Every Week Counts Oklahoma Aggregate Data 4th Quarter 2013 October – December 2013

October – December 2013 ~1 every other day This represents 51/52 EWC Hospitals. 46 total non-medically indicated schedule deliveries < 39 weeks for the quarter 48 were reported in Q3 2013 ~1 every other day

Qtr 4 2013: October 1 – December 31, 2013 ~8/day ~1 every other day Qtr 1 2011: January 1 – March 31, 2011 Qtr 4 2013: October 1 – December 31, 2013 Number of births in red area for baseline data (Q1 2011) is 680; Number of births in red area for Q3 2013 is 46—a decrease of 634 (93% decrease in number) scheduled births that were non-medically indicated prior to 39 weeks of participating hospitals.

41% 24% *Comparison is difference between Q1 2011 & Q4 2013 The denominator on this slide is total scheduled C/S. 1.2% of the scheduled c-sections in Q4 2013 were <39 weeks without a documented indication. This is down 93% from the rate of 16.2% in Q1 2011. 93%

14%* 9%* *Comparison is difference between Q1 2011 & Q4 2013 The denominator on this slide is total inductions. 0.5% of the inductions in Q4 2013 were <39 weeks without a documented indication. This is down 93% from the rate of 7.9% in Q1 2011. 93%*

7.4% 3.8% 0.5% 18% Comparison is Q1 2011 to Q4 2013 This slide represents changes in care practices when comparing Q1 2011 to Q4 2013. EWC data from participating hospitals show: A 7.4% increase in births that did not include induction or scheduled C/S A 3.8% decrease in the induction rate for women who intended to deliver vaginally (Inductions/Total Deliveries-Scheduled C/S) A 0.5% increase in the overall induction rate (Inductions/Total Deliveries) An 18% decrease in the scheduled C/S rate (Scheduled C-sections/Total Deliveries)

94%* *Comparison is difference between Q1 2011 & Q4 2013 The denominator on this slide is total deliveries. The labeled data points are for 12/2010 and 12/2013. Q1 2011 aggregate rate is 5.91%. Q4 2013 aggregate rate is 0.37%. There was a 94% decrease in rate between those two periods. Q3 2013 also showed an 94% decrease from Q1 2011 There was no change in rate from Q2 2013 to Q3 2013

Baseline Data: Dec 2010 – March 2011 -- October – December 2013 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. 34 Hospitals 6 Hospitals 17 Hospitals

October - December 2013 <300 300 - 499 500 - 999 1000+ 7 11 5 Each bar represents a hospital Hospitals’ individual reports indicate their bar by an arrow <300 300 - 499 500 - 999 1000+ 7 11 5 ORANGE number = approximate number of annual deliveries GREEN number = number of hospitals reporting zero rate

Scheduled Deliveries <39 Weeks October – December 2013 Scheduled deliveries at < 39 weeks. All 51 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 at <37 weeks without an indication and 4 scheduled C/S at < 37 weeks without an indication reported—5 non-medically indicated scheduled deliveries for preterm births.

Scheduled Deliveries <39 Weeks October – December 2013 46 The indicated area contains our target areas—scheduled cesareans and inductions at < 39 weeks without a documented medical indication. This area accounts for 3.2% of our scheduled deliveries at < 39 weeks—38, 37 or < 37 weeks As you can see, there was 1 induction at <37 weeks without an indication and 4 scheduled C/S at < 37 weeks without an indication reported. Of scheduled deliveries (inductions and c-sections) <39 weeks without a documented indication: 33 (72%) were at 38 weeks 8 (17%) were at 37 weeks 5 (11%) were <37 weeks 3.2% 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 49 hospitals. This line graph represents each quarter This represents 49 hospitals. This line graph represents each quarter. Of the 51 whose data we are including in the Q4 2013 report, 2 hospitals had a zero denominator (no cases in the measure population). 65% decrease from Q3 2012 to Q4 2013

This represents 49 hospitals. This line graph represents each month This represents 49 hospitals. This line graph represents each month. Of the 51 whose data we are including in the Q4 2013 report, 2 hospitals had a zero denominator (no cases in the measure population).

October – December 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 October – December 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 rates range from 0 – 22.2%. This depicts how a smaller denominator is likely to yield a higher rate, unless the numerator is 0.

October – December 2013 29 Hospitals 20 Hospitals Each bar represents one of the 49 hospitals that had a rate (2 of the 51 that reported PC-01 data did not have any cases in the measure population (denominator), and therefore do not have a rate represented). 29/49 (59%) had a 0% rate. 29 Hospitals 20 Hospitals

Oklahoma Birth Certificate Data

This data is from Oklahoma Vital Records This data is from Oklahoma Vital Records. 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 Q3 2013 Provided by Oklahoma Vital Records

3%* 9%* 3%* 12%* *comparison is Q1 2011 to Q3 2013 EWC Begins Induction – 39-41 Weeks 9%* Induction – 36-38 Weeks 3%* Augmentation – 36-38 Weeks This slide also represents Oklahoma birth certificate data representing ALL Oklahoma singleton births. Note the 2013 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 3% increase in augmentations. Augmentation – 39-41 Weeks 12%* EWC Begins *comparison is Q1 2011 to Q3 2013 Provided by Oklahoma Vital Records