Improving Recording Accuracy, Transparency, and Performance for Obstetric Quality Measures in a Community Hospital-Based Obstetrics Department

摘要

Background: The obstetric arena has been typically ignored in the race to determine hospital quality measures due primarily to the fact that a large majority of patients do not have Medicare federal insurance, which has been the focus of hospital measures of quality. With "normal vaginal delivery" being the number one hospital discharge diagnosis and cesarean sections rates varying greatly between hospitals, national organizations are taking greater interest in determining differences in quality. Methods: Sutter Medical Center, Sacramento (California) chartered a multidisciplinary Perinatal Data Committee to improve and simplify data capture for six obstetric quality measures. Results: All six quality measures showed significantly improved trends from 2010 through 2012, with elective delivery ＜ 39 weeks decreasing (153％ to 2.3％, p ＜ .001), nulliparous term singleton vertex cesarean (NTSV) delivery rate decreasing (31.3％ to 24.7％, p ＜ .001), episiotomy rates decreasing (4.7％ to 2.3％, p＜ .001), antenatal steroid documentation increasing (80.0％ to 100％, p ＜ .01), exclusive breastfeeding at hospital discharge increasing (57.9％ to 69.9％, p ＜ .001), and deep vein prophylaxis at cesarean increasing (95.4％ to 98.2％, p ＜ .001). Conclusion: That performance on all six quality measures improved suggests that the improvement approach was effective and perhaps reproducible in other clinical situations to improve hospital quality outcomes. A key contributor to success was that the dashboard of results was shared with the department's physicians and the hospital administration on a monthly basis. Reinforcement of good results helped keep the project front and center with the hospital, particularly more recently, given that data reporting for four of the six measures is soon to be required.