Sustaining and spreading quality improvement: Decreasing intrapartum malpractice risk.

Area of Science:

• Obstetrics and Gynecology
• Healthcare Management
• Patient Safety Research

Background:

• Malpractice liability remains a persistent challenge in obstetrics.
• Implementing and sustaining effective interventions for patient safety is difficult.
• This study evaluates the long-term spread and sustainability of an integrated practice and communication model.

Purpose of the Study:

• To assess the spread and sustainability of a multilevel integrated practice and coordinated communication model in obstetrics.
• To determine the model's impact on high-risk occurrence rates 66 months post-implementation.

Main Methods:

• Analysis of labor and delivery patient data from 37 hospitals (5 beta, 32 expansion sites).
• Data collection covered an 81-month period from January 2010 to September 2016.
• Comparison of high-risk occurrence rates before and after intervention implementation.

Main Results:

• High-risk occurrence rates per 1000 live births decreased by over 70% at both beta and expansion sites.
• The likelihood of high-risk occurrences was significantly lower post-intervention at beta sites (OR=0.218, p<0.0001) and expansion sites (OR=0.288, p<0.001).

Conclusions:

• The integrated practice and communication model demonstrated successful spread and sustained effectiveness.
• Key success factors included evidence-based guidelines, leadership support, performance measurement, accountability, training, and transparent communication.