253497 Decreasing the cesarean section rate in Los Angeles County (LAC)

Sunday, October 30, 2011

Shayla Livingston, MPH Candidate , Reproductive Health, Los Angeles County Department of Public Health, Los Angeles, CA
Diana E. Ramos, MD, MPH , Reproductive Health, Los Angeles County-Department of Public Health, Los Angeles, CA
Shin Margaret Chao, PhD, MPH , Maternal, Child, & Adolescent Health, Los Angeles County-Department of Health Services, Los Angeles, CA
Giannina M. Donatoni, PhD, MT(ASCP) , Maternal, Child, and Adolescent Health, Los Angeles County Department of Public Health, Los Angeles, CA
Cynthia Harding, MPH , Maternal, Child and Adolescent Health, Los Angeles County Department of Public Health, Los Angeles, CA
BACKGROUND Los Angeles County, with over 150,000 deliveries annually, has a 37% c-section rate, the highest in California and well above the 32% national average in 2008. Information on drivers for c-section are limited to vital records and ICD-9 discharge code studies. METHODS A three pronged approach focusing on hospitals, providers and patient education was developed. A total of 3,500 c-section and matched vaginal delivery charts from LAC's highest primary c-section hospitals, analyzing factors not typically captured by vital records and ICD-9 codes, was conducted. An obstetrics provider survey to understand reasons and motivators for performing c-sections was disseminated throughout LAC. A focus group on a patient education brochure about the risks of- and preventive strategies for- c-section was produced. RESULTS Initial chart review demonstrates discordance between ICD-9 codes and charted indicators for primary c-sections. Preliminary provider survey results demonstrate that respondents believe c-section rates in their hospitals are too high and that the threat of litigation is a major driver for c-sections. Feedback from the consumer focus group highlighted that not enough education is being provided to women about risk factors for c-section and interventions to prevent a c-section. DISCUSSION Results from a concerted effort to understand c-section drivers from a hospital, provider and consumer perspective will be used by LAC to develop initiatives to reduce the c-section rate. Obstetric providers, obstetric payers, hospitals and consumers will be critical in addressing the c-section rate.

Learning Areas:
Administer health education strategies, interventions and programs
Implementation of health education strategies, interventions and programs
Public health or related research

Learning Objectives:
1. List the most common methods used to evaluate c-section rates. 2. Discuss novel approaches to understanding high c-section rates. 3. List potential interventions to address the c-section rate in LAC.

Keywords: Quality of Care, Maternal Morbidity

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified because I worked on the design and implementation of the patient education, provider survey and chart review study while working for LA County Department of Health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.