1. Oklahoma Aggregate Data 2nd Quarter 2013 April 1 – June 30, 2013
Every Week Counts
Oklahoma Aggregate Data
2nd Quarter 2013
April 1 – June 30, 2013

2. April – June 2013
This represents 52/54 EWC Hospitals. This includes data from Moore Medical Center through April. When Moore Medical Center was lost on May 20th, that brought the count of Oklahoma birthing hospitals to 57 (53 in EWC).
94 total for the quarter
135 for Q ~1.5/day
~1/day

3. ~8/day ~1/day Qtr 1 2011: January 1 – March 31, 2011
Qtr : April 1 – June 30, 2013
Number of births in red area for baseline data (Q1 2011) is 680; Number of births in red area for Q is 94—a decrease of 86% in number of scheduled births that were non-medically indicated prior to 39 weeks of participating hospitals.

4. 41%
29%
*Comparison is difference between
Q & Q2 2013
The denominator on this slide is total scheduled C/S. 2.4% of the scheduled c-sections in Q were <39 weeks without a documented indication. This is down 85% from the rate of 16.2% in Q
85%

5. 15%*
15%*
*Comparison is difference between
Q & Q2 2013
The denominator on this slide is total inductions. 1.1% of the inductions in Q were <39 weeks without a documented indication. This is down 86% from the rate of 7.9% in Q
86%*

6. 86%*
*Comparison is difference between
Q & Q2 2013
The denominator on this slide is total deliveries. The labeled data points are for 12/2010 and 6/2013. Q aggregate rate is 5.91%. Q aggregate rate is 0.8%. There was an 86% decrease between those two periods.
Q showed an 81% decrease from Q1 2011

7. April – June 2013 30 Hospitals 22 Hospitals
Baseline Data: Dec 2010 – March
Purple line represents area covered by baseline data.
Each bar represents a hospital.
Hospitals’ individual reports indicate their bar by an arrow.
30 Hospitals
6 Hospitals
22 Hospitals

8. April – June 2013
Each bar represents a hospital
Hospitals’ individual reports indicate their bar by an arrow
<300
1000+ 8 9 4
ORANGE number = approximate number of annual deliveries GREEN number = number of hospitals reporting zero rate

9. Scheduled Deliveries <39 Weeks
April – June 2013
Scheduled deliveries at < 39 weeks. 52 hospitals reported on this.
The graph legend begins at the upper right section of the pie and works around clockwise.
As you can see, there was 1 induction and 2 scheduled c-sections <37 weeks without a medical indication reported for this period.
As you can see, we had 2 inductions at <37 weeks without an indication and 4 scheduled C/S at < 37 weeks without an indication.

10. Scheduled Deliveries <39 Weeks
April – June 2013
The indicated area contains our target areas—scheduled cesareans and inductions at < 39 weeks without a documented medical indication.
This area accounts for 7.1% of our scheduled deliveries at < 39 weeks—38, 37 or < 37 weeks 95
7.1% of Scheduled Deliveries <39 weeks do not have a documented indication

11. TJC Perinatal Care Core Measure* PC-01: Elective Delivery
*Data collected via the EWC Data Collection Tool is used to estimate TJC PC-01 Data.

12. This represents 46 hospitals
This represents 46 hospitals. Of the 52 whose data we are including in the Q report, 4 hospitals did not report core measure data and 2 hospitals had a zero denominator (no cases in the measure population).
30% decrease from Q to Q2 2013

13. This represents 46 hospitals
This represents 46 hospitals. Of the 52 whose data we are including in the Q report, 4 hospitals did not report core measure data and 2 hospitals had a zero denominator (no cases in the measure population).

14. April – June 2013 Total Bar = Denominator (Measure Population)
Red Section = Numerator (Non-medically Indicated Scheduled Deliveries)
(# indicates number of non-medically indicated scheduled deliveries)
Blue Section = Remainder (Non-scheduled Deliveries)
This graph reflects the variation in volume of 37 & 38 week deliveries. The total bar represents the denominator or measure population. The red section of the bar represents the numerator, those in the measure population (denominator) that were delivered by induction or scheduled c-section. The blue section of the bar represents the remainder of the measure population (not a scheduled delivery).

15. overlaid with corresponding hospital’s Core Measure Rate
April – June 2013
overlaid with corresponding hospital’s Core Measure Rate
Hospitals with smaller denominators are more likely to have higher rates, unless the numerator is zero.
The is the same graph as before with the corresponding hospital’s Core Measure Rate overlaid. The values range from 0 – 100%. This depicts how a smaller denominator is likely to yield a higher rate, unless the numerator is 0.

16. April – June 2013 24 Hospitals 22 Hospitals
Each bar represents one of the 46 hospitals that had a rate (2 of the 48 that reported PC-01 data did not have any cases in the measure population (denominator), and therefore do not have a rate represented). 24/46 had a 0% rate.
24 Hospitals
22 Hospitals

17. Oklahoma Birth Certificate Data
Provisional
April 2009 – June 2013

18. 10%* 14%* 39-41 weeks 36-38 weeks EWC Begins
This slide represents provisional Oklahoma birth certificate data representing ALL Oklahoma births.
It validates our EWC data, as it indicates an overall increase in births at weeks and a decrease in births at weeks
*comparison is Q to Q2 2013
Provisional Data provided by Oklahoma Vital Records

19. 1%* 10%* 15%* 11%* *comparison is Q1 2011 to Q2 2013 EWC Begins
Induction – Weeks
1%*
10%*
Induction – Weeks
Augmentation – Weeks
15%*
This slide also represents provisional Oklahoma birth certificate data representing ALL Oklahoma births.
The 15% increase in augmentations at weeks is concerning. Could this mean that some women who were previously “induced” at weeks are now being “augmented” at weeks?
Please examine this area in your hospital—are you also seeing an increase in augmentations at weeks? If so, you may need to look at this more closely.
It is generally agreed that augmentation refers to stimulation of contractions after labor has begun or after spontaneous rupture of membranes. In its June 2003 Practice Bulletin #49 (still current), “Dystocia and Augmentation of Labor” , ACOG states, “Augmentation refers to stimulation of uterine contractions when spontaneous contractions have failed to result in progressive cervical dilation or descent of the fetus.” There is also a statement in the beginning of this document stating, “This document focuses on labor subsequent to entering the active phase,…..”.
Please take a closer look at labor augmentations in your hospital.
Augmentation – Weeks
11%*
EWC Begins
*comparison is Q to Q2 2013
Provisional Data provided by Oklahoma Vital Records