Rate-based calculation of failure to progress: a proposed quality improvement method

Area of Science:

• Obstetrics and Gynecology
• Healthcare Quality Improvement
• Maternal Health

Background:

• The Joint Commission's "failure to progress" rate for primary cesarean delivery uses a denominator that includes patients not truly at risk.
• This misclassification bias hinders accurate comparisons and trend assessments of cesarean delivery rates.
• Variations in institutional practices and patient populations affect the current rate's meaningfulness.

Purpose of the Study:

• To propose a revised method for calculating the "failure to progress" rate in primary cesarean deliveries.
• To establish a more accurate and comparable metric for assessing cesarean delivery trends.
• To account for variations in clinical practice and patient risk factors.

Main Methods:

• Developed a new rate calculation based on the population truly at risk for "failure to progress".
• The revised denominator includes total vaginal deliveries plus primary cesareans for "failure to progress" minus vaginal births after cesarean.
• This method aims to control for differences in local practice standards.

Main Results:

• The proposed method corrects misclassification bias inherent in the current "failure to progress" rate calculation.
• It allows for more meaningful intra-institutional and inter-regional comparisons of cesarean delivery rates.
• This approach provides a better basis for trend assessment in obstetric practice.

Conclusions:

• The current "failure to progress" rate for primary cesarean delivery is flawed due to inclusion of at-risk patients.
• A refined calculation focusing on the at-risk population offers a more accurate metric.
• This improved method facilitates better quality assessment and comparison in obstetric care.