OBSTAT: Benchmarking for improvement in obstetrics
Database provides feedback for physicians
With cesarean section rates (CSRs) now among the most heavily emphasized and widely used measures of quality performance in the field of obstetrics, health care providers have plenty of motivation to find ways to decrease their use of this procedure without affecting outcomes for mothers and babies.
One roadblock to achieving this, however, has been the lack of a database on both patients and practice patterns. Such information would allow physicians to compare their practices with those of their peers, provide them with feedback about their performance, and open the way to improved clinical performance and lower CSRs.
One tool that has been developed to assist in these efforts is OBSTAT (pronounced oh-be stat), a custom obstetrical clinical database that has been developed at Saddleback Memorial Medical Center in Laguna Hills, CA.
Originally written in 1993, "OBSTAT is basically an electronic delivery logbook," says David C. Lagrew, MD, medical director of Women’s Hospital at Saddleback. "It allows us to collect and store obstetrical statistics regarding labor, delivery, outpatient treatments, and other factors," he explains. Utilizing OBSTAT, "We can run some very sophisticated reports and analyses that enable us to not only generate benchmarks — such as CSRs — at the institutional level, but also to break these benchmarks down to the individual-physician level."
In use throughout the four-hospital Memorial Health Services chain since 1997, OBSTAT provides physicians feedback on the effectiveness of their clinical practices. For example, a physician may be interested in finding ways to reduce repeat cesareans.
"Reports generated by OBSTAT show the physicians what their own success rates have been in getting these moms’ babies delivered vaginally as well as the same numbers for their colleagues," says Lagrew. Accompanying report data on the clinical practices employed in these cases "allow physicians to see what their colleagues are doing and compare it with what they are doing themselves, and also see what the impact has been on CSRs for these patients."
OBSTAT provides benchmarking data at the provider, hospital, and system levels. Summary statistics are provided at the institutional level, on-line, and at monthly departmental and administrative meetings. Meanwhile, says Lagrew, individual providers get feedback every six months with a summary report of CSRs, risk assessment, and various outcome parameters for both mothers and babies.
Over time, the use of OBSTAT appears to at least be positively correlated with a reduction of the CSR at Women’s Hospital. At the beginning of 1988, when data first started being collected, the CSR there was in the 30% range, according to Lagrew.
By 1994, one year after OBSTAT was developed, the rate was only 15%, and has remained in the teens ever since. By way of comparison, the national CSR declined from 24.4% to 22% of all deliveries between 1987 and 1994, according to the Office of Disease Prevention and Health Promotion of the U.S. Department of Health and Human Services. The year 2000 target, according to the agency’s "Healthy People 2000" program, is 15%.
[For more information, contact:
• David C. Lagrew, MD, Medical Director, Women’s Hospital, Saddleback Memorial Medical Center, 24411 Health Center Drive, Suite 260, Laguna Hills, CA 92653. Telephone: (949) 452-7199.]
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