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Evaluation of a Tennessee statewide initiative to reduce early elective deliveries using quasi-experimental methods

BACKGROUND: Concerted quality improvement (QI) efforts have been taken to discourage the practice of early elective deliveries (EEDs), but few studies have robustly examined the impact of directed QI interventions in reducing EED practices. Using quasi-experimental methods, we sought to evaluate the...

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Autores principales: Thompson, Michael P., Graetz, Ilana, McKillop, Caitlin N., Grubb, Peter H., Waters, Teresa M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444673/
https://www.ncbi.nlm.nih.gov/pubmed/30940130
http://dx.doi.org/10.1186/s12913-019-4033-1
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author Thompson, Michael P.
Graetz, Ilana
McKillop, Caitlin N.
Grubb, Peter H.
Waters, Teresa M.
author_facet Thompson, Michael P.
Graetz, Ilana
McKillop, Caitlin N.
Grubb, Peter H.
Waters, Teresa M.
author_sort Thompson, Michael P.
collection PubMed
description BACKGROUND: Concerted quality improvement (QI) efforts have been taken to discourage the practice of early elective deliveries (EEDs), but few studies have robustly examined the impact of directed QI interventions in reducing EED practices. Using quasi-experimental methods, we sought to evaluate the impact of a statewide QI intervention to reduce the practice of EEDs. METHODS: Retrospective cohort study of vital records data (2007 to 2013) for all singleton births occurring ≥36 weeks in 66 Tennessee hospitals grouped into three QI cohorts. We used interrupted-time series to estimate the effect of the QI intervention on the likelihood of an EED birth statewide, and by hospital cohort. We compared the distribution of hospital EED percentages pre- and post-intervention. Lastly, we used multivariable logistic regression to estimate the effect of QI interventions on maternal and infant outcomes. RESULTS: Implementation of the QI intervention was associated with significant declines in likelihood of EEDs immediately following the intervention (odds ratio, OR = 0.72; p < 0.001), but these results varied by hospital cohort. Hospital risk-adjusted EED percentages ranged from 1.6–13.6% in the pre-intervention period, which significantly declined to 2.2–9.6% in the post-intervention period (p < 0.001). The QI intervention was also associated with significant reductions in operative vaginal delivery and perineal laceration, and immediate infant ventilation, but increased NICU admissions. CONCLUSIONS: A statewide QI intervention to reduce EEDs was associated with modest but significant declines in EEDs beyond concurrent and national trends, and showed mixed results in related infant and maternal outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-019-4033-1) contains supplementary material, which is available to authorized users.
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spelling pubmed-64446732019-04-12 Evaluation of a Tennessee statewide initiative to reduce early elective deliveries using quasi-experimental methods Thompson, Michael P. Graetz, Ilana McKillop, Caitlin N. Grubb, Peter H. Waters, Teresa M. BMC Health Serv Res Research Article BACKGROUND: Concerted quality improvement (QI) efforts have been taken to discourage the practice of early elective deliveries (EEDs), but few studies have robustly examined the impact of directed QI interventions in reducing EED practices. Using quasi-experimental methods, we sought to evaluate the impact of a statewide QI intervention to reduce the practice of EEDs. METHODS: Retrospective cohort study of vital records data (2007 to 2013) for all singleton births occurring ≥36 weeks in 66 Tennessee hospitals grouped into three QI cohorts. We used interrupted-time series to estimate the effect of the QI intervention on the likelihood of an EED birth statewide, and by hospital cohort. We compared the distribution of hospital EED percentages pre- and post-intervention. Lastly, we used multivariable logistic regression to estimate the effect of QI interventions on maternal and infant outcomes. RESULTS: Implementation of the QI intervention was associated with significant declines in likelihood of EEDs immediately following the intervention (odds ratio, OR = 0.72; p < 0.001), but these results varied by hospital cohort. Hospital risk-adjusted EED percentages ranged from 1.6–13.6% in the pre-intervention period, which significantly declined to 2.2–9.6% in the post-intervention period (p < 0.001). The QI intervention was also associated with significant reductions in operative vaginal delivery and perineal laceration, and immediate infant ventilation, but increased NICU admissions. CONCLUSIONS: A statewide QI intervention to reduce EEDs was associated with modest but significant declines in EEDs beyond concurrent and national trends, and showed mixed results in related infant and maternal outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-019-4033-1) contains supplementary material, which is available to authorized users. BioMed Central 2019-04-02 /pmc/articles/PMC6444673/ /pubmed/30940130 http://dx.doi.org/10.1186/s12913-019-4033-1 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Thompson, Michael P.
Graetz, Ilana
McKillop, Caitlin N.
Grubb, Peter H.
Waters, Teresa M.
Evaluation of a Tennessee statewide initiative to reduce early elective deliveries using quasi-experimental methods
title Evaluation of a Tennessee statewide initiative to reduce early elective deliveries using quasi-experimental methods
title_full Evaluation of a Tennessee statewide initiative to reduce early elective deliveries using quasi-experimental methods
title_fullStr Evaluation of a Tennessee statewide initiative to reduce early elective deliveries using quasi-experimental methods
title_full_unstemmed Evaluation of a Tennessee statewide initiative to reduce early elective deliveries using quasi-experimental methods
title_short Evaluation of a Tennessee statewide initiative to reduce early elective deliveries using quasi-experimental methods
title_sort evaluation of a tennessee statewide initiative to reduce early elective deliveries using quasi-experimental methods
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444673/
https://www.ncbi.nlm.nih.gov/pubmed/30940130
http://dx.doi.org/10.1186/s12913-019-4033-1
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