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Strengthening the evidence for maternal and child health programs

Find State ESMs


Displaying records 1 through 7 (7 total).

2.1 Number of outreach activities (data reports, presentations, and technical assistance) on the topic of cesarean deliveries among low-risk first births. (Kentucky)

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Increase the availability of Kentucky-specific data, resources, and interventions to reduce the occurrence of cesarean deliveries among low-risk first time births.

Numerator: Number of data reports, presentations, and technical assistance activities documented by the Kentucky Title V program

Denominator: None

Significance: The reduction in number of cesarean deliveries will require an increased awareness among providers and the general public on this topic. The measurement of outreach activities will include providing reports and presentations on cesarean sections and early elective deliveries as well as MCH reports for birthing hospitals on these indicators. Targeted technical assistance will also be offered to birthing hospitals with higher percentages of cesarean deliveries.

Data Sources and Data Issues: MCH Programmatic Staff Reports

Year: 2017/2019

Unit Type: Count, Unit Number: 100

2.1 Number of maternity care providers who have participated in the Lamaze International Evidence Based Labor Support Workshop (West Virginia)

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities directed to professionals

Goal: Provision of evidence based support during labor to improve the birth process and reduce cesarean deliveries without a medical indication

Numerator: Number of labor/delivery nurses that receive evidence based labor support training

Denominator: Number of labor/delivery nurses employed in birth facilities

Significance: Research shows that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of one-on-one support. A Cochrane meta-analysis states the association with a statistically significant reduction in the rate of cesarean deliveries.

Data Sources and Data Issues: Birth facilities count of Labor and Delivery nurses employed January 1, 2017

Year: 2017/2019

Unit Type: Count, Unit Number: 10,000

2.1 Number of hospitals participating in a quality improvement process to reduce low-risk cesarean deliveries (Maine)

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Develop and implement a quality improvement (QI) process for hospitals with the highest rates of low-risk c-section deliveries.

Numerator: Number of hospitals who agree to participate in a QI process

Denominator: NA

Significance: The first step in the process of developing a QI initiative with hospitals is to engage hospitals in the process. This will involve data analysis to identify the hospitals with the highest rates of low risk c-sections and reviewing these data with hospitals to gain their interest in the project. We hope to engage 1-2 hospitals during the 1st year and continue to add hospitals to the QI efforts throughout the grant period.

Data Sources and Data Issues: Perinatal Outreach Education Coordinator (POEC) Maine’s POEC will engage and facilitate the QI process with hospitals. Information on hospital engagement in the process will be included in POEC’s annual report to the Maine CDC as part of the POEC contract.

Year: 2017/2019

Unit Type: Count, Unit Number: 10

2.1 Improve maternal/newborn health by increasing the number of hospitals that implement the Alliance for Innovation on Maternal Health (AIM) bundle “Safe Reduction of Primary Cesarean Births”. (Missouri)

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Missouri will increase the number of birthing hospitals implementing the AIM bundle “Safe Reduction of Primary Cesarean Births”.

Numerator: Number of birthing hospitals implementing the & quot;Safe Reduction of Primary Cesarean Births” AIM bundle.

Denominator: N/A

Significance: Childbirth by its very nature carries potential risks for the woman and her baby, regardless of the route of delivery. The National Institute of Health has commissioned evidence-based reports over recent years to examine the risks and benefits of cesarean and vaginal delivery. For certain conditions, such as placenta previa or uterine rupture, cesarean delivery is firmly established as the safest route of delivery. However, for most pregnancies, which are low-risk, cesarean delivery appears to pose greater risk of maternal morbidity and mortality than vaginal delivery (ACOG, 2014). A low-risk woman is defined as one with a full-term (at least 37 completed weeks of gestation), singleton pregnancy (not a multiple pregnancy), with vertex presentation (head facing downward position in the birth canal). The international healthcare community has considered the ideal rate for cesarean sections to be between 10-15%. Studies have proven that when cesarean section rates are high, so too are maternal and neonatal morbidity and mortality. Missouri’s cesarean section rate among low-risk women is 25.1% (2013), which is very close to the national average of 26.9% (2013). There are 22 other states with an average rate lower than Missouri’s so more can be done. Also, the average cost of a cesarean delivery in Missouri is $13,665 compared to a vaginal delivery at $8,805. A goal of Healthy People 2020, is to reduce cesarean births among low-risk women by 10%. Missouri has chosen to increase the percent of hospitals implementing the AIM bundle “Safe Reduction of Primary Cesarean Births”. Lowering the primary cesarean section rate will increase maternal safety by decreasing morbidity from unnecessary surgeries and the consequences of prior cesarean delivery in future pregnancies. A number of previous studies have shown by focusing on a number of clinical changes, significant improvements can be obtained.

Data Sources and Data Issues: Missouri Hospital Association yearly survey.

Year: 2017/2019

Unit Type: Count, Unit Number: 100

2.1 Hospital Technical Assistance on Low-risk Cesarean Delivery Reduction (Maryland)

Measure Status: Active

Measurement Category: Category 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Maintain technical assistance to Maryland delivery hospitals (including annual and quarterly data on individual hospital cesarean rates, ACOG guidelines, AIM resources, and policies/strategies) on low-risk cesarean reduction.

Numerator: Number of delivery hospitals that receive technical assistance on low-risk cesarean birth reduction

Denominator: Number of delivery hospitals

Significance: Cesarean delivery can be a life-saving procedure for certain medical indications. However, for most low-risk pregnancies, cesarean delivery poses avoidable maternal risks of morbidity and mortality, including hemorrhage, infection, and blood clots—risks that compound with subsequent cesarean deliveries. Much of the temporal increase in cesarean delivery (over 50% in the past decade), and wide variation across states, hospitals, and practitioners, can be attributed to first-birth cesareans. Moreover, cesarean delivery in low-risk first births may be most amenable to intervention through quality improvement efforts. This low-risk cesarean measure, also known as nulliparous term singleton vertex (NTSV) cesarean, is endorsed by the ACOG, The Joint Commission (PC-02), National Quality Forum (#0471), Center for Medicaid and Medicare Services (CMS) – CHIPRA Child Core Set of Maternity Measures, and the American Medical Association-Physician Consortium for Patient Improvement. MCHB will target hospital-level policy and practice changes to impact the entire population of pregnant women in Maryland. This will be supported by providing technical assistance to delivery hospitals across the state including resources from the Alliance to Improve Maternal Health (AIM), as well as quarterly and annual hospital-level data on cesarean birth rates.

Data Sources and Data Issues: MCHB and Maryland Patient Safety Center Data

Year: 2017/2019

Unit Type: Count, Unit Number: 32

2.1 Completion of a process evaluation of the implementation of the IHI Breakthrough Collaborative Series (BTS) implementation model for the LaPQC Reducing Severe Maternal Morbidity Initiative. (Louisiana)

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Middle level: enabling services

Service Recipient: Activities related to systems-building

Goal: Louisiana Title V aims to ensure that learnings from the process of implementing the BTS are captured in order to inform future initiatives.

Numerator: Completion of evaluation (yes/no)

Denominator: N/A

Significance: This measure is significant because it has a two-fold aim of capturing learnings to improve future implementation of an evidence-based systems improvement intervention, and because it reinforces the national shift for Title V programs to be contributing to the evidence base of public health practice. Yes indicates that the evaluation was completed; no indicates that the evaluation was not completed. Information about the BTS model is documented in The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003.

Data Sources and Data Issues: Program records and evaluation report.

Year: 2017/2019

Unit Type: Text, Unit Number: Yes/No

2.2 Number of Colorado birthing hospitals with NTSV c-section rates exceeding the HP 2020 and Colorado-specific target of 23.9% implementing at least one strategy from the CMQCC toolkit (Colorado)

Measure Status: Active

Measurement Category: Category 1: measuring quantity of effort (counts and "yes/no" activities)

Service Type: Bottom level: public health services and systems

Service Recipient: Activities related to systems-building

Goal: Reduce the rate of NTSV C/S deliveries among CO birthing hospitals with rates exceeding the HP 2020 and CO-specific target of 23.9%. (total =19).

Numerator: Number of Colorado birthing hospitals with NTSV c-section rates exceeding the HP 2020 and Colorado-specific target of 23.9% implementing at least one strategy from the CMQCC toolkit

Denominator: Not applicable since ESM is a count

Significance: The CMQCC toolkit provides a number of easily implemented strategies that can be employed by hospital staff to reduce the hospital-specific NTSV C/S rate. Most NTSV C/S result from difficulty in managing the active phase of labor so pilot hospitals will be encouraged to begin with strategies addressing this component of clinical care.

Data Sources and Data Issues: Field/narrative notes kept by the QI coach relative to the activities employed by participating hospitals.

Year: 2017/2019

Unit Type: Count, Unit Number: 20

   

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.