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Reducing Early Elective Deliveries: Perinatal Quality Improvement Collaboratives. Zsakeba Henderson, MD. Maternal and Infant Health Branch Division of Reproductive Health National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention.

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Reducing early elective deliveries perinatal quality improvement collaboratives
Reducing Early Elective Deliveries: Perinatal Quality Improvement Collaboratives

Zsakeba Henderson, MD

Maternal and Infant Health Branch

Division of Reproductive Health

National Center for Chronic Disease Prevention and Health Promotion

Centers for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health Promotion

Division of Reproductive Health


  • Networks of perinatal care providers and public health professionals working to improve pregnancy outcomes for women and newborns.

  • CDC Division of Reproductive Health currently supports

    • California Perinatal and Maternal Quality Care Collaboratives (CPQCC, CMQCC)

    • New York State Perinatal Quality Collaborative (NYSPQC)

    • Ohio Perinatal Quality Collaborative (OPQC)


Perinatal quality collaboratives
Perinatal Quality Collaboratives professionals working to improve pregnancy outcomes for women and newborns.

  • Members of the Collaborative identify processes of care that require improvement and use the best available methods to effect change and improve outcomes as quickly as possible

  • Quality improvement methods are based on principles developed and used in other areas of quality improvement

  • Baseline and ongoing collection of data is imperative

    • Involves rapid collection and return of data to member facilities to meet objectives to improve care


Perinatal quality collaboratives1
Perinatal Quality Collaboratives professionals working to improve pregnancy outcomes for women and newborns.

  • Goals of collaboratives include

    • Achieving a new level of safer, more effective care

    • Minimizing risks to patients

  • Successful efforts include

    • Reduction of late preterm and early term deliveries

    • Improvements in use of antenatal steroids for premature infants

    • Reduction in neonatal central line – associated bloodstream infections


States with PQCs and professionals working to improve pregnancy outcomes for women and newborns.

CDC/DRH funding

States with PQCs

States with PQCs in

development

Multi-state PQC


Reduction of early elective deliveries 39 weeks
Reduction of Early Elective Deliveries professionals working to improve pregnancy outcomes for women and newborns. <39 Weeks

  • The goal is to reduce scheduled births <39 weeks gestation that lack a medical indication

  • Approaches include

    • “Champion” leaders at member institutions

    • Educational efforts (webinars, conference calls, learning sessions)

      • Improving documentation of gestational age dating criteria

      • Improving documentation of indications for delivery

    • Feedback through review of site-specific and aggregate data

    • Troubleshooting of systemic and local issues

  • Data sources include medical records, patient discharge data, vital records


Reduction of early elective deliveries 39 weeks1
Reduction of Early Elective Deliveries professionals working to improve pregnancy outcomes for women and newborns. <39 Weeks

  • Improvement efforts have been successful:

    • A rapid-cycle process improvement program substantially decreased elective scheduled early-term deliveries to less than 5% in a group of diverse hospitals across multiple states.*

    • In New York State, PQC efforts resulted in a 68% decrease in scheduled deliveries without medical indication between 36 -38 weeks gestation and 20% decrease in admissions to neonatal intensive care units (NICUs) (September 2010 and January 2013, NYSPQC)

    • In Ohio, nearly 23,000 babies that would have been delivered at 36-38 weeks were delayed to 39 weeks, representing an increase of 8 percent in full-term deliveries (2008-2012, OPQC).

*Oshiro B, et al. Obstet Gynecol. 2013 May;121(5):1025-1031.


Data for quality improvement
Data for Quality Improvement professionals working to improve pregnancy outcomes for women and newborns.

  • Improving quality requires

    • Accurate information

    • Complete information

    • Timely feedback

  • Data is also used for performance measurement

    • Joint Commission

    • Centers for Medicare and Medicaid Services

    • Physician Consortium for Performance Improvement

    • Hospital Compare websites


Strategies to improve birth certificate data quality
Strategies to improve birth certificate data quality professionals working to improve pregnancy outcomes for women and newborns.

  • Provider education (medical record documentation)

  • Birth clerk training

  • Standardization of obstetric definitions

  • Identification of key data items (frequently missing or inconsistent, e.g. Ohio’s Baker’s dozen)

  • Validation of birth certificate data

  • Providing feedback on data quality to all staff involved in data documentation and collection


Improving birth certificate data quality ohio perinatal quality collaborative
Improving birth professionals working to improve pregnancy outcomes for women and newborns. certificate data quality:Ohio Perinatal Quality Collaborative

  • Recruitment by ODH and OPQC Ob

  • Call with each site to describe project

  • Site visit by ODH and OPQC QC with site’s clinical and birth data staff

  • Learning Session with all teams, clinical and data staff

  • Monthly group webinars

    • Review of data and sharing of successful strategies

  • Individual coaching calls as needed


Improving birth certificate data quality ohio perinatal quality collaborative1
Improving birth certificate data quality: professionals working to improve pregnancy outcomes for women and newborns. Ohio Perinatal Quality Collaborative

Birth Certificate Exercise

  • What are the barriers of accurate birth certificate data collection?

  • What do you see as opportunities for improvement?


Improving birth certificate data quality ohio perinatal quality collaborative2
Improving birth certificate data quality: professionals working to improve pregnancy outcomes for women and newborns. Ohio Perinatal Quality Collaborative


Ohio perinatal quality collaborative opportunities for accurate birth certificate completion
Ohio Perinatal Quality Collaborative -Opportunities professionals working to improve pregnancy outcomes for women and newborns. for Accurate Birth Certificate Completion

  • Ability to go back and correct data in IPHIS

  • Improve training of birth certificate clerks

  • Find ways to extract IPHIS data from EMR

  • One dedicated person to collect data


Improving birth certificate data quality ohio perinatal quality collaborative3
Improving birth certificate data quality: professionals working to improve pregnancy outcomes for women and newborns. Ohio Perinatal Quality Collaborative

  • Monthly review of medical records to check birth certificate data accuracy

  • Analysis of hospitals’ birth data variable processes

  • Development of training module for staff entering data into IPHIS

  • Use of participant feedback to refine training modules and begin to disseminate modules throughout Ohio.


Improving birth certificate data quality california maternal quality care collaborative
Improving birth certificate data quality: professionals working to improve pregnancy outcomes for women and newborns. California Maternal Quality Care Collaborative

  • Survey of birth clerks to identify priority areas for quality improvement

  • Multi-stakeholder taskforce for data quality improvement

  • Framework of strategies for improving perinatal data quality developed


Improving birth certificate data quality california maternal quality care collaborative1
Improving birth certificate data quality: professionals working to improve pregnancy outcomes for women and newborns. California Maternal Quality Care Collaborative

  • Standardize obstetric data definitions

  • Educate clinical and coding personnel

  • Promote redesign and system changes

  • Apply principles of Clinical Quality Improvement to Data Quality Improvement (DQI)

  • Create value for Perinatal DQI for hospitals


California maternal quality care collaborative
California Maternal Quality Care Collaborative professionals working to improve pregnancy outcomes for women and newborns.

  • Birth clerk training pilot in Santa Clara County hospitals

  • Expansion of intensive birth clerk data trainings and analytic support

  • Addition of data quality improvement metrics to the California Maternal Data Center (CMDC). https://demo.datacenter.cmqcc.org/hospitals/1

  • Match data quality to perinatal metrics calculations


Improving birth certificate data quality cmqcc california maternal data center
Improving birth certificate data quality: professionals working to improve pregnancy outcomes for women and newborns. CMQCC/California Maternal Data Center

  • CMDC is the source of rapid-cycle data for maternal quality improvement projects

    • Validation and use of perinatal quality and data quality measures

    • Interacitve web-based tool for rapid collection and feedback

  • Data quality metrics added to the CMDC include:

    • Missing/Inconsistent Birthweight (Among <2500 gram newborns)

    • Missing/Inconsistent Gestational Age (Among < 37 week newborns)

    • Percent Unknown in Birth Certificate Data

    • Missing/Inconsistent Diabetes Diagnosis

    • Missing/Inconsistent HTN Diagnosis

    • Missing/Inconsistent PROM

    • Missing/Inconsistent Induction


Perinatal quality care collaboratives improving perinatal care and data quality
Perinatal Quality Care Collaboratives: professionals working to improve pregnancy outcomes for women and newborns. Improving perinatal care and data quality

  • Use of QI science to reduce early elective deliveries has been shown to work

  • Statewide efforts to collect and report outcomes in a timely fashion is possible

  • Efforts will require continued attention to improving data quality



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