Clinical controversies

From the Field: Promoting The Birth Survey

Women of childbearing age need accurate, objective data in order to make informed choices about birth settings and providers. The Birth Survey, a mechanism to share, systematically track, and retrieve up-to-date information about the quality of care received will equip consumers with the information necessary to make informed decisions and enable individuals to play a larger role in determining their care and to make real informed health care choices.

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Filed in Blueprint, Clinical controversies, Community education/outreach, Consumer advocacy or political action, Decision making and choice, Performance measurement, Performance measurement/reporting, Strategies on Tue., Jul 17, 2012

From the Field: National Rally for Change

Our goal is to reduce the unnecessary induction and c-section rate in the US. This first project is meant to raise awareness and consciousness to the mainstream public. Our desire was for an event on such a mass scale that all major media outlets would pick up the story and continue to do stories both before and after the event.

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Filed in Clinical controversies, Community education/outreach, Decision making and choice, Progress, Stories from the Field on Wed., Mar 28, 2012

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From the Field: Practice Guidelines for Trial of Labor after Cesarean

As a Patient-Centered Maternity Home, two components of our Maternal-Child Health Care are evidence-based practice and shared decision-making. While ACOG guidelines are not always evidence-based, they have recently released guidelines allowing us all to offer trial of labor to women with two prior cesareans or twins. Our cesarean rate is 19% and our VBAC rate is 50%. North Carolina Medicaid is currently reimbursing cesarean birth at the same rate as vaginal birth.They were proactive in setting the rates pretty close to each other in years past.

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Filed in Clinical controversies, Clinical practice guideline/policy change, New care delivery model, Performance measurement/reporting, Scope of covered services, Shared decision making, Stories from the Field on Tue., Sep 20, 2011

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From the Field: Home Birth Consensus Summit

Safety of birth in any setting is of utmost priority. Maternity care providers and researchers in the U.S. disagree about appropriate settings for birth. Ultimately, women and families are ill-served by inter-professional conflict. The current debate on home birth indicates the need for constructive discussion and consensus-building. Successful collaboration between health professionals has been found to result in improved experience and outcomes for consumers.

The Home Birth Consensus Summit will be organized in a way that is most likely to foster the dialogue needed to find common ground and spark constructive action that will ultimately benefit all stakeholder groups. This summit will encourage dialogue among health care professionals, consumers, policy makers, and other leaders from disciplines that support maternity care, with the shared goal of identifying a common agenda for the provision of birth services in the U.S.

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Filed in Care coordination, Clinical controversies, Decision making and choice, Disparities, Stories from the Field on Fri., Sep 16, 2011

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From the Field: The Safe Motherhood Quilt Project

The Safe Motherhood Quilt Project, originated by midwife Ina May Gaskin, is a national effort developed to draw public attention to the current maternal death rates, as well as to the gross underreporting of maternal deaths in the United States. The Quilt honors American mothers who have died of pregnancy or childbirth related causes since 1982, the last year there was a reduction in maternal mortality.

The goal of the Safe Motherhood Quilt Project is to demand an equivalent system of counting, analyzing, and learning from mistakes made in our maternity care system here, regardless of where babies are born or what caregiver is the birth attendant. Until we do that, doctors, midwives, and nurses in the US will continue to work without a good system of feedback about what is and is not dangerous in maternity care, and preventable maternal deaths will continue to take place.

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Filed in Clinical audit, case review, or analysis of adverse events, Clinical controversies, Community education/outreach, Consumer advocacy or political action, Disparities, Educational materials for health professionals, Health information technology, Improved liability system, Performance measurement, Performance measurement/reporting, Stories from the Field, Team building on Mon., Sep 12, 2011

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From the Field: Empowering women with information and support

We want to change childbirth options in our area. Of the five local hospitals in our area only one will allow planned VBACs. Also, the c-section rate for first time moms with no complications during pregnancy is an average of 33% in our area. We want to change this! So we are reaching out to the pregnant and new moms in our area by hosting a monthly support group where we focus on the topic surrounding childbirth and the options that are actually available to them. We look to make a change one mom at a time and build a community of families that support each other and empower each other.

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Filed in Clinical controversies, Community education/outreach, Decision making and choice, Disparities, Shared decision making on Wed., Aug 10, 2011

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From the Field: Eliminating Preventable Perinatal Injuries and Reducing Malpractice Claims and Costs: Creating High Reliability Obstetrics Units

We intend to reduce perinatal harm and decrease malpractice events by eliciting improved compliance in 4 clinical care bundles and implementation of an evidence-based simulation training methodology focused on improving clinical staff’s ability to work in teams. We are measuring our impact through a culture of safety survey and a high reliability survey, various outcomes measures.

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Filed in Blueprint, Care coordination, Clinical audit, case review, or analysis of adverse events, Clinical controversies, Clinical practice guideline/policy change, Decision making and choice, Health professions education, Improved liability system, Performance measurement, Performance measurement/reporting, Risk management/liability reform, Shared decision making, Skills training or drills for health professionals, Strategies, Team building on Mon., Aug 1, 2011

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In the Literature: At Intermountain, process improvement reduces inductions, cesareans, NICU admissions, and costs

As a result of process improvement efforts bolstered by robust information systems, the proportion of all inductions that lacked strong indications for clinical appropriateness fell from 28 percent to less than 2 percent. The project also resulted in decreases in both NICU admissions and cesareans, and Intermountain estimates that the elective induction protocol reduces health care costs in Utah by $50 million per year.

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Filed in Blueprint, Clinical audit, case review, or analysis of adverse events, Clinical controversies, Clinical practice guideline/policy change, Health information technology, Health information technology, In the Literature, Payment reform, Performance measurement, Performance measurement/reporting on Fri., Jul 29, 2011

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From the Field: Becoming a Baby Friendly Facility

We wanted to design a center where the needs of the mother and the baby come first. A place where every aspect of care is based on supporting natural birth and breastfeeding.

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Filed in Care coordination, Clinical controversies, Clinical practice guideline/policy change, Decision making and choice, Disparities, Educational materials for health professionals, Performance measurement/reporting, Shared decision making, Skills training or drills for health professionals, Staffing/care coordination change, Stories from the Field, Team building on Thu., Jul 14, 2011

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From the Field: The Birth Trust

The Birth Trust provides funding for projects that advance midwifery and woman-centered childbirth or reduce birth disparities through educational, policy, and research projects. The Birth Trust is a grant-making fund where donors and birth activists commit a certain amount monthly and then vote and select which projects get funded. Since the Birth Trust launched in 2010, nine very diverse projects have been selected.

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Filed in Care coordination, Clinical controversies, Consumer advocacy or political action, Decision making and choice, Disparities, Educational materials for health professionals, Health professions education, New care delivery model, Nursing/medical/midwifery curriculum change, Payment/reimbursement change, Scope of covered services, Skills training or drills for health professionals, Stories from the Field on Tue., Jul 5, 2011

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