Transcript C-section Rates - Dr. Jeff Thompson

What’s the Goal?
Jeff Thompson, MD MPH
Chief Medical Officer,
Washington State Health Care Authority
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What’s the trend?
Medicaid Maternity Expenditures WA State C-Section
and Vaginal Deliveries 1989-2009
$12,000
45,000
$10,000
35,000
$8,000
30,000
25,000
$6,000
20,000
$4,000
15,000
N of Medicaid Deliveries
Ave. Maternity Care Cost per Delivery
40,000
10,000
$2,000
5,000
$0
0
Ave. C-Section Cost
Washington State
Department of Social
& Health Services
Ave. Vaginal Cost
N of Medicaid Deliveries
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What About this Variation
Thing?
1(http://www.doh.wa.gov/ehsphl/chs/chs-data/public/CSectionsInWA.pdf)
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
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What works to Elective Reduce C-sections,
Inductions and < 39 week delivery?
Interventions that work
Interventions that do not work
Improve VBAC use
Feedback and audit
Mandatory second opinions
Enforceable Guidelines
Financial incentives/disincentives
Community based care and alternative
provider models
Planned home birth / Midwives
Continuous labor support
Tort reform
Multifaceted interventions
Provider education
Computer assisted evaluation of labor
Outcomes management
Exercise
Early labor assessment
Decision aids
Patient education
Opinion leaders
Strategies to Reduce Cesarean Sections: Oregon Health and Science University
4
Using Birth Certificates – All Births
can be tracked
Feedback
Reporting: on the
< 39 weeks
program is
showing some
success!
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What’s the Goal!
Washington State
Department of Social
& ealth Services
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