Improving Quality and Safety Together: Reducing Primary Cesareans Perinatal Core Measure Collaborative


Lyn Yasumura, MD; Cheri Lowre, MD; Leslie Casper, MD;
Marianna Volodarskiy, RN, MSN, NE-BC

Abstracts from the Kaiser Permanente 2019 National Quality Conference

From Northwest, Southern California, Washington

Background: In 2014, the Pacific Business Group on Health, San Francisco, CA, and the Leapfrog Group, Washington, DC, reviewed cesarean sections and determined a mother’s chances of having a cesarean related to the hospital she was admitted to more than any other medical factor. Cesarean rates varied (18% to 84%). These groups set a goal of preventing unnecessary cesareans in low-risk mothers. This followed by the Joint Commission adopting the target rate of 23.9% as a publicly reported core measure.
Methods: Within Kaiser Permanente Southern California, NTSV (nulliparous, term, singleton, vertex) cesarean rates varied by hospital from less than 20% to more than 35%. To address regional gaps, Southern California Regional Core Measure Collaborative was formed in 2015. The Collaborative is driven by local champions and regional leadership. We adopted practices recommended by the California Maternal Quality Care Collaborative (CMQCC), set up a mentor group with Kaiser Permanente facilities, analyzed the data in the California Maternal Data Center, and recommended specific interventions for outlier medical centers. We then met with the outlier hospitals, coached them through a set of personalized recommendations, and helped them overcome specific barriers.
Results: In summer 2016, the CMQCC issued a tool kit to support vaginal birth. The Southern California Region embarked on implementation through the Perinatal Patient Safety Committee in collaboration with the Perinatal Core Measure Collaborative team. Development of tools and implementation extended through 2017. In 2017, we evaluated the status of CMQCC recommendations implementation and utilization at bedside and identified gaps and opportunities to reinforce. In 2018, we developed and implemented a coaching and accountability strategy to address medical center specific gaps. By using the process of analyzing fall outs, developing personalized recommendations for outlier hospitals, and 1:1 mentoring and coaching, we were able to drop our regional NTSV rate below 23.9% for the first time.
Discussion: Implementing and hardwiring the use of evidence-based standard tools is critical for success and can be challenging when working with multiple individual practitioners. By using the process of analyzing data, in-depth chart analysis of fallouts, developing personalized recommendations for hospitals, and 1:1 mentoring and coaching, a large and diverse region can lower their NTSV cesarean rate below the target goal of 23.9%. These strategies will continue to be implemented to assure safe and quality care is provided to all patients. Achieving this goal requires a combined effort from the entire labor and delivery team.

Abstracts from the Kaiser Permanente 2019 National Quality Conference


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