Oregon's Hard-Stop Policy Limiting Elective Early-Term Deliveries

Snowden, Jonathan M.; Muoto, Ifeoma; Darney, Blair G.; Quigley, Brian; Tomlinson, Mark; Neilson, Duncan R.; Friedman, Steven A.; Rogovoy, Joanne; Caughey, Aaron B.

doi:10.1097/aog.0000000000001737

Cited by 29 publications

(18 citation statements)

References 28 publications

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“…[6][7][8] Clinical strategies have begun to reverse these trajectories. [9][10][11] However, clinicians providing care during pregnancy and birth as well as their patients deserve a system of health care delivery, financing, and organization that supports evidence-based decision-making and adoption of emerging clinical guidance around maternity care access and management.…”

Section: Introductionmentioning

confidence: 99%

Maternity care access, quality, and outcomes: A systems-level perspective on research, clinical, and policy needs

Kozhimannil

Hardeman

Henning‐Smith

2017

Seminars in Perinatology

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Section: Introductionmentioning

confidence: 99%

Maternity care access, quality, and outcomes: A systems-level perspective on research, clinical, and policy needs

Kozhimannil

Hardeman

Henning‐Smith

2017

Seminars in Perinatology

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“… Baseline CS rate: 54.9% in China; 55.7% in the sample population Outcomes assessed: overall CS, caesarean delivery on maternal request (CDMR), Average annual growth rate (AAGR) of the overall CDMR. c) Other interventions Snowden 2016 [ 36 ] Retrospective cohort study Study period: 2008–2013 Country: USA Participants: 181,034 women who delivered in Oregon hospitals between 2008 and 2013, excluding 2011. 111,292 women delivered in the period before the hard-stop policy (2008–2010), and 69,742 women delivered after the rollout of the policy (2012–2013).…”

Section: Resultsmentioning

confidence: 99%

“…The CS rate was included among patient safety indicators. c) Other interventions Snowden 2016 [ 36 ] Oregon “hard-stop” policy limiting elective inductions and caesarean deliveries before 39 weeks of gestation Oregon “hard-stop” policy limiting elective inductions and caesarean deliveries before 39 weeks of gestation. Introduced by the Oregon Perinatal Collaborative in 2011.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies, retrospective cohort study (USA) [ 36 ] and interrupted time series study (Brazil) [ 37 ], assessed the following interventions: “hard stop” policy limiting elective inductions and caesarean births [ 36 ]; and multifaceted quality improvement initiative (“Appropriate Birth”) [ 37 ].…”

Section: Resultsmentioning

confidence: 99%

“…Post-intervention the CDMR, AAGR, the probability of performing CS, and the probability of a woman electing for CS decreased. CS decreased ⊕⊕⊖⊖ LOW c) Other interventions Snowden 2016 [ 36 ] “Hard-stop” policy limiting elective inductions and cesarean deliveries before 39 weeks of gestation Not serious Single study Not serious Not serious None The odds of overall elective caesarean section remained the same in the post-policy period compared with the pre-policy period (OR 1.00, 95% CI, 0.97 to 1.03). The odds of chorioamnionitis (OR 1.94, 95% CI 1.80 to 2.09) and blood transfusion (OR 1.42, 95% CI 1.20 to 1.67 were elevated in the post-policy period compared with the pre-policy period.…”

Section: Resultsmentioning

confidence: 99%

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Reducing unnecessary caesarean sections: scoping review of financial and regulatory interventions

et al. 2020

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Background: Caesarean sections (CS) are increasing worldwide. Financial incentives and related regulatory and legislative factors are important determinants of CS rates. This scoping review examines the evidence base of financial, regulatory and legislative interventions intended to reduce CS rates. Methods: We searched MEDLINE, EMBASE, CINAHL and two trials registers in June 2019. Both experimental and observational intervention studies were eligible for inclusion. Primary outcome measures were: CS, spontaneous vaginal and instrumental birth rates. We assessed quality of evidence using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. Results: We identified 9057 articles and assessed 65 full-texts. We included 16 observational studies. Most of the studies were conducted in high-income countries. Three studies assessed payment methods for health workers: equalising physician fees for vaginal and caesarean delivery reduced CS rates in one study; however, little or no difference in CS rates was found in the remaining two studies. Nine studies assessed payment methods for health organisations: There was no difference in CS rates between diagnosis-related group (DRG) payment system compared to fee-forservice system in one study. However, DRG system was associated with lower odds for CS in another study. There was little or no difference in CS rates following implementation of global budget payment (GBP) system in two studies. Vaginal birth after caesarean section (VBAC) increased after implementation of a case-based payment system in one study. Caesarean section increased while VBAC rates decreased following implementation of a cap-based payment system in another study. Financial incentive for providers to promote vaginal delivery combined with free vaginal delivery policy was found to reduce CS rates in one study. Studied regulatory and legislative interventions (comprising legislatively imposed practice guidelines for physicians in one study and multi-faceted strategy which included policies to control CS on maternal request in another

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Association of Widespread Adoption of the 39-Week Rule With Overall Mortality Due to Stillbirth and Infant Death

et al. 2019

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IMPORTANCE To improve neonatal morbidity, efforts have been made to reduce elective deliveries prior to 39 weeks' gestation, also known as the 39-week rule. Prolonging pregnancies also prolongs exposure to the risk of stillbirth. The true association of a 39-week rule with mortality is unknown and studies to date have shown conflicting results.OBJECTIVE To determine if widespread adoption of a 39-week rule, limiting elective deliveries prior to 39 weeks' gestation, is associated with an increase or decrease in overall mortality when considering both stillbirths and infant deaths. DESIGN, SETTING, AND PARTICIPANTSThis historical cohort study used birth certificate and infant death certificate data in the United States to compare years before and after the adoption of the 39-week rule. Births between 2008 and 2009 were considered to be in the preadoption period (n = 7 322 234), and those between 2011 and 2012 were considered to be in the postadoption period (n = 6 972 626). Included births were singleton, nonanomalous births between 37 0/7 weeks' and 42 6/7 weeks' gestation. Statistical analysis was performed from July 19, 2016, through June 27, 2019.EXPOSURES The exposure of interest was the Joint Commission adoption of the 39-week rule as a quality measure. MAIN OUTCOMES AND MEASURESThe primary outcomes of interest were stillbirth and infant death.RESULTS A total of 7 322 234 births (49.0% girls and 51.0% boys) were included in the preadoption period and 6 972 626 births (49.1% girls and 50.9% boys) were included in the postadoption period. Compared with the preadoption period, there was a decrease in the proportion of deliveries at 37 weeks (−0.06%) and 38 weeks (−2.5%) and an increase in the proportion of deliveries at 39 weeks (6.8%) and 40 weeks (0.2%) in the postadoption period (P < .001). The stillbirth rate increased in the postadoption cohort compared with preadoption (0.09% vs 0.10%; P < .001). The infant death rate decreased in the postadoption period compared with preadoption (0.21% vs 0.20%; P < .001). An overall mortality rate of 0.31% was calculated for the preadoption period and 0.30% for the postadoption period (P = .06). Additional analysis in a counterfactual model suggests that up to 34.2% of the difference in mortality could be associated with the 39-week rule. CONCLUSIONS AND RELEVANCEStable overall perinatal mortality rates were observed in the 2-year period immediately after adoption of the 39-week rule, despite an increase in stillbirth.

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Oregon's Hard-Stop Policy Limiting Elective Early-Term Deliveries

Cited by 29 publications

References 28 publications

Maternity care access, quality, and outcomes: A systems-level perspective on research, clinical, and policy needs

Maternity care access, quality, and outcomes: A systems-level perspective on research, clinical, and policy needs

Reducing unnecessary caesarean sections: scoping review of financial and regulatory interventions

Association of Widespread Adoption of the 39-Week Rule With Overall Mortality Due to Stillbirth and Infant Death

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