Wednesday, March 12, 2014

Systematic reform in medicine - the case of early elective delivery might offer a model

This interesting article in the New York Times tells the story of the dramatic reduction in early elective deliveries since 2010. This is not something I've followed before, but apparently early elective delivery (meaning an induced delivery or elective cesarean section before 39 weeks gestation that is not medically necessary) accounted for 17% of all births in 2010.

Although early elective delivery had been identified as an unsafe practice in 1979 and medical groups and non governmental organizations had lobbied for years for reform, the changes to practice have been slow. Yet since 2010, there has been a 73% decline in these procedures and the national average last year was 4.6%.

This article provides a good description of some of the catalyzing factors, including a couple of scientific articles offering examples of how hospitals had reduced the practice, increased pressure to measure the incidence of these procedures, and leadership by two states, South Carolina and Texas, to dramatically reduce their rates. South Carolina, for example, assembled a team of providers from all hospitals in the state. The team meets monthly and best practices are shared and challenges are discussed. Then, after a couple years of that, the state stopped payments to hospitals (through Medicaid and the main private insurer) for early elective deliveries. Over the following 6 months, rates dropped by 45%.

This is a nice example of how concerted efforts to produce reform can lead to real changes.

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