Issue link: https://beckershealthcare.uberflip.com/i/802380
29 QUALITY IMPROVEMENT & MEASUREMENT Quality Improvement Initiative Lowers C-Section Rates by 10%+ at Deaconess Medical Center By Brian Zimmerman A long-term, multi-strategy quality improvement initiative resulted in a significant reduction in the num- ber of births by cesarean section at Beth Israel Deaconess Medical Center in Boston, according to a study published in e Joint Commission Journal on Patient Safety. For the study, researchers established factors that may increase the likelihood of a cesarean delivery in nulliparous term singleton vertex cesarean pregnancies. ese are women who deliver a baby with its head positioned down at 37 weeks or more, traits that should reduce the likelihood of cesarean delivery. Estab- lished factors included the interpretation and management of fetal heart rate, the hospital's childbirth capacity and provider awareness, among others. From 2008 through 2015, the researchers ap- plied a multi-strategy approach, including provider education and provider feedback, to address the factors contributing to high C-sec- tion rates. e strategic initiative included pa- tient education and provider feedback. During this time period, C-section rates among this patient population dropped from 34.8 to 21.2 percent and the total cesarean delivery rate de- creased from 40 to 29.1 percent. "Nearly one third of births in the United States occur with cesarean delivery. Com- pared to vaginal delivery, cesarean delivery is associated with increased morbidity and mortality," wrote the study's authors. "A re- duction in NTSV cesarean delivery rate may have a substantial impact on healthcare. Hospitals can implement quality improve- ment initiatives reported here to decrease NTSV cesarean delivery rate. Aspects of this project such as provider education, provider feedback and change in policy are generalizable to many institutions." n CDC: 6 Tactics to Help Reduce Health Disparities Among Rural Patients By Brian Zimmerman F ive leading causes of death disproportionately kill rural Americans at higher rates than their urban counterparts, according to research from the CDC. After analyzing mortality data for both rural and urban counties, researchers found individuals living in rural communities were more susceptible to death from heart disease, cancer, unintentional injuries, chronic lower respi- ratory disease and stroke. Noted contributing factors to these disparities include higher rates of obesity and smok- ing among rural communities, high rates of poverty, lim- ited access to healthcare services and fewer people with health insurance coverage. "This new study shows there is a striking gap in health be- tween rural and urban Americans," said CDC Director Tom Frieden, MD, in a release. "To close this gap, we are working to better understand and address the health threats that put rural Americans at increased risk of early death." Here are six strategies for rural providers from the CDC to address these health disparities. 1. Screen patients regularly for high blood pressure and make controlling blood pressure rates among patients a goal for quality improvement. 2. Participate in state-level comprehensive cancer control programs to increase prevention efforts and improve early detection. 3. Encourage all patients to eat healthy and stay activate to combat rates of obesity. 4. Encourage patients who smoke to begin smoking cessation. 5. Promote safe driving practices by encouraging patients to always wear seatbelts, and counsel parents and child care providers to use appropriate car seats and booster seats for children on every trip. 6. Follow the CDC guidelines when prescribing opioid medications for pain and advise patients on the availability of nonpharmacological pain therapies. n Individuals living in rural communities are more susceptible to death from heart disease, cancer, unintentional injuries, chronic lower respiratory disease and stroke.