Hospital Quality Improvement Interventions, Statewide Policy Initiatives, and Rates of Cesarean Delivery for Nulliparous, Term, Singleton, Vertex Births in California

Abstract

The purpose of this observational study was to report on the impact of a statewide strategy to decrease the rates of cesarean delivery for nulliparous, term, singleton, vertex (NTSV) births in California. The researchers looked at 7,574,889 NTSV births in the United States between 2014 and 2019 and compared the cesarean delivery rate to 914,283 births in California over the same time period. In this project, the California Maternal Quality Care Collaborative (CMQCC) partnered with Smart Care California to implement different approaches to decrease cesarean delivery rates. Hospitals with rates of cesarean delivery greater than 23.9% for NTSV births were invited to join the CMQCC at no cost. They were placed in 1 of 3 cohorts for an 18-month quality improvement collaborative. The collaborative emulated a prior model that was used by the Institute for Healthcare Improvement Breakthrough Series. This approach added a mentorship aspect to a multidisciplinary team of physicians, nurses, and quality improvement professionals from different hospitals. The mentorship groups met every month 593 Ethics, Medicolegal Issues, and Public Policy