质量改进措施导致初产妇足月单胎头位剖宫产率降低。
Quality Improvement Initiatives Lead to Reduction in Nulliparous Term Singleton Vertex Cesarean Delivery Rate.
作者信息
Vadnais Mary A, Hacker Michele R, Shah Neel T, Jordan JoAnn, Modest Anna M, Siegel Molly, Golen Toni H
出版信息
Jt Comm J Qual Patient Saf. 2017 Feb;43(2):53-61. doi: 10.1016/j.jcjq.2016.11.008. Epub 2016 Nov 15.
BACKGROUND
The nulliparous term singleton vertex (NTSV) cesarean delivery rate has been recognized as a meaningful benchmark. Variation in the NTSV cesarean delivery rate among hospitals and providers suggests many hospitals may be able to safely improve their rates. The NTSV cesarean delivery rate at the authors' institution was higher than state and national averages. This study was conducted to determine the influence of a set of quality improvement interventions on the NTSV cesarean delivery rate.
METHODS
From 2008 through 2015, at a single tertiary care academic medical center, a multi-strategy approach that included provider education, provider feedback, and implementation of new policies was used to target evidence-based and inferred factors that influence the NTSV cesarean delivery rate. Data on mode of delivery, maternal outcomes, and neonatal outcomes were collected from birth certificates and administrative claims data. The Cochran-Armitage test and linear regression were used to calculate the p-trend for categorical and continuous variables, respectively.
RESULTS
More than 20,000 NTSV deliveries were analyzed, including more than 15,000 during the intervention period. The NTSV cesarean delivery rate declined from 35% to 21% over eight years. The total cesarean delivery rate declined as well. Increase in meconium aspiration syndrome and maternal transfusion were observed.
CONCLUSION
Quality improvement initiatives can decrease the NTSV cesarean delivery rate. Any increased incidence of fetal or maternal complications associated with decreased NTSV cesarean delivery rate should be considered in the context of the risks and benefits of vaginal delivery compared to cesarean delivery.
背景
初产妇足月单胎头位（NTSV）剖宫产率已被视为一个有意义的基准。医院和医疗服务提供者之间NTSV剖宫产率的差异表明，许多医院或许能够安全地提高这一比率。作者所在机构的NTSV剖宫产率高于州和全国平均水平。本研究旨在确定一系列质量改进干预措施对NTSV剖宫产率的影响。
方法
2008年至2015年期间，在一家三级医疗学术医学中心，采用了一种多策略方法，包括对医疗服务提供者进行教育、提供反馈以及实施新政策，以针对影响NTSV剖宫产率的循证因素和推断因素。从出生证明和行政索赔数据中收集分娩方式、产妇结局和新生儿结局的数据。分别使用 Cochr an-Armitage检验和线性回归来计算分类变量和连续变量的p趋势。
结果
分析了超过20000例NTSV分娩，其中干预期间超过15000例。NTSV剖宫产率在八年内从35%降至21%。总剖宫产率也有所下降。观察到胎粪吸入综合征和产妇输血有所增加。
结论
质量改进措施可降低NTSV剖宫产率。与剖宫产相比，在考虑阴道分娩的风险和益处时，应考虑与降低NTSV剖宫产率相关的任何胎儿或产妇并发症发生率的增加。
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