Oklahoma Aggregate Data 2nd Quarter 2013 April 1 – June 30, 2013 Every Week Counts Oklahoma Aggregate Data 2nd Quarter 2013 April 1 – June 30, 2013

April – June 2013 This represents 52/54 EWC Hospitals. This includes data from Moore Medical Center through April. When Moore Medical Center was lost on May 20th, that brought the count of Oklahoma birthing hospitals to 57 (53 in EWC). 94 total for the quarter 135 for Q1 2013--~1.5/day ~1/day

~8/day ~1/day Qtr 1 2011: January 1 – March 31, 2011 Qtr 2 2013: April 1 – June 30, 2013 Number of births in red area for baseline data (Q1 2011) is 680; Number of births in red area for Q2 2013 is 94—a decrease of 86% in number of scheduled births that were non-medically indicated prior to 39 weeks of participating hospitals.

41% 29% *Comparison is difference between Q1 2011 & Q2 2013 The denominator on this slide is total scheduled C/S. 2.4% of the scheduled c-sections in Q2 2013 were <39 weeks without a documented indication. This is down 85% from the rate of 16.2% in Q1 2011. 85%

15%* 15%* *Comparison is difference between Q1 2011 & Q2 2013 The denominator on this slide is total inductions. 1.1% of the inductions in Q2 2013 were <39 weeks without a documented indication. This is down 86% from the rate of 7.9% in Q1 2011. 86%*

86%* *Comparison is difference between Q1 2011 & Q2 2013 The denominator on this slide is total deliveries. The labeled data points are for 12/2010 and 6/2013. Q1 2011 aggregate rate is 5.91%. Q2 2013 aggregate rate is 0.8%. There was an 86% decrease between those two periods. Q1 2013 showed an 81% decrease from Q1 2011

April – June 2013 30 Hospitals 22 Hospitals Baseline Data: Dec 2010 – March 2011 -- Purple line represents area covered by baseline data. Each bar represents a hospital. Hospitals’ individual reports indicate their bar by an arrow. 30 Hospitals 6 Hospitals 22 Hospitals

April – June 2013 Each bar represents a hospital Hospitals’ individual reports indicate their bar by an arrow <300 300 - 499 500 - 999 1000+ 8 9 4 ORANGE number = approximate number of annual deliveries GREEN number = number of hospitals reporting zero rate

Scheduled Deliveries <39 Weeks April – June 2013 Scheduled deliveries at < 39 weeks. 52 hospitals reported on this. The graph legend begins at the upper right section of the pie and works around clockwise. As you can see, there was 1 induction and 2 scheduled c-sections <37 weeks without a medical indication reported for this period. As you can see, we had 2 inductions at <37 weeks without an indication and 4 scheduled C/S at < 37 weeks without an indication.

Scheduled Deliveries <39 Weeks April – June 2013 The indicated area contains our target areas—scheduled cesareans and inductions at < 39 weeks without a documented medical indication. This area accounts for 7.1% of our scheduled deliveries at < 39 weeks—38, 37 or < 37 weeks 95 7.1% of Scheduled Deliveries <39 weeks do not have a documented indication

TJC Perinatal Care Core Measure* PC-01: Elective Delivery *Data collected via the EWC Data Collection Tool is used to estimate TJC PC-01 Data.

This represents 46 hospitals This represents 46 hospitals. Of the 52 whose data we are including in the Q2 2013 report, 4 hospitals did not report core measure data and 2 hospitals had a zero denominator (no cases in the measure population). 30% decrease from Q3 2012 to Q2 2013

This represents 46 hospitals This represents 46 hospitals. Of the 52 whose data we are including in the Q2 2013 report, 4 hospitals did not report core measure data and 2 hospitals had a zero denominator (no cases in the measure population).

April – June 2013 Total Bar = Denominator (Measure Population) Red Section = Numerator (Non-medically Indicated Scheduled Deliveries) (# indicates number of non-medically indicated scheduled deliveries) Blue Section = Remainder (Non-scheduled Deliveries) This graph reflects the variation in volume of 37 & 38 week deliveries. The total bar represents the denominator or measure population. The red section of the bar represents the numerator, those in the measure population (denominator) that were delivered by induction or scheduled c-section. The blue section of the bar represents the remainder of the measure population (not a scheduled delivery).

overlaid with corresponding hospital’s Core Measure Rate April – June 2013 overlaid with corresponding hospital’s Core Measure Rate Hospitals with smaller denominators are more likely to have higher rates, unless the numerator is zero. The is the same graph as before with the corresponding hospital’s Core Measure Rate overlaid. The values range from 0 – 100%. This depicts how a smaller denominator is likely to yield a higher rate, unless the numerator is 0.

April – June 2013 24 Hospitals 22 Hospitals Each bar represents one of the 46 hospitals that had a rate (2 of the 48 that reported PC-01 data did not have any cases in the measure population (denominator), and therefore do not have a rate represented). 24/46 had a 0% rate. 24 Hospitals 22 Hospitals

Oklahoma Birth Certificate Data Provisional April 2009 – June 2013

10%* 14%* 39-41 weeks 36-38 weeks EWC Begins This slide represents provisional Oklahoma birth certificate data representing ALL Oklahoma births. It validates our EWC data, as it indicates an overall increase in births at 39-41 weeks and a decrease in births at 36-38 weeks *comparison is Q1 2011 to Q2 2013 Provisional Data provided by Oklahoma Vital Records

1%* 10%* 15%* 11%* *comparison is Q1 2011 to Q2 2013 EWC Begins Induction – 39-41 Weeks 1%* 10%* Induction – 36-38 Weeks Augmentation – 36-38 Weeks 15%* This slide also represents provisional Oklahoma birth certificate data representing ALL Oklahoma births. The 15% increase in augmentations at 36-38 weeks is concerning. Could this mean that some women who were previously “induced” at 36-38 weeks are now being “augmented” at 36-38 weeks? Please examine this area in your hospital—are you also seeing an increase in augmentations at 36-38 weeks? If so, you may need to look at this more closely. It is generally agreed that augmentation refers to stimulation of contractions after labor has begun or after spontaneous rupture of membranes. In its June 2003 Practice Bulletin #49 (still current), “Dystocia and Augmentation of Labor” , ACOG states, “Augmentation refers to stimulation of uterine contractions when spontaneous contractions have failed to result in progressive cervical dilation or descent of the fetus.” There is also a statement in the beginning of this document stating, “This document focuses on labor subsequent to entering the active phase,…..”. Please take a closer look at labor augmentations in your hospital. Augmentation – 39-41 Weeks 11%* EWC Begins *comparison is Q1 2011 to Q2 2013 Provisional Data provided by Oklahoma Vital Records