1. Every Week Counts Oklahoma Aggregate Data
4th Quarter 2013
October – December 2013

2. October – December 2013 ~1 every other day
This represents 51/52 EWC Hospitals.
46 total non-medically indicated schedule deliveries < 39 weeks for the quarter
48 were reported in Q3 2013
~1 every other day

3. Qtr 4 2013: October 1 – December 31, 2013
~8/day
~1 every other day
Qtr : January 1 – March 31, 2011
Qtr : October 1 – December 31, 2013
Number of births in red area for baseline data (Q1 2011) is 680; Number of births in red area for Q is 46—a decrease of 634 (93% decrease in number) scheduled births that were non-medically indicated prior to 39 weeks of participating hospitals.

4. 41%
24%
*Comparison is difference between
Q & Q4 2013
The denominator on this slide is total scheduled C/S. 1.2% of the scheduled c-sections in Q were <39 weeks without a documented indication. This is down 93% from the rate of 16.2% in Q
93%

5. 14%*
9%*
*Comparison is difference between
Q & Q4 2013
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. 7.4%
3.8%
0.5%
18%
Comparison is Q to Q4 2013
This slide represents changes in care practices when comparing Q to Q
EWC data from participating hospitals show:
A 7.4% increase in births that did not include induction or scheduled C/S
A 3.8% decrease in the induction rate for women who intended to deliver vaginally
(Inductions/Total Deliveries-Scheduled C/S)
A 0.5% increase in the overall induction rate (Inductions/Total Deliveries)
An 18% decrease in the scheduled C/S rate (Scheduled C-sections/Total Deliveries)

7. 94%*
*Comparison is difference between
Q & Q4 2013
The denominator on this slide is total deliveries. The labeled data points are for 12/2010 and 12/2013. Q aggregate rate is 5.91%. Q aggregate rate is 0.37%. There was a 94% decrease in rate between those two periods.
Q also showed an 94% decrease from Q1 2011
There was no change in rate from Q to Q3 2013

8. Baseline Data: Dec 2010 – March 2011 --
October – December 2013
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.
34 Hospitals
6 Hospitals
17 Hospitals

9. October - December 2013 <300 300 - 499 500 - 999 1000+ 7 11 5
Each bar represents a hospital
Hospitals’ individual reports indicate their bar by an arrow
<300
1000+ 7 11 5
ORANGE number = approximate number of annual deliveries GREEN number = number of hospitals reporting zero rate

10. Scheduled Deliveries <39 Weeks
October – December 2013
Scheduled deliveries at < 39 weeks. All 51 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 at <37 weeks without an indication and 4 scheduled C/S at < 37 weeks without an indication reported—5 non-medically indicated scheduled deliveries for preterm births.

11. Scheduled Deliveries <39 Weeks
October – December 2013 46
The indicated area contains our target areas—scheduled cesareans and inductions at < 39 weeks without a documented medical indication.
This area accounts for 3.2% of our scheduled deliveries at < 39 weeks—38, 37 or < 37 weeks
As you can see, there was 1 induction at <37 weeks without an indication and 4 scheduled C/S at < 37 weeks without an indication reported.
Of scheduled deliveries (inductions and c-sections) <39 weeks without a documented indication:
33 (72%) were at 38 weeks
8 (17%) were at 37 weeks
5 (11%) were <37 weeks
3.2% 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 49 hospitals. This line graph represents each quarter
This represents 49 hospitals. This line graph represents each quarter. Of the 51 whose data we are including in the Q report, 2 hospitals had a zero denominator (no cases in the measure population).
65% decrease from Q to Q4 2013

14. This represents 49 hospitals. This line graph represents each month
This represents 49 hospitals. This line graph represents each month. Of the 51 whose data we are including in the Q report, 2 hospitals had a zero denominator (no cases in the measure population).

15. October – December 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).

16. overlaid with corresponding hospital’s Core Measure Rate
October – December 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 rates range from 0 – 22.2%. This depicts how a smaller denominator is likely to yield a higher rate, unless the numerator is 0.

17. October – December 2013 29 Hospitals 20 Hospitals
Each bar represents one of the 49 hospitals that had a rate (2 of the 51 that reported PC-01 data did not have any cases in the measure population (denominator), and therefore do not have a rate represented). 29/49 (59%) had a 0% rate.
29 Hospitals
20 Hospitals

18. Oklahoma Birth Certificate Data

19. This data is from Oklahoma Vital Records
This data is from Oklahoma Vital Records. 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 Q3 2013
Provided by Oklahoma Vital Records

20. 3%* 9%* 3%* 12%* *comparison is Q1 2011 to Q3 2013 EWC Begins
Induction – Weeks
9%*
Induction – Weeks
3%*
Augmentation – Weeks
This slide also represents Oklahoma birth certificate data representing ALL Oklahoma singleton births. Note the 2013 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 3% increase in augmentations.
Augmentation – Weeks
12%*
EWC Begins
*comparison is Q to Q3 2013
Provided by Oklahoma Vital Records