Every Week Counts Oklahoma Aggregate Data 2nd Quarter 2014: April – June 2014

April – June 2014 ~1 every 2 days This represents 50/52 EWC Hospitals. 41 total non-medically indicated scheduled deliveries < 39 weeks for the quarter (22 Inductions and 19 Scheduled C-Sections) 35 were reported in Q1 2014 This is a 16.4% INCREASE in the number of early, elective deliveries (EEDs) from Q1 2014 to Q2 2014. In Q1 2014, there was a birth of a non-medically indicated scheduled C/S or induction at < 39 weeks approximately 1 every 2.6 days. For Q2 2014, this increased to approximately 1 every 2.2 days. ~1 every 2 days

~8/day ~1 every 2 days Qtr 1 2011: January 1 – March 31, 2011 Qtr 2 2014: April 1 – June 30, 2014 Number of births in red area for baseline data (Q1 2011) is 680; Number of births in red area for Q2 2014 is 41—a decrease of 639 (93% decrease in number) scheduled births that were non-medically indicated prior to 39 weeks of participating hospitals.

26% 4% *Comparison is difference between Q1 2011 & Q2 2014 The denominator on this slide is total scheduled C/S. 0.9% of the scheduled c-sections in Q2 2014 were <39 weeks without a documented indication. This is down 94% from the rate of 16.1% in Q1 2011. 94%

15%* 11%* *Comparison is difference between Q1 2011 & Q2 2014 The denominator on this slide is total inductions. 0.5% of the inductions in Q2 2014 were <39 weeks without a documented indication. This is down 93% from the rate of 7.9% in Q1 2011. 93%*

2% 0.4% 2.5% 9% Comparison is Q1 2011 to Q2 2014 This slide represents changes in care practices when comparing Q1 2011 to Q2 2014. EWC data from participating hospitals show: A 2% increase in births that did not include induction or scheduled C/S A 0.4% decrease in the induction rate for women who intended to deliver vaginally (Inductions/Total Deliveries-Scheduled C/S) A 2.5% increase in the overall induction rate (Inductions/Total Deliveries) A 9% decrease in the scheduled C/S rate (Scheduled C-sections/Total Deliveries)

94%* *Comparison is difference between Q1 2011 & Q2 2014 The denominator on this slide is total deliveries. The labeled data points are for 12/2010 and 6/2014. Q1 2011 aggregate rate is 5.92%. Q2 2014 aggregate rate is 0.36%. There was a 94% decrease in rate between those two periods. Q1 2014 showed an 95% decrease from Q1 2011 There was 16.4% increase in rate from Q1 2014 (0.31%) to Q2 2014 (0.36%)

Baseline Data: Dec 2010 – March 2011 -- April – June 2014 Baseline Data: Dec 2010 – March 2011 -- Purple line represents area covered by baseline data. Each bar represents a hospital. Red is scheduled C/S and blue is inductions. Hospitals’ individual reports indicate their bar by an arrow. 35 Hospitals 6 Hospitals 15 Hospitals

April - June 2014 Each bar represents a hospital Hospitals’ individual reports indicate their bar by an arrow <300 300 - 499 500 - 999 1000+ 6 12 5 ORANGE number = approximate number of annual deliveries GREEN number = number of hospitals reporting zero rate

Scheduled Deliveries <39 Weeks April – June 2014 Scheduled deliveries at < 39 weeks. All 50 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 were 2 inductions at <37 weeks without an indication, a non-medically indicated scheduled delivery for preterm birth.

Scheduled Deliveries <39 Weeks April – June 2014 The indicated area contains our target areas—scheduled cesareans and inductions at < 39 weeks without a documented medical indication. This area accounts for 2.7% of our scheduled deliveries at < 39 weeks—38, 37 or < 37 weeks As you can see, there were 2 inductions at <37 weeks without an indication reported. There were 0 scheduled C/S at < 37 weeks without an indication reported. Of scheduled deliveries (inductions and c-sections) <39 weeks without a documented indication: 36 (88%) were at 38 weeks 3 (7%) were at 37 weeks 2 (5%) were <37 weeks 41 2.7% 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 line graph represents each quarter This represents 46 hospitals. This line graph represents each quarter. Of the 50 whose data we are including in the Q2 2014 report, 1 hospital had a zero denominator (no cases in the measure population) and 3 hospitals did not report PC-01. 64% decrease from Q3 2012 to Q2 2014

April – June 2014 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). The higher the total bar, the higher the number of deliveries at 37 & 38 weeks in the measure population. The larger the red section of the bar, the higher the number of EEDs. Some births in the red section could be a mother with a medical indication that is not listed in the table 11.07—this should not be a usual occurrence. Most births in the red section are EEDs.

overlaid with corresponding hospital’s Core Measure Rate April – June 2014 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 rates range from 0 – 50%. This depicts how a smaller denominator is likely to yield a higher rate, unless the numerator is 0.

April – June 2014 29 Hospitals 17 Hospitals Each bar represents one of the 46 hospitals that had a rate (1 of the 47 that reported PC-01 data did not have any cases in the measure population (denominator), and therefore do not have a rate represented). 29/46 (63%) had a 0% rate. 29 Hospitals 17 Hospitals

Oklahoma Birth Certificate Data

This data is from Oklahoma Vital Records This data is from Oklahoma Vital Records. These are all singleton Oklahoma births. The increase in births at 39-41 weeks with an associated decrease in births at 36-38 weeks validates the data that was submitted through EWC. Comparison is Q1 2011 to Q2 2014 Provided by Oklahoma Vital Records

3%* 9%* 13%* 6%* *comparison is Q1 2011 to Q2 2014 EWC Begins Induction – 39-41 Weeks 9%* Induction – 36-38 Weeks 13%* Augmentation – 36-38 Weeks This slide also represents Oklahoma birth certificate data representing ALL Oklahoma singleton births. Note the 2013 and 2014 data are preliminary and subject to change. Among babies born between 36 and 38 weeks gestation, there has been a 9% reduction in inductions, and a 13% increase in augmentations. Augmentation – 39-41 Weeks 6%* EWC Begins *comparison is Q1 2011 to Q2 2014 Provided by Oklahoma Vital Records

Thank you for the support from all partners Thank you for the support from all partners! And a big THANK YOU to the EWC participating hospitals for all of your hard work!