NQF: Nationally, EEDs rates fell dramatically over a relatively short period of time. How did it happen?

Corry: The stars really aligned. Just after Childbirth Connection joined NQF in 2006, an NQF steering committee was formed to identify the first set of perinatal performance measures. ACOG’s clinical guidelines had supported the reduction of EEDs for years, the growing body of research pointed to the likely harms for both mothers and babies and the consumer voice on this issue was—and is—very, very strong and important. NQF endorsed the measure set, which include an EED measure developed by HCA and then, things really took off. The Leapfrog Group included the measure in its hospital survey and was the first to publicly report EED rates of participating hospitals. Women and purchasers finally had access to the data, which helped raise awareness and drive action. The California Maternal Quality Care Collaborative and the March of Dimes issued its essential toolkit. Public-private quality collaboratives jumped on board to collect and report data to providers. The 2012 NQF-convened Maternity Action Team successfully urged the Joint Commission to mandate reporting its perinatal core measure set and now, hospitals that deliver more than 1,100 babies a year are required by the Commission to report their EED rates. The CMS Hospital Inpatient Quality Reporting (IQR) Program also requires participating hospitals to report the EED measure.

NQF: But the work is not done. Some state and hospital EED rates are still too high.

Corry: That’s right and that was the impetus for convening the 2014 Maternity Action Team that developed the new Playbook for the Elimination of Early Elective Deliveries. The Playbook provides guidance and strategies for those still struggling to reduce their EED rates. The goal is to eliminate EED in every maternity hospital across the country.

NQF: What is the next quality measure that will have the same impact?

Corry: NTSV is going to be the next EED measure. NTSV--nulliparous term singleton vertex--refers to a woman with a low-risk, full-term, singleton pregnancy and a baby in the right position, who winds up with a C-section. The Joint Commission has embraced the NQF-endorsed NTSV measure and has required that hospitals that deliver 1,100 babies or more report their rates. I think the data are going to have a real impact on reducing the C-section rate among low-risk women. If it’s not measured, it’s not going to improve and we have a good measure and its driving change in the right direction.