Strategies to reduce the caesarean section rate in a private hospital and their impact

Negrini, Rômulo; D’Albuquerque, Izabella Mikaella Souza Campos; Oliveira, Rita de Cássia Sanchez e; Ferreira, Raquel Domingues da Silva; Stefani, Luciana Francine Bocchi De; Podgaec, Sérgio

doi:10.1136/bmjoq-2020-001215

Cited by 9 publications

(7 citation statements)

References 23 publications

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“…These findings are surprising and inconsistent with many other BSS‐R validation studies, for example, Jefford et al, 3 Romero‐Gonzalez et al, 5 Nespoli et al, 6 Emmens et al, 28 Skvirsky et al 29 which invariably show that women who had an intervention delivery (i.e., caesarean section) have significantly lower BSS‐R scores compared with vaginal delivery. Since the dominant agenda within maternity care is to reduce the cesarean section rate, 31 findings from the current investigation are at odds with established evidence regarding BSS‐R scores in study and policy itself. It is possible that these findings may again relate to the dynamics of the public healthcare system in India, which primarily focus upon medical aspects of care and safe, efficient, and clinical removal of the fetus.…”

Section: Discussionmentioning

confidence: 67%

Translation and validation of the Hindi‐Indian version of the Birth Satisfaction Scale‐Revised

Tiwari¹,

Murry

Joshi

et al. 2023

J of Obstet and Gynaecol

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Aim Critical to maternal outcome and development of a healthy and relationship between mother and baby, is the woman's perception of her birth experience. The Birth Satisfaction Scale‐Revised (BSS‐R) has been demonstrated to be psychometrically robust, easily administered, and scored self‐report measure of birth experience. Aim of the study was to translate the UK‐BSS‐R into Hindi, collect data, and psychometrically validate an Indian (Hindi)‐BSS‐R. Methods Psychometric assessment of the Indian (Hindi)‐BSS‐R was undertaken following translation using a cross‐sectional design. Evaluation of known‐groups validity was undertaken using an embedded between‐subjects component. Data were collected from (n = 312) postnatal Hindi speaking women in India. Measurement characteristics were assessed using confirmatory factor analysis, divergent validity and internal consistency analysis. Results The measurement properties of the Indian (Hindi)‐BSS‐R were observed to be equivocal, with the established tri‐dimensional measurement model not achieving best fit to data. Instead, an alternative two‐factor model offered an excellent fit to data. Significant differences were observed between Indian (Hindi)‐BSS‐R scores and family type and gestation term status, which highlights the relevance of these contextual aspects to the Indian birth experience. Internal consistency was observed to be low on some sub‐scales, indicating the potential need for future revision. Conclusions The Indian (Hindi)‐BSS‐R is a measure of birth experience, which accepting some measurement caveats, is acceptable for use with Hindi speaking women in India. Further research is required to determine if modification of some of the items is required to improve internal consistency.

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Section: Discussionmentioning

confidence: 67%

Translation and validation of the Hindi‐Indian version of the Birth Satisfaction Scale‐Revised

Tiwari¹,

Murry

Joshi

et al. 2023

J of Obstet and Gynaecol

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“…In a randomised controlled trial, local opinion leader education was an effective method of encouraging a trial of labour and vaginal birth for women with previous caesarean deliveries 20. Since 2014, our hospital has carried out a programme called Adequate Childbirth, which with a multicomponent approach (creation and training of a multidisciplinary team, education of pregnant women, improvements in infrastructure and audits of delivery types) achieved an increase in the vaginal delivery rate of 27.5% and reduced neonatal intensive care unit admissions by 31.2% 21…”

Section: Discussionmentioning

confidence: 99%

“…20 Since 2014, our hospital has carried out a programme called Adequate Childbirth, which with a multicomponent approach (creation and training of a multidisciplinary team, education of pregnant women, improvements in infrastructure and audits of delivery types) achieved an increase in the vaginal delivery rate of 27.5% and reduced neonatal intensive care unit admissions by 31.2%. 21 The US healthcare system wastes $760 billion to $935 billion annually, representing 25% of total healthcare costs. 22 In 2012, the American Board of Internal Medicine Foundation started a campaign called 'Choosing Wisely', which aimed to reduce low-value care services.…”

Section: Discussionmentioning

confidence: 99%

Impact of a quality programme on overindication of surgeries for endometriosis and cholecystectomies

Conte de Oliveira,

Fernandes,

Vasconcelos

et al. 2023

BMJ Open Qual

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Approximately 45% of patients receive medical services with minimal or no benefit (low-value care). In addition to the increasing costs to the health system, performing invasive procedures without an indication poses a potentially preventable risk to patient safety. This study aimed to determine whether a managed quality improvement programme could prevent cholecystectomy and surgery for endometriosis treatment with minimal or no benefit to patients.This before-and-after study was conducted at a private hospital in São Paulo, Brazil, which has a main medical remuneration model of fee for service. All patients who underwent cholecystectomy or surgery for endometriosis between 1 August 2020 and 31 May 2021 were evaluated.The intervention consisted of allowing the performance of procedures that met previously defined criteria or for which the indications were validated by a board of experts.A total of 430 patients were included in this analysis. The programme prevented the unnecessary performance of 13% of cholecystectomies (p=0.0001) and 22.2% (p=0.0006) of surgeries for the treatment of endometriosis. This resulted in an estimated annual cost reduction to the health system of US$466 094.93.In a hospital with a private practice and fee-for-service medical remuneration, the definition of clear criteria for indicating surgery and the analysis of cases that did not meet these criteria by a board of reputable experts at the institution resulted in a statistically significant reduction in low-value cholecystectomies and endometriosis surgeries.

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“…One of the reasons why multidisciplinary collaboration reduced CS is more related to the general atmosphere and ethos which were built when it was leveraged: strong teamwork where every member in the team has greater awareness on what their roles are, work collaboratively in resolving issues, and communicate with each other respectfully. For example, a recent study in Brazil reported that implementing multidisciplinary collaboration among providers, along with engagement with pregnant women and improvements to hospital facilities reduced CS and increased vaginal birth [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Globally, interventions targeting healthcare providers to change their behaviours around CS have been tested. A Cochrane intervention review identified 16 intervention studies targeting healthcare providers and systems, typically focusing on implementation of audit and feedback of CS data combined with either implementation of clinical guidelines and protocols, mandatory secondary opinion for CS decision-making, or working with local opinion leaders to influence change [19][20][21]. Audit and feedback can help healthcare providers to assess the distribution of CS across different groups of women, and identify areas for appropriate increases or decreases in these groups based on obstetric characteristics [22].…”

Section: Introductionmentioning

confidence: 99%

Interventions targeting healthcare providers to optimise use of caesarean section: a qualitative comparative analysis to identify important intervention features

Zahroh

Kneale

Sutcliffe

et al. 2022

BMC Health Serv Res

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Background Rapid increases in caesarean section (CS) rates have been observed globally; however, CS rates exceeding 15% at a population-level have limited benefits for women and babies. Many interventions targeting healthcare providers have been developed to optimise use of CS, typically aiming to improve and monitor clinical decision-making. However, interventions are often complex, and effectiveness is varied. Understanding intervention and implementation features that likely lead to optimised CS use is important to optimise benefits. The aim of this study was to identify important components that lead to successful interventions to optimise CS, focusing on interventions targeting healthcare providers. Methods We used Qualitative Comparative Analysis (QCA) to identify if certain combination of important intervention features (e.g. type of intervention, contextual characteristics, and how the intervention was delivered) are associated with a successful intervention as reflected in a reduction of CS. We included 21 intervention studies targeting healthcare providers to reduce CS, comprising of 34 papers reporting on these interventions. To develop potential theories driving intervention success, we used existing published qualitative evidence syntheses on healthcare providers’ perspectives and experiences of interventions targeted at them to reduce CS. Results We identified five important components that trigger successful interventions targeting healthcare providers: 1) training to improve providers’ knowledge and skills, 2) active dissemination of CS indications, 3) actionable recommendations, 4) multidisciplinary collaboration, and 5) providers’ willingness to change. Importantly, when one or more of these components are absent, dictated nature of intervention, where providers are enforced to adhere to the intervention, is needed to prompt successful interventions. Unsuccessful interventions were characterised by the absence of these components. Conclusion We identified five important intervention components and combinations of intervention components which can lead to successful interventions targeting healthcare providers to optimise CS use. Health facility managers, researchers, and policy-makers aiming to improve providers’ clinical decision making and reduce CS may consider including the identified components to optimise benefits.

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Strategies to reduce the caesarean section rate in a private hospital and their impact

Cited by 9 publications

References 23 publications

Translation and validation of the Hindi‐Indian version of the Birth Satisfaction Scale‐Revised

Translation and validation of the Hindi‐Indian version of the Birth Satisfaction Scale‐Revised

Impact of a quality programme on overindication of surgeries for endometriosis and cholecystectomies

Interventions targeting healthcare providers to optimise use of caesarean section: a qualitative comparative analysis to identify important intervention features

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