1. Every Week Counts Oklahoma Aggregate Data
2nd Quarter 2014: April – June 2014

2. April – June 2014 ~1 every 2 days This represents 50/52 EWC Hospitals.
41 total non-medically indicated scheduled deliveries < 39 weeks for the quarter (22 Inductions and 19 Scheduled C-Sections)
35 were reported in Q1 2014
This is a 16.4% INCREASE in the number of early, elective deliveries (EEDs) from Q to Q In Q1 2014, there was a birth of a non-medically indicated scheduled C/S or induction at < 39 weeks approximately 1 every 2.6 days. For Q2 2014, this increased to approximately 1 every 2.2 days.
~1 every 2 days

3. ~8/day ~1 every 2 days Qtr 1 2011: January 1 – March 31, 2011
Qtr : April 1 – June 30, 2014
Number of births in red area for baseline data (Q1 2011) is 680; Number of births in red area for Q is 41—a decrease of 639 (93% decrease in number) scheduled births that were non-medically indicated prior to 39 weeks of participating hospitals.

4. 26% 4%
*Comparison is difference between
Q & Q2 2014
The denominator on this slide is total scheduled C/S. 0.9% of the scheduled c-sections in Q were <39 weeks without a documented indication. This is down 94% from the rate of 16.1% in Q
94%

5. 15%*
11%*
*Comparison is difference between
Q & Q2 2014
The denominator on this slide is total inductions. 0.5% of the inductions in Q were <39 weeks without a documented indication. This is down 93% from the rate of 7.9% in Q
93%*

6. 2%
0.4%
2.5% 9%
Comparison is Q to Q2 2014
This slide represents changes in care practices when comparing Q to Q
EWC data from participating hospitals show:
A 2% increase in births that did not include induction or scheduled C/S
A 0.4% decrease in the induction rate for women who intended to deliver vaginally
(Inductions/Total Deliveries-Scheduled C/S)
A 2.5% increase in the overall induction rate (Inductions/Total Deliveries)
A 9% decrease in the scheduled C/S rate (Scheduled C-sections/Total Deliveries)

7. 94%*
*Comparison is difference between
Q & Q2 2014
The denominator on this slide is total deliveries. The labeled data points are for 12/2010 and 6/2014. Q aggregate rate is 5.92%. Q aggregate rate is 0.36%. There was a 94% decrease in rate between those two periods.
Q showed an 95% decrease from Q1 2011
There was 16.4% increase in rate from Q (0.31%) to Q (0.36%)

8. Baseline Data: Dec 2010 – March 2011 --
April – June 2014
Baseline Data: Dec 2010 – March
Purple line represents area covered by baseline data.
Each bar represents a hospital.
Red is scheduled C/S and blue is inductions.
Hospitals’ individual reports indicate their bar by an arrow.
35 Hospitals
6 Hospitals
15 Hospitals

9. April - June 2014
Each bar represents a hospital
Hospitals’ individual reports indicate their bar by an arrow
<300
1000+ 6 12 5
ORANGE number = approximate number of annual deliveries GREEN number = number of hospitals reporting zero rate

10. Scheduled Deliveries <39 Weeks
April – June 2014
Scheduled deliveries at < 39 weeks. All 50 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 were 2 inductions at <37 weeks without an indication, a non-medically indicated scheduled delivery for preterm birth.

11. Scheduled Deliveries <39 Weeks
April – June 2014
The indicated area contains our target areas—scheduled cesareans and inductions at < 39 weeks without a documented medical indication.
This area accounts for 2.7% of our scheduled deliveries at < 39 weeks—38, 37 or < 37 weeks
As you can see, there were 2 inductions at <37 weeks without an indication reported. There were 0 scheduled C/S at < 37 weeks without an indication reported.
Of scheduled deliveries (inductions and c-sections) <39 weeks without a documented indication:
36 (88%) were at 38 weeks
3 (7%) were at 37 weeks
2 (5%) were <37 weeks 41
2.7% of Scheduled Deliveries <39 weeks do not have a documented indication

12. 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.

13. This represents 46 hospitals. This line graph represents each quarter
This represents 46 hospitals. This line graph represents each quarter. Of the 50 whose data we are including in the Q report, 1 hospital had a zero denominator (no cases in the measure population) and 3 hospitals did not report PC-01.
64% decrease from Q to Q2 2014

14. April – June 2014 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).
The higher the total bar, the higher the number of deliveries at 37 & 38 weeks in the measure population. The larger the red section of the bar, the higher the number of EEDs. Some births in the red section could be a mother with a medical indication that is not listed in the table 11.07—this should not be a usual occurrence. Most births in the red section are EEDs.

15. overlaid with corresponding hospital’s Core Measure Rate
April – June 2014
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 rates range from 0 – 50%. This depicts how a smaller denominator is likely to yield a higher rate, unless the numerator is 0.

16. April – June 2014 29 Hospitals 17 Hospitals
Each bar represents one of the 46 hospitals that had a rate (1 of the 47 that reported PC-01 data did not have any cases in the measure population (denominator), and therefore do not have a rate represented). 29/46 (63%) had a 0% rate.
29 Hospitals
17 Hospitals

17. Oklahoma Birth Certificate Data

18. This data is from Oklahoma Vital Records
This data is from Oklahoma Vital Records. These are all singleton Oklahoma births. The increase in births at weeks with an associated decrease in births at weeks validates the data that was submitted through EWC.
Comparison is Q to Q2 2014
Provided by Oklahoma Vital Records

19. 3%* 9%* 13%* 6%* *comparison is Q1 2011 to Q2 2014 EWC Begins
Induction – Weeks
9%*
Induction – Weeks
13%*
Augmentation – Weeks
This slide also represents Oklahoma birth certificate data representing ALL Oklahoma singleton births. Note the 2013 and 2014 data are preliminary and subject to change. Among babies born between 36 and 38 weeks gestation, there has been a 9% reduction in inductions, and a 13% increase in augmentations.
Augmentation – Weeks
6%*
EWC Begins
*comparison is Q to Q2 2014
Provided by Oklahoma Vital Records

20. Thank you for the support from all partners
Thank you for the support from all partners! And a big THANK YOU to the EWC participating hospitals for all of your hard work!