Early Elective Deliveries (EED)
An Improvement Highlight of PSF and CalHEN Efforts

Success story
Goal: Reduce Early Elective Delivery rate across California to less than three percent (3%)

Early elective deliveries are those induced (medically or surgically) that do not meet ACOG guidelines for medical necessity. ACOG reports infants born at 37 weeks are nearly 23 times more likely to suffer severe respiratory distress than those born between 39 and 41 weeks.

EED has shown evidence of high cost and risk with little benefit and has been a focus of National Institutes for Health, Department of Health and Human Services, California Department of Public Health, March of Dimes and payers, all of which influenced the selection of EED as a statewide focus.

The PSF goal was to reduce EED below five percent in participating hospitals by 2012. A small percentage of PSF hospitals were also engaged in the CalHEN. The CalHEN goal, as directed by CMS, was to reduce the EED rate at or below three percent statewide. (HQI has since aligned program measurement goals to three percent.)

A partnership with ACOG state leaders was developed to direct the interventions to reduce EEDs, as well as provide direct consultation to physician and operations leaders throughout California upon request.

Town hall meetings with physician peer-to-peer learning were very effective; however, the major activity identified to impact the EED rate was the implementation of a hard stop policy.

PSF and CalHEN provided assistance to support hospital development of hard stop policies. If internal barriers were identified, ACOG provided influential physicians to work on-site with the hospital OB/GYN physician staff.

In October 2012, only 23 percent of the birthing hospitals reported a hard stop policy (CalHEN). By August 2013, this had increased to 83 percent of birthing hospitals reporting either a hard stop policy or an EED rate below 3 percent. This change demonstrates a clear correlation with healthier babies and mothers in California.

74% PSF Phase 1 EED Improvement between 2010 and 2012. Source: National Health Foundation, 2013.

CalHEN EED Improvement between Jan. 2012 and Nov. 2013.

The following represents additional targeted learning and spread during the past 24 months:

  • Peer-sharing webinars, using hospitals in the state that had successfully reduced EEDs;
  • Regional Perinatal Safety meetings with Labor and Delivery professionals, midwives, quality leaders, patient safety and risk managers, nurses, educators and military medical personnel;
  • March of Dimes –community education, support, promotion, funding and programing;
  • California Maternal Quality Care Collaborative – data collection and root cause analysis tools; and
  • Text4Baby.org –the first mobile information service designed to promote maternal and child health through text messaging.