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Q&A

Obstetric Quality and Safety

Poster Session 2

(396) Efforts to reduce NTSV cesareans by achieving ACOG/SMFM recommendations in a statewide quality improvement initiative

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: The Promoting Vaginal Birth (PVB) quality improvement (QI) initiative aims to reduce nulliparous, singleton, term and vertex (NSTV) cesarean section deliveries (C/S) and increase the percent of C/S meeting ACOG/SMFM OB care consensus recommendations for C/S indication. We aim to identify progress towards meeting initiative goals from baseline (Oct-Dec 2019) to 27-months into initiative Q1 (Jan-Mar) 2023. 

Study Design: ILPQC facilitated collaborative learning, rapid-response data and QI support for hospitals. Hospitals reported a random sample of 20 NTSV C/S per month and monthly progress on implementation of systems changes. McNemar’s Test was used to evaluate progress on systems changes, proportion of deliveries that met ACOG/SMFM recommendations and % of hospitals achieving initiative goal of ≤23.6% NTSV C/S between baseline and Q1 2023. A Chi-Square Test was used to evaluate change in statewide NTSV C/S rate between baseline and Q1 2023 and change in disparities between NTSV C/S rate between white and Black patients.

Results: 69 participating hospitals were included in the analysis. Hospitals improved between baseline and Q1 2023 on implementation of all systems changes (p< .0001) and meeting ACOG/SMFM recommendations overall from 50.1% to 65.3% (p< .0001) and for all C/S indications (Table 1). In Q1 2023, 47.8% of hospitals were at NTSV C/S rate goal of ≤23.6%. The statewide overall NTSV C/S rate was 25.1% at baseline and reduced to 23.4% by Q1 2023 (p=.0118). At baseline, the rate of NTSV C/S was higher in Black patients than white (30.5% vs. 26.3%, p=0.02) but by Q1 2023, the rate was similar between groups (24.3% vs. 23.1%. p=0.37). 

Conclusion: Decreasing the rate of non-indicated NTSV C/S can improve maternal outcomes. Our results indicate that a statewide PVB QI initiative is associated with equitable implementation of systems changes, meeting ACOG/SMFM recommendations, an overall reduction in NTSV C/S births and reduction in the disparities gap 27 months into the initiative. Ongoing work will focus on safe reduction of NTSV C/S rates to goal for all Illinois hospitals.