Effect of external peer review on cesarean delivery rates: A statewide program

Bickell, Nina A.; Zdeb, Michael; Applegate, Mary; Roohan, Patrick J.; Siu, Albert L.

doi:10.1016/0029-7844(96)00024-5

Cited by 25 publications

(28 citation statements)

References 7 publications

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“…32 Nine of the 11 studies evaluating audit and feedback demonstrated a positive impact on guideline implementation. 18,38,40 -46 One study presented mixed effects 26 because of the contamination of the control group by a national effort to promote vaginal birth after cesarean delivery and the weakness of feedback quality. Most of the studies concerned labor management and medical interventions in peripartum care, particularly cesarean procedures.…”

Section: Resultsmentioning

confidence: 96%

“…18,29,34 -36,39,50,52 The remaining studies were rated "fair." The main reasons for the fair quality rating for randomized controlled trials and controlled before-after studies were that protection against exclusion bias was not clear, 24,27,30,38 baseline measures were not reported or were unclear, 26,27,32,33,37 reliable primary outcome measures were unclear or not reported, 24,28,30,37,38 and protection against contamination was not clear. 28,37 Twelve interrupted time series studies were rated "fair" because no autoregressive integrated moving average models (ARIMA) or time series regression models were used for data analysis.…”

Section: Resultsmentioning

confidence: 97%

“…5,38,40 -46 In the present review, only one study with poor feedback 24 was ineffective, and another with weak feedback quality presents mixed effects. 26 The author states that it is essential to develop more adapted feedback mechanisms. 26,58 Also, an identified key to success of audit and feedback is local implementation and collaboration with local staff.…”

Section: Resultsmentioning

confidence: 98%

“…26 The author states that it is essential to develop more adapted feedback mechanisms. 26,58 Also, an identified key to success of audit and feedback is local implementation and collaboration with local staff. Mousa and Mahmood 42 showed that it is essential to achieve an audit process to optimize feedback to get the desirable level of care.…”

Section: Resultsmentioning

confidence: 98%

See 3 more Smart Citations

Evidence-Based Strategies for Implementing Guidelines in Obstetrics

Chaillet

Dubé²,

Dugas³

et al. 2006

Obstetrics & Gynecology

210

194

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show abstract

Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 98%

See 2 more Smart Citations

Evidence-Based Strategies for Implementing Guidelines in Obstetrics

Chaillet

Dubé²,

Dugas³

et al. 2006

Obstetrics & Gynecology

210

194

View full text Add to dashboard Cite

show abstract

“…29 Peer review has been tried in efforts to lower the cesarean delivery rate with variable success, although not in our institution. 30–32 …”

Section: Commentmentioning

confidence: 99%

New labor management guidelines and changes in cesarean delivery patterns

Rosenbloom

Stout

Tuuli

et al. 2017

American Journal of Obstetrics and Gynecology

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Background In 2010 the Consortium on Safe Labor published labor curves. It was proposed that the rate of cesarean delivery (CD) could be lowered by avoiding the diagnosis of arrest of dilation before 6 cm. However, there is little information on the uptake of the guidelines and on changes in CD rates that may have occurred. Objective To test the hypotheses that: 1) among patients laboring at term, rates of arrest of dilation disorders have decreased leading to a decrease in the rate of CD; 2) in the second stage, pushing duration prior to diagnosis of arrest of descent has increased also leading to reduction in the rate of CD for this indication. As a secondary aim, we investigated changes in maternal and neonatal morbidity. Study Design This was a secondary analysis of a prospective cohort study of all patients presenting at ≥ 37 weeks’ gestation from 2010–2014 with a non-anomalous vertex singleton and no prior history of CD. Rates of CD, arrest of dilation, and changes in rates of maternal and neonatal morbidity were calculated in crude and adjusted models. Cervical dilation at diagnosis of arrest of dilation, time spent at the maximal dilation prior to diagnosis of arrest of dilation, and time in the second stage prior to diagnosis of arrest of descent were compared over the study period. Results There were 7845 eligible patients. The CD rate in 2010 was 15.8% and in 2014 17.7% (p-trend 0.51). In patients undergoing CD for arrest of dilation, the median cervical dilation at the time of CD was at 5.5 cm in 2010 and 6.0 cm in 2014 (p-trend 0.94). In these patients, there was an increase in the time spent at last dilation: 3.8h in 2010 to 5.2h in 2014 (p-trend 0.02). There was no change in the frequency of patients diagnosed with arrest of dilation at <6 cm: 51.4% in 2010 and 48.6% in 2014 (p-trend 0.56). However, in these patients, the median time spent at the last cervical dilation was 4.0h in 2010 and 6.7h in 2014 (p-trend 0.046). There were 206 CDs for arrest of descent. The median pushing time in these patients increased in multiparous patients from 1.1h in 2010 to 3.4h in 2014 (p-trend 0.009); in nulliparous patients these times were 2.7h in 2010 and 3.8h in 2014 (p-trend 0.09). There was a significant trend towards increasing adverse neonatal and maternal outcomes (p<0.001 for each). The aOR for adverse maternal outcome for 2014 compared to 2010 was 1.66 (95%CI 1.27, 2.17); however considering only transfusion, hemorrhage, or infection, there was no difference (p-trend 0.96). The aOR of adverse neonatal outcome in 2014 compared to 2010 was 1.80 (95%CI 1.36, 2.36). Conclusion Despite significant changes in labor management that have occurred over the initial years since publication of the new labor curves and associated guidelines, the primary CD rate was not reduced and there has been an increase in maternal and neonatal morbidity in our institution. A randomized controlled trial is needed.

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Non-clinical interventions for reducing unnecessary caesarean section

Khunpradit

Tavender

Lumbiganon

et al. 2011

Cochrane Database of Systematic Reviews

122

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BackgroundCaesarean section rates are increasing globally. The factors contributing to this increase are complex, and identifying interventions to address them is challenging. Non-clinical interventions are applied independently of a clinical encounter between a health provider and a patient. Such interventions may target women, health professionals or organisations. They address the determinants of caesarean births and could have a role in reducing unnecessary caesarean sections. This review was first published in 2011. This review update will inform a new WHO guideline, and the scope of the update was informed by WHO's Guideline Development Group for this guideline. ObjectivesTo evaluate the effectiveness and safety of non-clinical interventions intended to reduce unnecessary caesarean section. Search methodsWe searched CENTRAL, MEDLINE, Embase, CINAHL and two trials registers in March 2018. We also searched websites of relevant organisations and reference lists of related reviews. 1 Non-clinical interventions for reducing unnecessary caesarean section (Review)

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Effect of external peer review on cesarean delivery rates: A statewide program

Abstract: This joint-specialty society and health department peer review had no apparent impact on cesarean rates.

Cited by 25 publications

References 7 publications

Evidence-Based Strategies for Implementing Guidelines in Obstetrics

Evidence-Based Strategies for Implementing Guidelines in Obstetrics

New labor management guidelines and changes in cesarean delivery patterns

Non-clinical interventions for reducing unnecessary caesarean section

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