1

What’s the Goal?

Jeff Thompson, MD MPHChief Medical Officer,Washington State Health Care Authority

2

Washington StateDepartment of Social

& Health Services

What’s the trend? Medicaid Maternity Expenditures WA State C-Section and Vaginal Deliveries 1989-2009

3

What About this Variation Thing?

Cesarean rates rose significantly in each state from 1996 to 2007 In WA State Cesarean rates vary greatly by hospital and region using 2008 data •Level 3 Nursery Hospitals: 34% (range 18 – 39%)

•Level 2 Nursery Hospitals: 28% (range 23 – 36%)

•Level 1 Nursery Hospitals: 27%(range 10 – 39%)

Accounting for risk

factors WA still has

variation

1(http://www.doh.wa.gov/ehsphl/chs/chs-data/public/CSectionsInWA.pdf)

4

What works to Elective Reduce C-sections, Inductions and < 39 week delivery?

Interventions that work Interventions that do not work

Improve VBAC useFeedback and auditMandatory second opinionsEnforceable GuidelinesFinancial incentives/disincentivesCommunity based care and alternative provider modelsPlanned home birth / MidwivesContinuous labor supportTort reformMultifaceted interventions

Provider educationComputer assisted evaluation of laborOutcomes managementExerciseEarly labor assessmentDecision aidsPatient educationOpinion leaders

Strategies to Reduce Cesarean Sections: Oregon Health and Science University

5

Using Birth Certificates – All Births can be tracked

Feedback Reporting: on the

< 39 weeks program is

showing some success!

6

Washington StateDepartment of Social

& ealth Services

What’s the Goal!