Supporting Vaginal Birth in Illinois: the Role of Unit Culture

支持伊利诺伊州的阴道分娩：单位文化的作用

• 批准号: 10369439
• 负责人: Emily White VanGompel
• 金额: $ 13.85万
• 依托单位: NORTHSHORE UNIVERSITY HEALTHSYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2026-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10369439
• 关键词: Supporting; Vaginal; Birth; Illinois; Role

SUMMARY Cesarean deliveries (cesareans), when used judiciously, save lives. However, research indicates that the use of cesareans in the United States (US) has risen well above the level of necessity and has become a contributor to maternal morbidity and mortality. Patients who have cesareans face increased risk of serious complications such as amniotic fluid embolism, catastrophic hemorrhage, placental abnormalities in future pregnancies, and death. Babies born by cesarean face increased risk of respiratory complications, and, emerging research suggests, chronic disease. For these reasons, the Healthy People 2020 goal is to reduce cesarean rates to ≤ 23.9% for first-time mothers. Currently, over one-third of all women giving birth in the United States deliver via cesarean. Hospital cesarean rates across the US range from 6% to 69%, and significant variation remains even when controlling for patient clinical factors and hospital and patient demographics. Patient request for a cesarean make up less than 1% of cesareans nationwide, and, thus, cannot explain this variation. Our prior work has found that this variation in practice is associated with labor and delivery unit culture and, moreover, that successful reduction in cesarean overuse correlates with specific aspects of unit culture, such as decreased fear of vaginal birth, physician acceptance of oversight, agreement with evidence-based practices, and belief in the importance of maternal agency. Organizational culture has been shown to be a key element in reducing variation in hospital outcomes in other clinical areas; and, underscoring its importance, the national safety bundle addressing cesarean overuse charges hospitals to “develop a unit culture that supports vaginal birth.” Unfortunately, there is evidence that this aspect of quality improvement receives the least attention from hospitals that participate in initiatives to reduce cesarean overuse. After 2 years of a California statewide initiative, about 42% of hospitals still had cesarean rates over the Healthy People 2020 goal. This is not surprising given that few tools and no rigorously designed user- centered tools exist to help hospitals implement culture change. This proposal leverages the strength and support of multiple state-level perinatal quality collaboratives at different stages of implementation and a novel, continually improving Labor Culture Survey tool. We will engage in a comprehensive user-centered design process to create, adapt, and implement a “Culture Change Toolset” for use in hospital-based, organizational culture quality improvement efforts to reduce cesarean overuse. Furthermore, we will incorporate patient perspectives and feedback as key stakeholders in the design and adaptation process. Based on our prior data, a 1-point improvement in unit culture supportive of vaginal birth would convert 331,773 cesarean deliveries or 27% of US cesarean births and 9% of all US births each year to vaginal deliveries and the low-risk, primary cesarean rate would decrease from 28% to 19%, thus achieving the Healthy People 2020 goal and improving maternal and newborn morbidity and mortality.

概括 如果明智地使用剖腹产，可以挽救生命。然而，研究表明，使用 在美国，剖腹产率已远远高于必要水平，并已成为 产妇发病率和死亡率的一个因素。剖腹产患者面临严重并发症的风险增加 未来出现羊水栓塞、灾难性出血、胎盘异常等并发症 怀孕和死亡。剖腹产出生的婴儿出现呼吸道并发症的风险增加，并且， 新兴研究表明，慢性疾病。出于这些原因，“健康人民 2020”的目标是减少 首次母亲的剖宫产率降至 ≤ 23.9%。目前，超过三分之一的妇女在分娩 美国是剖腹产分娩。美国各地的医院剖腹产率从 6% 到 69% 不等， 即使控制了患者临床因素以及医院和患者，仍然存在显着差异 人口统计。全国范围内，要求剖腹产的患者比例不到剖腹产的 1%，因此， 无法解释这种变化。我们之前的工作发现，实践中的这种变化与劳动力有关 和分娩单位文化，此外，成功减少剖宫产过度使用与特定的 单位文化的各个方面，例如减少对阴道分娩的恐惧、医生接受监督、同意 以证据为基础的实践，并相信母亲机构的重要性。组织文化有 已被证明是减少其他临床领域医院结果差异的关键因素；和， 为了强调其重要性，针对剖腹产过度使用的国家安全捆绑包向医院收取费用 “发展一种支持阴道分娩的单位文化。”不幸的是，有证据表明这方面的质量 参与减少剖宫产举措的医院对改善的关注最少 过度使用。加州全州范围内的一项举措实施两年后，约 42% 的医院仍有剖腹产率 健康人民 2020 目标。鉴于工具很少且没有严格设计的用户，这并不奇怪。 存在以中心为中心的工具来帮助医院实施文化变革。该提案利用了力量和 在不同实施阶段支持多个国家级围产期质量合作以及一个新颖的、 不断改进劳动文化调查工具。我们将进行全面的以用户为中心的设计 创建、调整和实施“文化变革工具集”的流程，用于以医院为基础的组织 努力提高文化质量，减少剖宫产过度使用。此外，我们还将把患者纳入 作为设计和适应过程中关键利益相关者的观点和反馈。根据我们之前的数据， 支持阴道分娩的单位文化每提高 1 分，就会使 331,773 例剖腹产或 每年 27% 的美国剖腹产婴儿和 9% 的美国新生儿是阴道分娩，并且是低风险、原发性分娩 剖宫产率将从 28% 下降至 19%，从而实现“健康人民 2020”目标并改善 孕产妇和新生儿发病率和死亡率。