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":"旨在降低初次剖宫产率的多方面质量改进倡议的影响。","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":"{\"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}","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}
引用次数: 0
摘要
安全降低剖宫产率（cd）的理想方法尚不清楚。作者评估了多方面的质量改进（QI）倡议的影响，该倡议旨在遏制城市，学术，安全网医院机构无产期单胎顶点（NTSV） CD率的上升趋势。方法：主要干预措施是每两周一次的跨学科教育会议，对NTSV CD病例进行回顾和审核。此外，还介绍了教育公报、NTSV记分卡、劳动岗位培训和促进指南遵守的努力。研究小组按季度检查了机构NTSV CD率，并评估了趋势，使用逻辑回归对干预前后的CD概率进行建模，将时间作为序数变量。作者还检查了宫产指征以及QI实施前后的孕产妇和新生儿并发症。结果：干预后cd呈下降趋势，实施后12个月内从32.9%下降到26.3%。采用中断时间序列分析评估趋势差异，干预前的趋势为每季度+2.63%(95%可信区间[CI] 2.30-3.03, p < 0.001)，干预后的趋势变化为每季度-3.78% （95% CI -4.74至-2.81,p < 0.001, R2 = 0.973）。这表明，在干预之前，这种上升趋势已得到有效扭转。在NTSV cd患者的干预前后，产妇和新生儿并发症发生率保持可比性。结论：结合互动式病例审查会议的多方面策略可以导致实践变化，并且可能是降低机构NTSV CD率的可行策略。
Impact of a Multifaceted Quality Improvement Initiative Aimed at Reducing Primary Cesarean Delivery Rates
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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