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Obstetrics Project:

New York State Perinatal Quality Collaborative (NYSPQC) Obstetrical Improvement Project to Reduce Scheduled Deliveries

In September 2010, the New York State Department of Health (NYSDOH) began collaborating with New York State’s Regional Perinatal Centers (RPCs) and the National Institute for Children’s Health 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 initial NYSPQC Obstetrical Improvement Project specifically sought to reduce scheduled deliveries without a medical indication between 36 0/7 and 38 6/7 weeks gestation. Participating birthing hospitals 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 the project’s close in November 2014, participating RPCs reported a 97% decrease in scheduled deliveries without medical indication during the specified gestation period, including a 96% decrease in inductions and a 98% decrease in cesarean sections. Additionally, primary cesarean sections decreased by 97%, and documentation of maternal education on the risks and benefits of preterm scheduled delivery increased by 124%.

Early in 2012, the project aligned with the New York State Partnership for Patients (NYSPFP) to expand the project from RPCs to all interested Level I, II and III New York State birthing hospitals (RPC-affiliate hospitals). Eighty RPC-affiliate hospitals joined the expanded project at this time.  Between the expansion of the Collaborative June 2012, through the close of the project in November 2014, participating RPC-affiliate hospitals reported a 94% decrease in scheduled deliveries without a medical indication during the specified gestation period, including an 88% decrease in inductions and a 96% 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 84%.

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.