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CONFIDENTIAL

CONFIDENTIAL WSHA CQIP Peer Review and Quality Improvement Information. Protected from disclosure or discovery under RCW 43.70.510. Improving Safety of Deliveries Roger Rowles, MD Perinatal Medical Director Central Washington Perinatal Program April 26, 2010.

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CONFIDENTIAL

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  1. CONFIDENTIAL WSHA CQIP Peer Review and Quality Improvement Information. Protected from disclosure or discovery under RCW 43.70.510

  2. Improving Safety of DeliveriesRoger Rowles, MDPerinatal Medical Director Central Washington Perinatal ProgramApril 26, 2010

  3. Who are you and what are you doing here?

  4. Washington State Perinatal Advisory Committee History 1980s Regionalization of Perinatal Care, focusing on delivering preterm infants at age appropriate facilities   1990s Regionalization with focus on outreach education   2008 Statewide Quality Initiatives

  5. Cesarean Births 2006 WA State US Total Births 86,845 1,321,054 Cesarean Births 23,991 410,847 C/S Rate 29.9% (15.6%-48.3%) 31.1% Primary C/S Rate 17.8% 20.3% Repeat Rate 12.0% 10.8% -WA State DOH -ACOG Resource Center

  6. WASHINGTON STATE PERINATAL COLLABORATIVE “Closing the Gap: Washington State Safe Deliveries Initiative”

  7. Improving Perinatal Care: Best Practice Initiatives in Washington State • Decreasing Elective Induction • Decreasing Iatrogenic Prematurity • Decreasing Cesarean Section rates December 9, 2009 Roger Rowles, MD Perinatal Medical Director Central Washington Regional Perinatal Program

  8. Is There a Useful Cesarean Birth Measure? Assessment of the Nulliparous Term Singleton Vertex Cesarean Birth Rate as a Tool for Obstetric Quality Improvement Main, et al AJOG, 2006

  9. Has anyone been successful in reducing EIOL @<39 weeks? • Magee-Women's Hospital of University of Pittsburgh Medical Center • Labor Induction Process Improvement; A patient Quality of Care Initiative, Fisch, et al, Obstet Gynecol 2009;113:797-803 • Intermountain Health System/Idaho and Utah • Decreasing Elective Deliveries Before 39 weeks of Gestation in an Integrated Health Care System, Oshiro, et al, Obstet Gynecol 2009;113:804-811 • Swedish Medical Center/Seattle • Reduction of elective inductions in a large community hospital, Reisener, et al, Am J Obstet Gynecol 2009;200:674e1-674e7

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