Judith M. Kimelman, MD, Washington Section chair, and Roger B. Rowles, MD
The formation of perinatal collaboratives, where states can work on quality initiatives with collaborative committees, was one of the priorities at the ACOG Congressional Leadership Conference, The President’s Conference, this year. Washington state has a perinatal collaborative, which has helped significantly decrease elective deliveries prior to 39 weeks’ gestation. This successful quality initiative is a testament to the need for collaboratives across the country and to the importance of funding them.
The Washington State Perinatal Collaborative (WSPC) was formed in 2008 as a subcommittee of the state Perinatal Advisory Committee, a group that was formed in 1985 and functions under the auspices of the Washington State Department of Health. The impetus for the formation of the collaborative was a shift in the focus of the Perinatal Advisory Committee from perinatal education and regionalization of health care resources to the development of initiatives to improve the quality of perinatal care in the state.
The collaborative includes stakeholders in the Perinatal Advisory Committee, including the March of Dimes, Washington State Hospital Association, Washington State Department of Health, Midwives’ Association of Washington State, ACOG, and many others. It also partners with representatives of organizations throughout the state, such as businesses, insurance carriers, and consumer groups, as well as most of the obstetric hospitals in Washington.
Increasing national attention to the rising cesarean delivery rate and concerns about elective deliveries prior to 39 weeks framed the initial discussions of the collaborative and gave rise to its first initiative in 2011. Hospital surveys at that time showed wide unexplained variations in the percentage of elective deliveries prior to 39 weeks. Reducing the statewide percentage to less than 7% became the first quality initiative of the collaborative.
By utilizing webinars, in-person conferences, personal visits to struggling hospitals, and a publicity blitz facilitated by the March of Dimes and the Washington State Hospital Association, the statewide percentage of elective deliveries prior to 39 weeks dropped from 15% to less than 5% over the first 12 months of the initiative, and it continues to drop.
Other quality initiatives of the collaborative include Smooth Transitions, a project to enhance the safety of planned out-of-hospital birth transports; an evidence-based breastfeeding hospital support program; and an ongoing project to optimize episiotomy rates in the state. Most recently, the collaborative has queried all the obstetric hospitals in the state regarding practices that may influence the cesarean delivery rate. It is now working closely with the Washington State Hospital Association to develop evidence-based guidelines that may favorably affect the overall cesarean delivery rate and reduce maternal and neonatal morbidity.
The stated objectives of WSPC are to produce better outcomes for babies and mothers, to provide better experiences for families when babies are born sick or premature, and to provide better value for each health care dollar. These quality initiatives are the beginning of a long and sustainable mission.
Thanks to the success of WSPC and another committee appointed by the governor to decrease cesarean delivery rates, a similar collaborative group has emerged with funding through the Centers for Medicare and Medicaid Services Partnership for Patients. This group includes the Washington State Hospital Association, ACOG, WSPC, and physician leaders. Hospital surveys have revealed large variation in hospitals’ approaches to induction and labor management. This collaborative will help hospitals across the state adopt better strategies for scheduling elective inductions, delaying admission in labor until a patient is in active labor, and redefining labor curves. The group will measure its impact on cesarean delivery rates and maternal and neonatal complications.