Every Week Counts ended in 2014, but the effort to eliminate early elective deliveries continues. As an annual update, the Office of Perinatal Quality Improvement created a report sent to hospitals that includes individual hospital data from Hospital Compare and updated Oklahoma birth certificate data. Individual hospital data is reported on CMS’s Hospital Compare website (publicly available at https://www.medicare.gov/hospitalcompare/). Hospitals submit data to CMS utilizing the Joint Commission’s National Quality Core Measure in Perinatal Care, Elective Delivery (PC-01). This measure is periodically updated, and the current version of the measure can be found at manual.jointcommission.org. PC-01 is based on ICD-10 coding. The tables listing the codes used in each measure (including Table 11.07) are located in Appendix A of the manual.
The data from Hospital Compare (reported as rolling averages) show that the Oklahoma PC-01 rate continues to match the national average of 2% through the periods ending in Q1 2018.
However, more current data from Oklahoma birth certificates continue to show a concerning trend. In Q4 2016, the rate of births at 39-41 weeks decreased and births at 36-38 weeks increased—a reversal of the trend we saw with EWC. This reversal continued in 2017, and the rates increased even further in 2018. If this trend continues, the births at 36-38 weeks will reach the rate experienced before we started EWC.
ACOG and SMFM recently released updated Committee Opinions (#764 & #765) addressing this issue. The overall recommendations have not changed. These documents are open access. We suggest your hospital clinical and administrative teams use them as a guide to update your policies/protocols. We also have an updated data tool for 2019 that may be useful for hospitals that need/want to collect this data. AWHONN has also released the position statement, Elective Induction of Labor.
Know the early elective delivery rates at your hospital (contact email@example.com for more information). When a hospital’s rate is above the national rate, it is usually because of one, or a combination of, these three issues:
- Lack of enforcement of a hard stop policy for scheduling inductions and cesareans before 39 weeks without a medical indication
- Documentation not reflecting the appropriate medical indication
- Improper coding of the medical indication
Our office staff is available to assist your hospital in a QI process to reduce your early elective deliveries or investigate your data issues. We are also available to answer your questions. Contact firstname.lastname@example.org for assistance.
CONGRATULATIONS to those hospitals who have consistently remained at ≤ 2%. We know it takes hard work to sustain these efforts – great work!