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Published on: January 27, 2010
Reducing cesarean birth rates with data-driven quality improvement activities
1Department of Obstetrics and Gynecology, California Pacific Medical Center, San Francisco, California 94118, USA.
Pediatrics
|January 26, 1999
Summary
Intensive feedback on cesarean section rates, using a computerized system and open-label data, significantly reduced surgical births. This physician behavior change, not just education, proved effective in lowering cesarean section rates.
Area of Science:
- Obstetrics and Gynecology
- Health Services Research
- Medical Informatics
Background:
- Reducing cesarean section rates is a persistent challenge in obstetrics.
- Institutional guidelines alone have often proven insufficient for significant change.
- Physician behavior modification is key to altering cesarean birth rates.
Purpose of the Study:
- To analyze the impact of intensive outcomes feedback on cesarean section rates.
- To evaluate the effectiveness of a computerized information system for obstetric outcomes.
- To assess the influence of 'open label' feedback on physician practice patterns.
Main Methods:
- A comparative study of two private obstetric services in San Francisco.
- Implementation of The Perinatal Data Center for intensive outcomes feedback at one hospital.
- Introduction of the system to the control hospital and subsequent 'open label' feedback post-merger.
Main Results:
- Cesarean birth rates remained stable (24-25%) before intervention.
- Introduction of the outcomes system led to a decrease to 21% in the first hospital.
- Subsequent system introduction and 'open label' feedback further reduced rates to 18.5%.
Conclusions:
- Intensive use of comparative outcome data can alter physician practice and lower cesarean birth rates.
- Strong physician leadership is crucial for implementing practice pattern changes.
- Nonblinded, intradepartmental distribution of outcomes is a highly effective tool for change.
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