inspiring change through quality initiatives
the local and national efforts to end non medically indicated inductions prior to 39 weeks' gestation,which have met with success in many regions of the United States,are laudable but do not go far enough.Improving neonatal outcomes was the main motivation for these initiatives because it was recognized that those neonates who were born after non medically indicated inductions and planned cesareans that occurred before 39 0/7 weeks' gestation suffered higher rate of morbidity than did those born after 39 0/7 weeks' gestation. The collaboration in the past decade of maternity care stakeholders to decrease non medically indicated inductions before 39 weeks' gestation serves as an example of how clinical practices that have become widespread but lack evidence of benefit can be changed. These stakeholders, including the Joint Commission, the Center for Medicaid and medicare Services, the March of Dimes, and state-based collaboratives, have led successful nation wide,state wide,state wide, or systems-wide quality improvement initiatives. Since January 2014,all hospitals with 1100 or more births annually are required by the Joint Commission to report data on 5 perinatal care core measures.The Joint Commission, a not for profit organization accrediting more than 17,000 US health care organization, develops performance measure sets that identify target areas for performance improvement. The core measures do not have specific goals to achieve; rather.they allow the joint Commission to measure hospital improvement over time compare performance to similar institutions. The perinatal core measure set includes 5 measures: 1) elective birth before 39 weeks' gestation ; 2)administration of antenatal steroids to women at risk of preterm birth between 24 and 34 weeks' gestation; 3)health care associated bloodstream infections in newborns; 4)exclusive breast milk feeding; and 5)the nulliparous, term, singleton,vertex (NTSV) cesarean rate. The selection of these measures emphasizes their importance as indication of high quality care and high priority areas for change, if we are to make progress toward meeting national health goals. The perinatal core measures on electives induction and cesareans have the potential to increase the number of women who experience spontaneous labor and decrease the NTSV cesareans rates. Both of these measures can be used to push for the increased scrutiny of routine intrapartum care practices that are used without the careful examination of medical need and to inspire institutional policies that promote physiologic labor and birth.