In the Literature: A statewide initiative in Ohio reduces scheduled births before 39 weeks with no documented medical indication

This project was selected from among many reported in the peer reviewed literature. For a list of more articles on quality improvement, visit our resource bibliography.

Article Citation

Donovan EF, Lannon C, Bailit J, Rose B, Iams JD, Byczkowski T; Ohio Perinatal Quality Collaborative Writing Committee. A statewide initiative to reduce inappropriate scheduled births at 36(0/7)-38(6/7) weeks’ gestation, Am J of Obstet Gynecol. 2010; 202(3), 243.e1-8 [abstract]

Name of Organization, Agency, or Institution

Ohio Perinatal Quality Collaborative

Project Aim and Goals

A quality collaborative consisting of twenty hospitals in the state of Ohio representing 47% of all births in the state came together to reduce the number of scheduled births occurring before 39 weeks gestation without an appropriate documented medical indication.

Approach and Activities

Interdisciplinary teams from each hospital championed the initiative in their sites, and participated in regular meetings and learning sessions.  Key drivers for change were agreed upon, drawing upon research evidence, ACOG clinical guidelines, and other successful projects reported in the literature, and the teams used improvement techniques derived from the Institute for Healthcare Improvement Breakthrough Series.


The collaborative reported that the rate of scheduled births taking place between 36 and 39 weeks gestation decreased significantly from 25% to <5% in participating hospitals in one year.  Birth certificate data in the corresponding period showed a significant decrease in the mean rate of inductions with no indication from 13% to 8%.

Blueprint Area(s) Addressed

Strategies Used

Filed in Blueprint, Clinical controversies, Clinical practice guideline/policy change, Community education/outreach, Educational materials for health professionals, In the Literature, Performance measurement, Performance measurement/reporting, Team building on Sun., Mar 6, 2011

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