From the Field: Obstetrics Clinical Outcomes Assessment Program (OB COAP)

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PROJECT TITLE

Obstetrics Clinical Outcomes Assessment Program (OB COAP)

NAME OF ORGANIZATION, AGENCY, OR INSTITUTION

Foundation for Health Care Quality (Washington)

PRIMARY CONTACT NAME AND TITLE

Kristin Sitcov, Program Director, and Ellen Kauffman, MD, Medical Director

PROJECT AIM AND GOALS

The Obstetrics Clinical Outcomes Assessment Program (OB COAP) is a clinician-led data collection and analysis initiative that uses chart-abstracted data of the variables relating to the management of a pregnant woman who delivers in the state of Washington. Its goal is to ensure that all women in the state of Washington receive the same evidence-based obstetrical care. OB COAP gathers the intrapartum data needed to optimize management of labor and delivery. The interventions commonly practiced in labor and delivery can be scrutinized as a function of practitioner, facility, gestational age, and presence/absence of medical and/or obstetrical complications. The response to the conversations generated by comparing the benefits and harms of management decisions will result in increased safety for the mother and the newborn, reduction in adverse outcome, and increased predictability, and can be the basis for educational efforts targeted to both patients and practitioners.

BLUEPRINT AREA(S) ADDRESSED

STRATEGIES USED

RESULTS

OB COAP just completed a 6 month pilot project analyzing data from 4 hospitals of varying sizes and level of care as well as representation from the home and birth center community. A few select results include:

  1. The incidence of breast feeding on discharge (an NQF guideline) is significantly lower among women who had a cesarean following induction – providing information on where to focus education and intervention efforts.
  2. There was a 2:1 increase in the rate of cesarean section among women who were admitted in the early phase of labor (<= 3 cm cervical dilation) as compared to the active stage of labor (>=4 cm cervical dilation). This was true for the population as a whole as well as for the NTSV population – suggesting that analyzing practice patterns regarding when to admit may be useful in lowering overall cesarean rates.
  3. There was a distinct relationship between higher BMI, higher rates of induction, higher incidence of planned cesarean, and overall cesarean section rates – shedding light on specific populations where further analysis of practice patterns may improve outcomes.

FOR MORE INFORMATION

Interested practitioners and hospitals can visit our website for additional information (http://www.obcoap.org) or contact us directly at ksitcov@qualityhealth.org.

OB COAP is now open for enrollment of all interested hospitals in the state of Washington. If hospitals or systems outside of WA state are interested in participating, please contact us for more information.

Filed in Blueprint, Clinical audit, case review, or analysis of adverse events, Clinical controversies, Decision making and choice, Disparities, Performance measurement, Performance measurement/reporting, Stories from the Field, Workforce on Wed., Apr 6, 2011

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