1. 1 What’s the Goal? Jeff Thompson, MD MPH Chief Medical Officer, Washington State Health Care Authority

2. 2 Washington State Department of Social & Health Services What’s the trend? Medicaid Maternity Expenditures WA State C-Section and Vaginal Deliveries 1989-2009

3. 3 What About this Variation Thing? Cesarean rates rose significantly in each state from 1996 to 2007 In WA State Cesarean rates vary greatly by hospital and region using 2008 data Level 3 Nursery Hospitals: 34% (range 18 – 39%) Level 2 Nursery Hospitals: 28% (range 23 – 36%) Level 1 Nursery Hospitals: 27%(range 10 – 39%) Accounting for risk factors WA still has variation 1(http://www.doh.wa.gov/ehsphl/chs/chs-data/public/CSectionsInWA.pdf)

4. 4 What works to Elective Reduce C-sections, Inductions and < 39 week delivery? Interventions that workInterventions that do not work  Improve VBAC use  Feedback and audit  Mandatory second opinions  Enforceable Guidelines  Financial incentives/disincentives  Community based care and alternative provider models  Planned home birth / Midwives  Continuous labor support  Tort reform  Multifaceted interventions  Provider education  Computer assisted evaluation of labor  Outcomes management  Exercise  Early labor assessment  Decision aids  Patient education  Opinion leaders Strategies to Reduce Cesarean Sections: Oregon Health and Science University

5. 5 Using Birth Certificates – All Births can be tracked Feedback Reporting: on the < 39 weeks program is showing some success!

6. 6 Washington State Department of Social & ealth Services What’s the Goal!