheduled births at 370/7 to 386/7 gestational ages, either by cesareans or inductions. The results demonstrate that the Big 5 March of Dimes quality improvement initiative can have a large measurable impact in changing medical cultures to reduce non-medically indicated deliveries in hospitals (83% decline).
For over a decade, the American Congress of Obstetricians and Gynecologists has supported guidelines outlining that if a pregnancy is healthy then women should wait for labor to occur spontaneously, generally at 39, 40 or 41 weeks. The March of Dimes calls the findings good news because past research has shown that the last few weeks of a healthy pregnancy are critical to the health of the infant as many vital organs, such as the brain and lungs, are still developing.
This initiative took place in 25 public and private hospitals from the five most populous states – California, Texas, New York, Florida and Illinois – and engaged perinatal advocates from state health departments, academic health centers, March of Dimes chapters and state collaboratives. The Florida Perinatal Quality Collaborative (FPQC) coordinated the initiative in Florida with a reduction in the rate of our six pilot hospitals to the same low national study rate of 5% although they started with a substantially higher rate of 39%.
“Our study demonstrates that the Big 5 March of Dimes quality initiative can have a large measurable impact in reducing non-medically indicated deliveries in hospitals. In fact, the initiative coordinated in Florida by the Florida Perinatal Quality Collaborative (FPQC) at USF Health and the Lawton and Rhea Chiles Center for Healthy Mothers and Babies reduced the rate in Florida’s pilot hospitals to the same low national study rate of 5% although the Florida pilot hospitals started the initiative with a substantially higher rate of 39%. This would not have been possible without our partnership with the March of Dimes and our obstetrical consultants from Florida’s new district of the American Congress of Obstetricians and Gynecologists.” – William M. Sappenfield, MD, MPH, FPQC Research and Data Consultant, Chairman of the Department of Community and Family Health, Director of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies, University of South Florida College of Public Health
Just like the entire Big 5 March of Dimes quality improvement initiative, the FPQC demonstrated through its pilot hospitals that change can be brought about within a variety of medical cultures. Florida’s pilot hospitals included:
- Level I, Level II and Level III NICUs
- Rural and urban locales
- Socially and ethnically diverse regions throughout the state – Northern, Central and Southern Florida
- Government-owned, not-for-profit and for-profit hospitals
- Small hospitals with deliveries fewer than 300 per year to large hospitals with greater than 5,000 per year
Dramatic, measurable changes were made over one year both in early non-medically indicated cesarean sections as well as inductions across all of Florida’s six pilot hospitals.
- The percentage of non-medically indicated scheduled cesarean sections <39 weeks went down from 53% in January 2011 to 8% in December 2011.
- The percentage of non-medically indicated scheduled inductions <39 weeks went down from 14% in January 2011 to 4% in November 2011.
- The percentage of all deliveries that are non-medically indicated <39 weeks went down from 39% in January 2011 to 5% in December 2011.
In post-implementation surveys, all of the hospitals stated they have reduced non-medically indicated deliveries <39 weeks. In addition:
- Most of the pilot hospitals reported that admissions to the NICUs had dropped. One hospital reported they had 74 admissions to the NICU in 2010 before enactment of the MOD protocols and only 2 admissions in 2011 after enactment – claiming potential cost savings in the NICU to the facility as $720,000. Another hospital indicated they saw “a huge difference in NICU admissions at expected peak times – typically women were scheduled for the week before September 1 (to qualify for school) and the last week of the year (so-called tax babies), but this surge in scheduled deliveries did not happen [in 2011].”
- On the provider side, one hospital reported that “the majority of providers bought into the project once they saw the successes of it.” Another claimed “others have taken years to do what we did in one year.”
- On the patient side, one hospital did not see the negative changes in patient satisfaction they had anticipated. They stated the “project was a nice example of partnership – good for the community. Once patient education went out they found they had fewer requests for scheduling and fewer complaints from women about being fed up with being pregnant and wanting to do something about it.”
- Overall, the majority of pilot hospitals found the initiative to be very successful. One hospital reported they felt they had exceeded their own goals by markedly changing attitudes of physicians, patients and staff. “We joined this project to do what is right for our patients, and [we] feel [we] have succeeded.”
“This study is only the beginning. Not only do other hospitals in Florida need to reduce their rates of non-medically indicated deliveries, but this is the first of many needed perinatal quality improvement initiatives in Florida to assure that all mothers and infants have access to quality health care. New initiatives under development by the FPQC in coordination with hospitals, obstetricians, pediatricians, nurses, and nurse midwives include reducing preterm births, averting infections, and preventing maternal deaths.” – William M. Sappenfield, MD, MPH
Written By; Heidi K. Curran
Tags: Big 5 State Collaborative, Florida Perinatal Quality Collaborative, FPQC, Heidi K. Curran, Lawton and Rhea Chiles Center for Healthy Mothers and Babies, March of Dimes, MOD, NMID, Non Medically Indicated Deliveries <39 Weeks, Quality Improvement, The Chiles Center