“Fixing the Pressure Tank: The Role of Operational Management in Safely Reducing Primary Cesarean Deliveries “
NPIC partnered with Ariadne Labs, on a joint center for health systems innovation, a research project to study the relationship between operational management and institutional cesarean section (C-section) rates. Up to fifty NPIC member hospitals participated in the study.
Upon completion of the study, participating hospitals received valuable benchmarking information on how their own institution compares to others with respect to operational management factors that may impact their risk-adjusted cesarean section rate. Information was designed to be actionable in order to help NPIC members meet expected pay-for-performance targets.
Given awareness of increasing rates of labor induction and cesarean delivery, and guidelines to reduce non-medically indicated preterm and early term births, we examined recent trends in delivery methods.
Using data from 2006 and 2010 from 47 hospitals in the NPIC member hospital trend database, we examined (stratified by teaching hospital status): total deliveries, labor inductions, cesarean deliveries, operative vaginal deliveries. Maternal complications (e.g., operative vaginal delivery, hypertension, diabetes) were considered.
A secondary analysis was conducted from a subset of hospitals with a high proportion of maternal-newborn linked records and week-specific gestational age. We examined changes in gestational age at delivery and induction and cesarean delivery by gestational age over time.)
NPIC surveyed a subset of member hospitals to determine if OB hospitals were covering their service with “laborists” or “OB hospitalists” and if so, their scope of service, and what type of contractual arrangements were being used.
Twenty-eight of the 56 hospitals/regional perinatal centers responded to this survey, a 50% response rate.