Reduction in Cesarean Delivery Rates Associated With a State Quality Collaborative in Maryland.
Reduction in Cesarean Delivery Rates Associated With a State Quality Collaborative in Maryland.
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DOI：
10.1097/aog.0000000000004540
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发表时间：
2021-10-01
影响因子：
7.2
通讯作者：
Creanga AA
中科院分区：
文献类型：
--
作者：
Callaghan-Koru JA;DiPietro B;Wahid I;Mark K;Burke AB;Curran G;Creanga AA
评估参与马里兰州围产期质量协作（MDPQC）以减少初次剖宫产分娩的医院采用政策和实践变化的程度，以及这种采用与州级剖宫产率的相关性。MDPQC的前瞻性评估包括该州31家（97%）分娩医院，这些医院都自愿参加了2016年6月至2018年12月的30个月合作。医院工作队同意执行妇女保健中病人安全问题理事会制定的“安全减少初次剖腹产”病人安全包中的做法。通过对12个月和30个月时的团队负责人进行调查，来衡量每家医院对捆绑实践的实施情况。根据每家医院的出生证明汇总数据计算半年一次的剖宫产率，并对合作前6个月（基线）和合作后6个月（终点）之间的比率差异进行统计学显著性检验。在评估的26个捆绑实践中，参与医院报告在合作之前已经实施了7个实践（范围：0-23），并在合作期间实施了4个新实践（范围：0-17）。在协作组中，所有未经产足月单胎头位分娩的剖宫产率从28.5%降至26.9%（p=0.011），未经产足月单胎头位分娩的剖宫产率从36.1%降至31.3%（p<0.001）。五家医院的未产妇、足月、单胎、头位剖宫产率有统计学显著下降，四家医院有显著增加。未产妇，足月，单胎，头位剖宫产率显着降低医院实施更多的做法，在“反应”领域的捆绑。MDPQC与全州范围内未经产、足月、单胎、头位分娩的剖宫产率降低有关。马里兰州围产期质量协作与未产妇、足月、单胎、头位分娩的剖宫产率降低有关
To assess the extent to which hospitals participating in Maryland’s perinatal quality collaborative (MDPQC) to reduce primary cesarean deliveries adopted policy and practice changes and the association of this adoption with state-level cesarean delivery rates. This prospective evaluation of the MDPQC includes 31 (97%) of the birthing hospitals in the state, which all voluntarily participated in the 30-month collaborative from June 2016 to December 2018. Hospital teams agreed to implement practices from the “Safe Reduction of Primary Cesarean Births” patient safety bundle, developed by the Council on Patient Safety in Women’s Health Care. Each hospital’s implementation of practices in the bundle was measured through surveys of team leaders at 12 and 30 months. Half-yearly cesarean delivery rates were calculated from aggregate birth certificate data for each hospital and differences in rates between the 6 months prior to the collaborative (baseline) and the 6 months afterwards (endline) were tested for statistical significance. Among the 26 bundle practices that were assessed, participating hospitals reported having a median of 7 practices (range: 0–23) already in place prior to the collaborative and implementing a median of 4 (range: 0–17) new practices during the collaborative. Across the collaborative, the cesarean delivery rates decreased from 28.5% to 26.9% (p=0.011) for all nulliparous term singleton vertex births and from 36.1% to 31.3% (p<0.001) for nulliparous, term, singleton, vertex inductions. Five hospitals had a statistically significant decrease in nulliparous, term, singleton, vertex cesarean delivery rates and four had a significant increase. Nulliparous, term, singleton, vertex cesarean delivery rates were significantly lower across hospitals that implemented more practices in the “Response” domain of the bundle. The MDPQC was associated with a statewide reduction in cesarean delivery rates for nulliparous, term, singleton, vertex births. The Maryland perinatal quality collaborative was associated with reductions in cesarean delivery for nulliparous, term, singleton, vertex births