TJC perinatal measure aims to reduce c-sections

This is the perinatal care measure set from The Joint Commission: Set Measure ID: PC-02 Rationale: The removal of any pressure to not perform a cesarean birth has led to a skyrocketing of hospital, state, and national cesarean section rates. Some hospitals now have c-section rates of more than 50%. Hospitals with c-section rates at 15-20% have infant outcomes that are just as good and better maternal outcomes (Gould et al., 2004). There are no data that higher rates improve any outcomes, yet the c-section rates continue to rise. This measure seeks to focus attention on the most variable portion of the c-section epidemic, the term labor c-section in nulliparous women. This population segment accounts for the large majority of the variable portion of the c-section rate and is the area most affected by subjectivity.

As compared to other c-section measures, what is different about NTSV [Nulliparous Term Singleton Vertex] c-section rate (Low-risk Primary c-section in first births) is that there are clear cut quality improvement activities that can be done to address the differences. Main et al. (2006) found that over 60% of the variation among hospitals can be attributed to first birth labor induction rates and first birth early labor admission rates. The results showed if labor was forced when the cervix was not ready the outcomes were poorer. Alfirevic et al. (2004) also showed that labor and delivery guidelines can make a difference in labor outcomes. Many authors have shown that physician factors, rather than patient characteristics or obstetric diagnoses are the major driver for the difference in rates within a hospital (Berkowitz, et al., 1989; Goyert et al., 1989; Luthy et al., 2003). The dramatic variation in NTSV rates seen in all populations studied is striking according to Menacker (2006). Hospitals within a state (Coonrod et al., 2008; California Office of Statewide Hospital Planning and Development [OSHPD], 2007) and physicians within a hospital (Main, 1999) have rates with a 3-5 fold variation.