Reduction in Cesarean Delivery Rates Associated With a State Quality Collaborative in Maryland

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Healthcare Quality Improvement

Background:

• Cesarean deliveries represent a significant portion of births, with variations in rates across hospitals.
• Quality improvement collaboratives aim to standardize care and reduce unnecessary interventions.
• The Maryland Perinatal-Neonatal Quality Care Collaborative (MDPQC) focused on reducing primary cesarean deliveries.

Purpose of the Study:

• To evaluate the adoption of policy and practice changes by hospitals in the MDPQC.
• To determine the association between practice adoption and changes in state-level cesarean delivery rates.

Main Methods:

• Prospective evaluation of 31 Maryland birthing hospitals participating in the MDPQC (June 2016-December 2018).
• Hospitals implemented practices from the 'Safe Reduction of Primary Cesarean Births' patient safety bundle.
• Cesarean delivery rates for nulliparous, term, singleton, vertex births were analyzed pre- and post-intervention using birth certificate data.

Main Results:

• Hospitals implemented a median of four new practices during the collaborative.
• Statewide cesarean delivery rates decreased for nulliparous, term, singleton, vertex births (28.5% to 26.9%) and inductions (36.1% to 31.3%).
• Greater implementation of 'Response' domain practices was associated with lower cesarean delivery rates.

Conclusions:

• The MDPQC initiative was associated with a statewide reduction in cesarean delivery rates for nulliparous, term, singleton, vertex births.
• Policy and practice changes adopted by hospitals contributed to improved maternal care outcomes.