Melissa Peskin MD (is Clinical Associate Professor, Department of Obstetrics and Gynecology, New York University Long Island (NYULI), and Director, Obstetrics and Gynecology Simulation, NYU Langone Hospital–Long Island, Mineola, New York.), Brittany H. Sanford MD (is Clinical Assistant Professor, Department of Obstetrics and Gynecology, Westchester Medical Center, Valhalla, New York.), Celia A. Muoser MD, MPH (is Maternal Fetal Medicine Specialist, Maternal Fetal Medicine Associates, New York City.), Emma Chew Murphy MD (is Complex Family Planning Specialist, University of California, San Francisco.), Amoli Kulkarni MD (is Obstetrics and Gynecology Resident, Montefiore Medical Center, Einstein College of Medicine, Bronx, New York.), Beatrice Lynch MD (is Obstetrics and Gynecology Resident Resident, Rutgers-New Jersey Medical School, Newark, New Jersey.), Tess Nienaltowa (is Medical Student, Albert Einstein College of Medicine.), Marlena Gehret Plagianos (is Senior Biostatistician, Center for Biomedical Research, Population Council, New York City.), Peter Bernstein MD, MPH (is Maternal Fetal Medicine Specialist, and System Vice Chair of Obstetrics for Quality and Safety, Mount Sinai Hospital, New York City.), Pe’er Dar MD (is Director, Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology and Women’s Health, Montefiore Medical Center, Einstein College of Medicine. Please address correspondence to Melissa Peskin, MD)
{"title":"Impact of a Multifaceted Quality Improvement Initiative Aimed at Reducing Primary Cesarean Delivery Rates","authors":"Melissa Peskin MD (is Clinical Associate Professor, Department of Obstetrics and Gynecology, New York University Long Island (NYULI), and Director, Obstetrics and Gynecology Simulation, NYU Langone Hospital–Long Island, Mineola, New York.), Brittany H. Sanford MD (is Clinical Assistant Professor, Department of Obstetrics and Gynecology, Westchester Medical Center, Valhalla, New York.), Celia A. Muoser MD, MPH (is Maternal Fetal Medicine Specialist, Maternal Fetal Medicine Associates, New York City.), Emma Chew Murphy MD (is Complex Family Planning Specialist, University of California, San Francisco.), Amoli Kulkarni MD (is Obstetrics and Gynecology Resident, Montefiore Medical Center, Einstein College of Medicine, Bronx, New York.), Beatrice Lynch MD (is Obstetrics and Gynecology Resident Resident, Rutgers-New Jersey Medical School, Newark, New Jersey.), Tess Nienaltowa (is Medical Student, Albert Einstein College of Medicine.), Marlena Gehret Plagianos (is Senior Biostatistician, Center for Biomedical Research, Population Council, New York City.), Peter Bernstein MD, MPH (is Maternal Fetal Medicine Specialist, and System Vice Chair of Obstetrics for Quality and Safety, Mount Sinai Hospital, New York City.), Pe’er Dar MD (is Director, Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology and Women’s Health, Montefiore Medical Center, Einstein College of Medicine. Please address correspondence to Melissa Peskin, MD)","doi":"10.1016/j.jcjq.2025.12.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>The ideal approach to safely reduce the rising rates of cesarean deliveries (CDs) is unknown. The authors evaluated the impact of a multifaceted quality improvement (QI) initiative aimed at curbing the rising trend in the institutional nulliparous term singleton vertex (NTSV) CD rate at an urban, academic, safety-net hospital.</div></div><div><h3>Methods</h3><div>The primary intervention was a biweekly interdisciplinary educational meeting, wherein NTSV CD cases were reviewed and audited. In addition, an educational bulletin, NTSV score cards, labor position training, and efforts to promote guideline adherence were introduced. The research team examined the institutional NTSV CD rates by quarters and evaluated the trend, modeling the probability of a CD for the pre- and postintervention periods using logistic regression, with time as an ordinal variable. The authors also examined cesarean indications as well as maternal and neonatal complications before and after the QI implementation.</div></div><div><h3>Results</h3><div>There was a trend toward a decrease in CDs during the postintervention period, falling from 32.9% to 26.3% in the 12 months following implementation. Using an interrupted time series analysis to assess differences in trends, the trend before intervention was +2.63% per quarter (95% confidence interval [CI] 2.30–3.03, p < 0.001), while the change in trend postintervention was -3.78% per quarter (95% CI -4.74 to -2.81, p < 0.001, R<sup>2</sup> = 0.973). This suggests an increasing trend prior to intervention that was effectively reversed. Both maternal and neonatal complications rates remained comparable between pre- and postintervention periods for those who had NTSV CDs.</div></div><div><h3>Conclusion</h3><div>Multifaceted strategies incorporating interactive case review meetings can lead to practice change and may be a feasible strategy to reduce an institutional NTSV CD rate.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"52 3","pages":"Pages 107-114"},"PeriodicalIF":3.0000,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553725025003162","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/12/8 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
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Abstract
Introduction
The ideal approach to safely reduce the rising rates of cesarean deliveries (CDs) is unknown. The authors evaluated the impact of a multifaceted quality improvement (QI) initiative aimed at curbing the rising trend in the institutional nulliparous term singleton vertex (NTSV) CD rate at an urban, academic, safety-net hospital.
Methods
The primary intervention was a biweekly interdisciplinary educational meeting, wherein NTSV CD cases were reviewed and audited. In addition, an educational bulletin, NTSV score cards, labor position training, and efforts to promote guideline adherence were introduced. The research team examined the institutional NTSV CD rates by quarters and evaluated the trend, modeling the probability of a CD for the pre- and postintervention periods using logistic regression, with time as an ordinal variable. The authors also examined cesarean indications as well as maternal and neonatal complications before and after the QI implementation.
Results
There was a trend toward a decrease in CDs during the postintervention period, falling from 32.9% to 26.3% in the 12 months following implementation. Using an interrupted time series analysis to assess differences in trends, the trend before intervention was +2.63% per quarter (95% confidence interval [CI] 2.30–3.03, p < 0.001), while the change in trend postintervention was -3.78% per quarter (95% CI -4.74 to -2.81, p < 0.001, R2 = 0.973). This suggests an increasing trend prior to intervention that was effectively reversed. Both maternal and neonatal complications rates remained comparable between pre- and postintervention periods for those who had NTSV CDs.
Conclusion
Multifaceted strategies incorporating interactive case review meetings can lead to practice change and may be a feasible strategy to reduce an institutional NTSV CD rate.
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