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New York State Perinatal Quality Collaborative: Obstetrical Improvement Project
Since September 2010, the New York State Department of Health (NYS DOH) has been collaborating with its Regional Perinatal Centers (RPCs) and the National Center for Children’s Healthcare Quality (NICHQ) to improve and ensure the quality of obstetrical and neonatal care related to preterm births through the New York State Perinatal Quality Collaborative (NYSPQC).
The NYSPQC Obstetrical Improvement Project seeks specifically to reduce scheduled deliveries without a medical indication between 36 0/7 and 38 6/7 weeks gestation. Since the project’s inception, participants have had the opportunity to learn from faculty and colleagues; receive individual coaching from faculty members; gather new knowledge on the subject matter and process improvement; share experiences and collaborate on improvement plans; and create strategies to overcome improvement barriers. Between September 2010 and July 2013, participating RPCs reported a 92% decrease in scheduled deliveries without medical indication during the specified gestation period, including an 88% decrease in inductions and a 93% decrease in cesarean sections. Additionally, primary cesarean sections decreased by 94%, and documentation of maternal education on the risks and benefits of preterm scheduled delivery increased by 88%.
Early in 2012, the project aligned with the New York State Partnership for Patients (NYSPFP) to expand the Collaborative from RPCs to all birthing hospitals in New York State. Ninety-eight New York State birthing hospitals are currently participating in the Collaborative. Between the expansion of the Collaborative to include Level I, II and III hospitals in June 2012 through July 2013, participating RPC affiliate hospitals reported a 73% decrease in scheduled deliveries without medical indication during the specified gestation period, including a 76% decrease in inductions and a 72% decrease in cesarean sections. Additionally, primary cesarean sections decreased by 48%, and documentation of maternal education on the risks and benefits of preterm scheduled delivery increased by 65%.
Why is this initiative important?
According to the Centers for Disease Control and Prevention, preterm birth affects more than 500,000 babies, or 1 of every 8 infants born in the U.S. It is the most frequent cause of infant death, and the leading cause of long-term neurological disabilities in children. Preterm birth can lead to severe health problems, including issues with breathing and feeding, vision impairment and developmental delays. The brain is the last major organ to mature in babies; the more prematurely a baby is born, the more likely it is that bleeding or other signs of stress will affect the brain. Preterm birth costs the U.S. health care system more than $26 billion each year. New York State ranks 8th nationally in infant mortality and 22nd in premature births.