Improving Physician Behavior With an Obstetric Dashboard [30M

Abstract

INTRODUCTION: The American College of Obstetricians and Gynecologists no longer recommends routine use of episiotomy. However, high variation in provider practice continues to exist. The objective of this study was to determine if a physician dashboard reporting individual and group episiotomy rates could reduce usage to below the national benchmark of 5.5%. METHODS: Baseline data extracted from records of patients delivering between 1/1/2015 and 7/15/2015 were entered into a dashboard that listed all obstetricians at our hospital. Identities were blinded and physicians were provided individual and group rates. Data were then collected prospectively following dashboard implementation. RESULTS: The institutional baseline rate for episiotomy performance was 9.9%, with individual rates ranging from 0.0% to 55.6%. Following dashboard implementation, there was a significant reduction in the institutional rate (9.9% pre-intervention vs 2.7% post-intervention, P value less than .001). Our analysis also validated the increased risk of severe, third and fourth degree perineal lacerations with the performance of episiotomy [OR 4.1 (1.2, 14.0)]. Despite the reduction in episiotomy utilization, we were unable to demonstrate a reduction in the frequency of severe perineal lacerations (2.42% pre- vs 1.31% post-intervention, P value equal to 0.1), suggesting that multiple factors contribute to these events. CONCLUSION: When variation in physician performance exists, utilizing a physician dashboard comparing providers' behaviors can result in significant improvements in provider and institutional performance on specific metrics. We plan to evaluate whether this intervention can significantly reduce our rates of cesarean delivery in nulliparous, term, singleton, vertex gestations.