Quality & Safety

Safe Deliveries

Reducing Elective Delivery Prior to 39 Weeks

View the press release on the results of hospital efforts

Download slides from the online press conference

View hospital specific data

Clinical Rationale

For almost three decades, the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) have had in place a standard requiring 39 completed weeks gestation prior to elective delivery, either vaginal or operative (ACOG, 1996). A survey conducted in 2007 of almost 20,000 births in HCA hospitals throughout the U.S. carried out in conjunction with the March of Dimes at the request of ACOG revealed that almost 1/3 of all babies delivered in the United States are electively delivered with 5% of all deliveries in the U.S. delivered in a manner violating ACOG/AAP guidelines. Most of these are for convenience, and result in significant short term neonatal morbidity (neonatal intensive care unit admission rates of 13-21%) (Clark, et al., 2009).

According to Glantz (2005), compared to spontaneous labor, elective inductions result in more cesarean deliveries and longer maternal length of stay. The American Academy of Family Physicians (2000) also notes that elective induction doubles the cesarean delivery rate. Repeat elective cesarean sections before 39 weeks gestation also result in higher rates of adverse respiratory outcomes, mechanical ventilation, sepsis, and hypoglycemia for the newborns (Tita et al., 2009). In Washington, the rate of elective delivery prior to 39 weeks was 17.8% in 2008.

The focus on elective deliveries prior to 39 weeks is the first step in an effort to reduce the rate of C-sections in Washington State. Next year's goal will focus more directly on C-sections after more discussion with key groups on goal setting and measures.

Medicaid Quality Incentive

Hospitals in Washington State have the opportunity to earn a new one percent Medicaid quality incentive. The incentive was part of the Safety Net Assessment law passed in the 2009-2010 legislative session.

The incentive is built on the base Medicaid payment for PPS, case rate, and per diem services. The payment is funded in part from the hospitals' contribution to the Safety Net Assessment and federal matching dollars. The rate increases for qualifying hospitals will begin on July 1, 2013

One of five Medicaid quality incentive measures is Elective Delivery Prior to 39 Weeks.

Measure

Target

Submission Date

Elective Delivery Prior to 39 Weeks

7% or less

1st Quarter Data:

June 30, 2011

Data Submission

Data for this measure is entered into WSHA's Quality Benchmarking System (QBS). Data can be entered by registered users of QBS using an Excel spreadsheet that is generated by the application. In addition, a worksheet is available that will help summarize case information for easy entry into the QBS upload spreadsheet. This worksheet is available at the Washington State Perinatal Collaborative website. For questions about this process, please contact Ken Rudberg at kenr@wsha.org.