Quality of Care Measures for Women During Pregnancy, Labor and Delivery
The Department of Obstetrics and Gynecology at Cedars-Sinai is dedicated to providing high quality patient care . A variety of measures of quality of care are monitored continuously at Cedars-Sinai.
These measures include:
- Prenatal Testing
- Safe and Effective Care During the Delivery
- Pain Management
- Patient Satisfaction
Knowing if -- and what kind -- of risk factors exist helps the obstetrician plan the care of a pregnant woman and her newborn. This helps assure the best outcomes for both mother and child during pregnancy, labor and delivery. The table below reflects the performance of the Cedars-Sinai Prenatal Diagnosis Center on measures of quality care for pregnant women who are referred for concerns about genetic disorders (including women age 35 or older).
|Caring for Pregnant Women Age 35 and Older at the Cedars-Sinai Prenatal Diagnosis Center||2009||2010||2011|
|Number of referrals for genetic screens done during the first six months of pregnancy (including noninvasive screening tests*)||Not available||2,200||1,895|
|Number of women receiving chorionic villus samples (CVS)**||1,656||1,506||1,375|
|The percentage of CVS samples for which a preliminary result is requested and returned to the doctor in three days. (The goal is to have 95% of samples returned in three days.)||100%||100%||100%|
* Noninvasive screening tests done during the first three months of pregnancy are measuring the fetus' neck (nuchal fold) and blood tests on the moth. Noninvasive screening tests during the second three months are genetic sonograms in cases where the mother refused invasive testing such as chorionic villus sampling or amniocentesis during the first or second three months of pregnancy respectively.
**Chorionic villus sampling takes a small sample of placental tissue to examine for genetic abnormalities such as Down syndrome or chromosomal conditions
More than 6,000 deliveries are performed at Cedars-Sinai Medical Center annually.
When a woman delivers a baby vaginally there are fewer possible complications for both mother and child. In some circumstances, it is necessary to intervene with surgery by delivering the baby using a cesarean section.
If this occurs during a woman's first pregnancy, it is considered a primary cesarean delivery, and it puts the woman at increased risk for complications in future pregnancies (such as repeat cesarean delivery). Hence, a quality goal is to have a low percentage of first births by cesarean section (low primary cesarean rate).
Sometimes during labor and delivery, the obstetrician will do a surgical procedure called an episiotomy. The obstetrician makes an incision to widen the vaginal opening to make it easier for the baby's head to come through. At Cedars-Sinai, the goal is to have a low rate of episiotomies because they can increase the risk of nearby tissue tearing (third or fourth degree lacerations). Low percentages of these types of lacerations are an indicator of quality of care as the tearing can increase the risk of complications.
|Quality Measures for Delivery Care||Cedars-Sinai 2012||Nationally|
|Number of women having their first delivery by cesarean section among all women who are at risk of having their first delivery by cesarean section (primary cesarean rate).*||28.1%||23.6%1|
|Total number of women having a cesarean (either a primary or a repeat cesarean)||36.9%||32.8%2|
|Percentage of women who successfully deliver vaginally after having once had a cesarean (VBAC)||13.8%||9.2%2|
|Percentage of women who have an episiotomy during delivery.|
A low number is better than a higher one.
|Percentage of women who have a severe vaginal or rectal laceration (tear). These are known as third or fourth degree lacerations.||2.7%||3.25%|
|Percentage of women who deliver premature babies (after 24 to 34 weeks of pregnancy), who were given steroids before the birth to improve the outcomes for the infant. |
A high percentage is better than a lower one.
|Percentage of women who have elective deliveries before 39 weeks.|
A low number is better than a higher one.
Fear of a painful labor and delivery can cause some women anxiety about giving birth. In managing labor pain, an obstetrician has to weigh the benefits of less pain and anxiety during labor with the effects of the various pain management options on the mother and the infant.
Sensitivity and reactions to pain are highly individual. An important measure of the quality of care a pregnant woman received is her perception of how well her labor pains were managed during delivery. The chart below compares the responses of women who gave birth at Cedars-Sinai Medical Center on a survey about the quality of care they received with the average responses of women surveyed by the Picker Institute.
The chart below compares the percentage of Cedars-Sinai patients who stated that they had the right amount of pain medicine compared to percentage of women delivering babies nationally, based on Picker scores.
Breastfeeding results in improved infant and maternal health outcomes1. The longer a baby is exclusively breastfed, the greater the protection. This includes:
- A decreased risk of respiratory infections, ear infections, and gastrointestinal infections.
- A reduced risk of asthma, allergies including atopic dermatitis, and celiac disease.
- A reduction in the incidence of type 1 and type 2 diabetes.
- Significantly lower rates of obesity in infants who are breastfed.
- A reduction in childhood leukemia and lymphoma correlated to length of breastfeeding.
Mothers also enjoy short- and long-term health benefits including:
- Decreased postpartum blood loss and a more rapid return to her pre-pregnant state.
- Reduced risk of rheumatoid arthritis, adult cardiovascular disease, diabetes, premenopausal breast cancer, and ovarian cancer.The longer a woman breastfeeds, the greater the reduction in the above diseases.
Because of these benefits, a national quality goal is to encourage and support women who want to breastfeed. Healthy People 2020, a national initiative to reduce preventable threats to Americans' health, has set a national goal of having 81.9% of women breastfeed their babies soon after birth.
The following table shows how many women initiated breastfeeding while at Cedars-Sinai Medical Center and how many women were exclusively breastfeeding at discharge.
Initiation of breastfeeding at Cedars-Sinai consistently exceeds the national goals of 81.9% as established by the Healthy People 2020 Initiative.
|In-Hospital Breastfeeding Rates2||Jan-Mar 2012||Apr-June 2012||Jul-Sep 2012||Oct-Dec 2012|
|Percentage of women who initiated breastfeeding during hospital stay||96%||94%||96%||96%|
|Percentage of women who were exclusively breastfeeding at discharge||72%||75%||74%||73%|
1Eidelman AI, Schanler RJ, et al; American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012; 129:e827-e841
2 Excludes babies who were discharged from the Neonatal Intensive Care Unit, and other specific conditions. We use the exclusions developed by The Joint Commission, a national organization whose mission is "to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value."
Women who delivered babies at Cedars-Sinai Medical Center were asked two questions about their experience as patients at the Medical Center:
- Overall rating of the care they received. The women were asked to rate their experience on a 10-point scale, with 10 being "best hospital possible."
- Willingness to recommend the hospital. The women were asked to rank the hospital on a 10-point scale, with 10 being "best hospital possible."
The chart below shows the percentage of women who rated the care they received during labor and delivery as 9 or 10.
The chart below shows patient rankings of Cedars-Sinai Medical Center for obstetrical care compared to patient rankings nationwide.