Perinatal Institute, the James M. Anderson Center for Health Systems Excellence, and the Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, the Ohio Beacon Council and the Ohio Colleges of Medicine Government Resource Center, Columbus, the Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Aultman Hospital, Canton, the Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Good Samaritan Hospital, Cincinnati, the Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, The Ohio State University Wexner Medical Center, Columbus, the Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, and the Bureaus of Child & Family Health Services and Vital Statistics, Ohio Department of Health, Columbus, Ohio; and the American Board of Pediatrics, Chapel Hill, North Carolina.
Obstet Gynecol. 2018 Apr;131(4):688-695. doi: 10.1097/AOG.0000000000002516.
To evaluate the success of a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation and improve birth registry data accuracy rapidly and at scale in Ohio.
Between February 2013 and March 2014, participating hospitals were involved in a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation and improve birth registry data. This initiative was designed as a learning collaborative model (group webinars and a single face-to-face meeting) and included individual quality improvement coaching. It was implemented using a stepped wedge design with hospitals divided into three balanced groups (waves) participating in the initiative sequentially. Birth registry data were used to assess hospital rates of nonmedically indicated inductions at less than 39 weeks of gestation. Comparisons were made between groups participating and those not participating in the initiative at two time points. To measure birth registry accuracy, hospitals conducted monthly audits comparing birth registry data with the medical record. Associations were assessed using generalized linear repeated measures models accounting for time effects.
Seventy of 72 (97%) eligible hospitals participated. Based on birth registry data, nonmedically indicated inductions at less than 39 weeks of gestation declined in all groups with implementation (wave 1: 6.2-3.2%, P<.001; wave 2: 4.2-2.5%, P=.04; wave 3: 6.8-3.7%, P=.002). When waves 1 and 2 were participating in the initiative, they saw significant decreases in rates of early elective deliveries as compared with wave 3 (control; P=.018). All waves had significant improvement in birth registry accuracy (wave 1: 80-90%, P=.017; wave 2: 80-100%, P=.002; wave 3: 75-100%, P<.001).
A quality improvement initiative enabled statewide spread of change strategies to decrease early elective deliveries and improve birth registry accuracy over 14 months and could be used for rapid dissemination of other evidence-based obstetric care practices across states or hospital systems.
评估在俄亥俄州迅速大规模实施一项质量改进计划的效果，以降低不足 39 孕周的选择性剖宫产率，并提高出生登记数据的准确性。
2013 年 2 月至 2014 年 3 月，参与医院参与了一项质量改进计划，以减少不足 39 孕周的选择性剖宫产，并改善出生登记数据。该计划采用学习合作模式（小组网络研讨会和一次面对面会议）设计，并包括个体质量改进辅导。它采用逐步楔形设计实施，医院分为三组（波），按顺序参与该计划。使用出生登记数据评估医院不足 39 孕周非医学指征引产率。在两个时间点比较参与和未参与该计划的组。为了衡量出生登记数据的准确性，医院每月进行审计，将出生登记数据与病历进行比较。使用广义线性重复测量模型评估时间效应的关联。
72 家符合条件的医院中有 70 家（97%）参与。根据出生登记数据，随着计划的实施，所有组的不足 39 孕周非医学指征引产率均下降（波 1：6.2%-3.2%，P<.001；波 2：4.2%-2.5%，P=.04；波 3：6.8%-3.7%，P=.002）。当波 1 和波 2 参与该计划时，与波 3（对照组）相比，早期选择性剖宫产率显著下降（P=.018）。所有波都显著提高了出生登记数据的准确性（波 1：80%-90%，P=.017；波 2：80%-100%，P=.002；波 3：75%-100%，P<.001）。
质量改进计划在 14 个月内实现了改变策略在全州范围内的传播，以降低早期选择性剖宫产率并提高出生登记数据的准确性，并且可以用于在各州或医院系统内快速传播其他基于证据的产科护理实践。
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