ArticleJoint Commission journal on quality and patient safety2017
Quality Improvement Initiatives Lead to Reduction in Nulliparous Term Singleton Vertex Cesarean Delivery Rate.
Article in Joint Commission journal on quality and patient safety, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- Caesarean section in uninsured women in the USA: systematic review and meta-analysis.BMJ open · 2019Pooled it
- Disparities in indication for primary cesarean delivery before and after implementation of quality initiatives.Pregnancy (Hoboken, N.J.) · 2026Article
- Racial and Ethnic Disparities in Cesarean Birth Trends in the United States.JAMA network open · 2025Observational
- Contemporary Trends in Operative Vaginal Delivery and Obstetric Anal Sphincter Injuries from 2016-2023.Pregnancy (Hoboken, N.J.) · 2025Article
- Adherence to Labor Arrest and Failed Induction of Labor Guidelines: The Impact of a Quality-Improvement Educational Intervention.Journal of clinical medicine · 2024Article
- Reducing primary cesarean delivery rate through implementation of a smart intrapartum surveillance system.NPJ digital medicine · 2023Article
- The evolution of the labor curve and its implications for clinical practice: the relationship between cervical dilation, station, and time during labor.American journal of obstetrics and gynecology · 2023Review
- Leadership Driven Persistent Reduction in Cesarean Trends: An Interventional Study for Quality Improvement.Journal of obstetrics and gynaecology of India · 2023Article
- Benchmarking cesarean delivery rates using machine learning-derived optimal classification trees.Health services research · 2022Article
- Language Preference and Risk of Primary Cesarean Delivery: A Retrospective Cohort Study.Maternal and child health journal · 2021Article
- Do quality improvement projects require IRB approval?Journal of perinatology : official journal of the California Perinatal Association · 2021Article
- Cesarean delivery in low- and middle-income countries: A review of quality of care metrics and targets for improvement.Seminars in fetal & neonatal medicine · 2021Review
- Long-term effects of the nine-item list intervention on obstetric and neonatal outcomes in Robson group 1 - A time series study.Acta obstetricia et gynecologica Scandinavica · 2021Article
- Preventing Cesarean Birth in Women with Obesity: Influence of Unit-Level Midwifery Presence on Use of Cesarean among Women in the Consortium on Safe Labor Data Set.Journal of midwifery & women's health · 2020Article
- Effect of a two-stage intervention package on the cesarean section rate in Guangzhou, China: A before-and-after study.PLoS medicine · 2019Article
- WHEN LESS IS MORE: SHIFTING RISK MANAGEMENT IN AMERICAN CHILDBIRTH.Advances in medical sociology · 2019Article
- Differences in Cesarean Rates for Nulliparous, Term, Singleton, Vertex Births Among Racial and Ethnic Groups and States Before and After Stay-at-Home Orders During the COVID-19 Pandemic, United States, 2017-2021.Public health reports (Washington, D.C. : 1974)Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 1 institution in 2 countries.
Funding
Abstract
backgroundThe nulliparous term singleton vertex (NTSV) cesarean delivery rate has been recognized as a meaningful benchmark. Variation in the NTSV cesarean delivery rate among hospitals and providers suggests many hospitals may be able to safely improve their rates. The NTSV cesarean delivery rate at the authors' institution was higher than state and national averages. This study was conducted to determine the influence of a set of quality improvement interventions on the NTSV cesarean delivery rate.
methodsFrom 2008 through 2015, at a single tertiary care academic medical center, a multi-strategy approach that included provider education, provider feedback, and implementation of new policies was used to target evidence-based and inferred factors that influence the NTSV cesarean delivery rate. Data on mode of delivery, maternal outcomes, and neonatal outcomes were collected from birth certificates and administrative claims data. The Cochran-Armitage test and linear regression were used to calculate the p-trend for categorical and continuous variables, respectively.
resultsMore than 20,000 NTSV deliveries were analyzed, including more than 15,000 during the intervention period. The NTSV cesarean delivery rate declined from 35% to 21% over eight years. The total cesarean delivery rate declined as well. Increase in meconium aspiration syndrome and maternal transfusion were observed.
conclusionQuality improvement initiatives can decrease the NTSV cesarean delivery rate. Any increased incidence of fetal or maternal complications associated with decreased NTSV cesarean delivery rate should be considered in the context of the risks and benefits of vaginal delivery compared to cesarean delivery.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.