Institutional Characteristics Research Articles

Prescription of Nonpharmacologic Interventions in Memory Clinics: Data from the Clinical Pathway for Alzheimer's Disease in China (CPAD) Study

ObjectivesNonpharmacologic interventions are recommended to improve outcomes in dementia. Little is known about their prescription in practice, especially in non-Western populations. We investigated individual- and institution-level characteristics associated with nonpharmacologic interventions prescription in China. DesignA multicenter observational study. Setting and ParticipantsThis study used cross-sectional data from 889 community-dwelling outpatients living with dementia aged ≥45 years from a multicenter registry of 28 memory clinics in China. MethodsPrescription records of nonpharmacologic interventions, carer and clinic characteristics, and reasons for declining interventions were collected. Multilevel logistic regression was used to identify factors associated with the prescription. ResultsNonpharmacologic interventions were prescribed in 323 people (36.3%) with mild cognitive impairment or dementia. Cognitive activities and carer training/support were the most prescribed interventions. Multilevel logistic regression showed that 73% of the variance in prescription was attributed to institutional characteristics of the memory clinic. Greater caregiving gain [odds ratio (OR), 1.05; 95% CI, 1.02-1.09], lower burden (OR, 0.97; 95% CI, 0.95-1.00), worse carer-perceived dyad relationship (OR, 0.83; 95% CI, 0.70-0.99), and family history of dementia (OR, 2.08; 95% CI, 1.19-3.65) were individual-level factors associated with prescription. Among 440 people considered having a need but received no prescription, declined by user/carer was the main reason for not prescribing (70.7%). Skepticism about effectiveness by physicians/carers and carers being unable or lacking resources to use the interventions were the common reasons given. Conclusions and ImplicationsA relatively low prescription rate of nonpharmacologic interventions is related to both individual- and institution-level factors. Carer support and education, instrumental support, and prescription guidelines across specialties and sites are possible strategies to improve access to nonpharmacologic interventions in dementia care.

Ideological narratives of liberalism and socialism

Objective: to compare the ideologies of liberalism and socialism in economic science in the context of the current stage of their evolution. For this purpose, the paper identifies the goals of these ideologies by analyzing the scientific narratives of economists. The study is also aimed at identifying similarities and differences between the ideologies of liberalism andsocialism. Methods: qualitative methods, narrative analysis, review of scientific literature. Results: the comparison of common interpretations of the “ideology” concept in various branches of economics and in other social sciences shows differences in terminology. The comparison of the liberalism and socialism ideologies in economics shows the difference between the declared goals of liberals and socialists. The goal of liberalism ideology is human freedom,and of socialism ideology – distribution equality. The ideologies considered are internally heterogeneous and have evolved over time. At present, liberalism is continued in neoliberalism, which aims at increasing the population wealth rather than freedom as an end in itself. There are non-egalitarian interpretations of the essence of socialism, which reduce it to the economy governmentalization. There are also debates about the advantages of the market over centralized planning in socialism. The extremes of the ideologies of liberalism and socialism can be clearly distinguished, but in practice, many studies take an intermediate position. A common feature of liberalism and socialism is their modernist character and criticism of archaic economic institutions designed to redistribute wealth from the poor to the rich. Scientific novelty: it consists in identifying the economic goals proclaimed by the ideologies of liberalism and socialism, based on the analysis of the relevant theoretical narratives in scientific literature. Practical significance: it is determined by the need to understand the factors influencing the economists’ worldview. Studying the ideologies of liberalism and socialism is useful for understanding the intent of the authors of recommendations for improving the institutions of the modern Russian economic order.

Explaining heterogeneity in student diversity across economics departments

While the field of economics lacks diversity, there is little consensus on the underlying causes of or most effective solutions to this problem. The authors of this article combine data from the Integrated Postsecondary Education Data System (IPEDS) with data from their own survey of U.S. economics departments to identify institution and department characteristics associated with observed variation in gender and racial diversity of undergraduate students across departments. They focus their attention on student support, role modeling, course content, and the use of active learning pedagogy. While they find no significant associations between course content or student support with student diversity, they find that gender diversity in departmental faculty is a strong predictor and that active learning is positively associated with gender diversity.

Development of a model for solving the functional task «Formation of surgical operations schedule» in a medical institution

The object of the research is the process of forming the schedule of surgical operations of the Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine. Modern research in the field of modeling work on the formation of the work schedule of medical institutions and surgical departments is focused on the development of models for the formation of schedules for the requirements of specific institutions. The use of these models to automate the formation of the schedule in other medical institutions is impossible without theoretical and applied modification of existing solutions taking into account the requirements and features of a particular institution. Therefore, conducting research to solve this problem is relevant from a theoretical and applied point of view. It was proposed to use a complex of mathematical models of target programming as the basis of the schedule formation model, which made it possible to form a schedule under conditions of limited resources. The main features of the Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine as an object of automation. Based on these features, a modification of the proposed models was developed, which allows automating the process of forming a schedule that would have minimal deviations from the submitted applications for operations. Based on the results of the modification of the schedule formation model, the choice of the method of solving the problem was justified and it was proposed to adapt the modification of the method of branches and boundaries to solve the problem of forming the schedule of surgical operations, it is proposed to adapt this modification to the specifics of the specified problem. The peculiarities of implementation of algorithmic, informational and software tools of the developed functional task are considered. Experimental verification of the obtained scientific results was carried out. For such verification, real data of applications for operations at the Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine The obtained results of the experimental test allow to make a decision about the possibility of applying the results of solving the functional problem in the industrial operation of the medical institution.

Development and Implementation of the Independent Curriculum in "Penggerak" Kindergartens: A Case Study of Semarang City

Implementing the Independent Curriculum in early childhood education presents challenges and opportunities, particularly in aligning curriculum design with local needs and ensuring stakeholder collaboration. This research examines the development and implementation of the Independent Curriculum in three "Penggerak" Kindergartens in Semarang City: TK ABA 54, TK Talenta, and TK Pertiwi 31. The study employs a descriptive qualitative method involving principals, teachers, supervisors, and parents and focuses on institutional readiness and stakeholder collaboration. Data collection was conducted through semi-structured interviews, observations, and document analysis. Findings reveal that each kindergarten developed a curriculum tailored to its unique institutional characteristics and student needs, with an emphasis on integrating national standards, local values, and religious principles. TK Talenta prioritized inclusive education for special needs children, while TK Pertiwi 31 focused on contextual learning approaches. Collaborative curriculum planning involving key stakeholders was a central strategy in all three institutions. Despite the successes, challenges emerged, particularly in teachers’ comprehension of the Independent Curriculum, which necessitated additional support through professional development. The study concludes that a flexible and contextually grounded curriculum fosters inclusivity and adapts to local needs in early childhood education. However, the limited geographic focus and short observation period challenge generalizing the findings. Future research should adopt longitudinal approaches to evaluate the curriculum's long-term impacts and explore interdisciplinary strategies in curriculum design.

Delegitimising Potential of the “Friend-Foe” Axiological Opposition (Exemplified by English-Language Political Internet Comments)

The article considers the axiological opposition “friend-foe” on the material of non-professional political discourse. English-language comments to the posts of Bill de Blasio, Mayor of New York City, and Sadiq Aman Khan, Mayor of London, published in 2016–2021 in social networks are analyzed in the linguapersonological aspect. The speech techniques of expressing the “friend-foe” binary used in discrediting the current government by users of social networks are revealed. The authors of the comments use various means of verbal aggression to undermine the legitimacy of the authorities. At the lexical level, invective and pejorative units are used. At the grammatical level, the users have recourses to imperative constructions and the superlative degree of adjectives with negative evaluation. Internet users’ comments to politicians’ posts in social networks are shown to form the image of a political actor on the basis of the dominants ‘deviant behaviour’, ‘bad manager’, ‘foe, not their own’, which are determinants in discrediting the authorities. Delegitimising characteristics-determinants used in American and British non-professional political discourse are revealed to be similar due to the general unification and globalization trends. When writing a negative response, the universal institutional characteristics of a politician come to the fore. The unique individual and personal characteristics of mayors are also found to be important in creating a more voluminous image of an illegitimate leader.

Ownership concentration and SME IPO underpricing in India – moderating impact of board monitoring and resource provision role

PurposeThe study aims to explore how the monitoring and resource provision function of board of directors impact the association between ownership concentration and small- and medium-sized enterprise (SME) initial public offering (IPO) underpricing in the context of an emerging economy like India.Design/methodology/approachThe sample comprises 390 SME IPOs listed on Bombay Stock Exchange SME platform and National Stock Exchange EMERGE (EMERGE is the NSE new initiative for SMEs to raise the funds from investors) in India. To test the moderating impact of the board monitoring role and resource provision role, the study employs hierarchical moderated regression subject to the fulfillment of assumptions.FindingsThe findings divulge that ownership concentration significantly reduces underpricing, hinting towards the operationalization of alignment of interest hypothesis. With regards to moderating relationship, the study found that while board resource providing role negatively moderates the relationship between ownership concentration and SME IPO underpricing, board monitoring function fails to cast any significant impact on the relationship between ownership concentration and SME IPO underpricing.Research limitations/implicationsThe present study ignores larger firms listed on the main platform which have complex decision-making than smaller firms. Besides, it is confined to only a single country, i.e. India. Extending the study to other countries with similar institutional characteristics would have validated the findings. Furthermore, the moderating impact of other organizational factors like firm age, lifecycle of firm and change in technology would form an interesting avenue for future research.Practical implicationsThe findings of the study have practical implications for managers in designing the adequate board structure that significantly reduces underpricing. It thus further advices the issuers on focusing more on strengthening the resource provision role of board of directors for achieving higher rewards. The findings are helpful to policymakers in framing such policies that enhance the resource-oriented role of board of directors and resource accessibility for SMEs. Furthermore, the results advise the investors to be relatively assured about the SMEs whose board exercises its resource provision role emphatically. Accordingly, findings are helpful to investors in making investment decisions in alternative market settings characterized by the concentrated ownership structure.Originality/valueThe study furthers the debate on the importance of two prominent roles played by board as a moderating variable in the underexplored context of IPO underpricing of small and medium-sized firms in India.

What helps improve outcomes of industrial policy in developing countries? Evidence from Russia

ABSTRACT In developing countries, implementing effective industrial policies faces challenges due to capacity and governance constraints, hindering accumulation of recognised success stories. This impedes our understanding of effective industrial policy tools in countries with accountability deficits. This article explores Russia’s Industrial Development Fund (IDF) support programmes, initiated since 2014, aimed at promoting import substitution through low-interest loans to industrial firms. These IDF programmes appeared to be more effective than most of Russia’s other industrial policy instruments. The article shows that they have resulted in statistically significant sales growth for supported businesses. It highlights institutional features contributing to programme effectiveness, ensuring the integrity of beneficiary selection and project support. It offers valuable insights for organisations implementing state support programmes in challenging governance conditions. Additionally, the recent emergence of more effective industrial policy tools like the IDF may partly explain Russia’s increased economic resilience against international sanctions imposed due to the war in Ukraine.

TERMINOLOGYOF MANAGEMENT IN THE DISCOURSE SPACE (BASED ON ENGLISH LANGUAGE)

The article is devoted to the study of the English terminological system in the field of management with regard to aspects of the structure and semantics of its components. The typology of cognitive-linguistic and institutional features that distinguish management discourse from other discursive types is explored. A comprehensive analysis of the main ways of forming management terms is carried out, among which morphological derivation, compounding and abbreviation are highlighted. The reasons that determine the dominant role of compounding in management terminology are established. The most frequent morpho-grammatical models in the discursive space of management are identified. Attention is focused on the syntactic status of such terminological units, which allows us to assert that multicomponent terms represent one member of a sentence that does not have synonyms, which fundamentally makes them different from free phrases. Extralinguistic and intralinguistic factors that determine the specifics of the formation of the terminological layer of the lexical system of a language are also explored. Based on the analysis of practical material with its integrative connection to the structural and compositional realities of the modern discursive space of management, the authors of the article propose a comprehensive structural and thematic stratification of terminological units, which allows us to study the conceptual apparatus and trace the main algorithms of the hierarchical interaction of terms of each of the identified structural and thematic segments. Using the continuous sampling method, five structural and thematic groups are identified and stratified, which allows us to conclude that the term management system is a consciously constructed system, divided into flexible and open terminological fields. A statistical analysis is carried out to establish the frequency of use of terminological units of structural and thematic subsystems of the general management terminological system in the discursive space of business. The distinctive feature of abbreviations is investigated, which is represented by a high level of consistency and hierarchy of correlations between abbreviation terms.

Service design technology as a tool for the development of the Institute of social services

The purpose of this study is to analyze the features of the service design technology in social services. The object of the research is the institutional features of social services for the population, the subject is the role and essence of service design technology as a tool for the development of the institute of social services. The author provides an analysis of the institutional features of the development of social services, examines the impact of the use of service design technologies in the provision of social services. Special attention is paid to the characteristics of innovative social service practices based on the implementation of service design technology, as well as to the analysis of the development and transformation of institutional functions of social services as a result of the widespread introduction of service design practices in the social sphere. Based on the data of the analysis of best practices of social services, the author also analyzes the processes of formation of new social institutions as a result of the implementation of the service approach in the social sphere, one of which is the institute of regional service commissioners. The main research method is the traditional analysis of documents, generalization of the research of the Institute of Social Services, experience in the implementation of service design technology, as well as analysis of its impact on the processes of transformation of social institutions. The theoretical and methodological basis of the research is the works devoted to the study of the peculiarities of the development of the institute of social services, the introduction of service design technology into the processes of service provision. The main results of this study are conclusions about the special role of service design of social services in ensuring the sustainability of public relations by balancing the implementation of public interests associated with the absence of excessive spending on social services and the interests of small groups meeting their needs at an optimal level through convenient routing and individual design of social services. The author's scientific contribution consists in analyzing the transformation of institutional functions of social services in the implementation of service design technology. The author concludes that the institutional function of social services for reproduction, distribution and exchange also changes with the implementation of the service design approach, becoming simpler and more effective, and the structure of public relations is changing under the influence of the need for new actors and institutional forms of social services with an increased role of interdepartmental interaction.

Economic crimes as a threat to Russia's socio-economic security

The security of the State, society and the individual is a fundamental task in ensuring the stability and prosperity of the country. This task implies the definition of rules and norms in relation to various social groups that correspond to the current institutional environment in Russia. The purpose of this study is to analyze the impact of economic crimes on the social security of citizens of the Russian Federation and ensuring economic growth in the country.To reveal the research topic, the paper considers the main basic indicators of Russia's socio-economic security. The methodological basis is general scientific methods: analysis, synthesis, comparison, generalization, ranking, etc. The main causes of the emergence and spread of economic crimes are presented in a systematic way. A retrospective analysis of economic crimes was carried out, and a trend line was drawn up. Using the ranking method, a rating of the leading regions in terms of socio-economic development was formed. It has been revealed that the scale of the spread of economic crimes has a fairly strong correlation with the institutional characteristics of the regions. The methods of combating economic offenses through the use of information technology are proposed.

Tackling the Digital Divide? A Comparative Policy Analysis of International Organizations’ Varying Approaches to the Digitalization of Education

This paper explores how international organizations (IOs) identify similar problems while endorsing different strategies. It examines how IOs address a fair and accessible digital education environment that reduces the digital divide. Using mixed methods, the article analyzes documents from 22 IOs. The quantitative analysis reveals the diverse concepts associated with digitalization. A qualitative content analysis delves into the strategies employed by four distinct cases of IOs – African Union, EU, OECD, and UNESCO. The article argues that while many IOs address digitalization in education as a global standard, their institutional characteristics shape their policy recommendations on the issue.

College President Departure After No-Confidence Votes: An Event History Analysis

ABSTRACT Faculty-led no-confidence votes against college presidents have increased over the past decade. These votes often aim to create conditions that lead to the president’s departure. In this study, I used event history analysis to investigate the influence of faculty-led no-confidence votes on the tenure of college presidents. The analysis reveals that nearly 70% of presidents leave their positions within four semesters of a no-confidence vote. The study further explores the influence of various factors, including institutional and presidential characteristics, on the likelihood of presidential departure after no-confidence votes. The results indicate that student enrollment size is the only significant predictor, with smaller institutions more likely to experience leadership turnover following a vote. The study concludes that no-confidence votes are a powerful tool for facilitating presidential change across diverse institutional types. These findings have important implications for faculty governance bodies and boards of trustees, highlighting the need for strategic planning in response to such votes.

The curse of COVID-19 on foreign direct investment: assessing the role of property rights amidst the pandemic

ABSTRACT How did the COVID-19 pandemic impact foreign direct investment (FDI)? Following the outbreak of COVID-19, the overall volume of FDI inflows plummeted. However, COVID-19’s adverse effects on FDI in host countries exhibited discernible variability contingent upon the characteristics of domestic institutions, particularly the robustness of property rights within these countries. While host countries with strong property rights experienced a mitigated negative impact on FDI, contrary to general expectations, our analysis suggests that host countries with weak property rights may have also evaded a significant reduction in FDI inflows during the pandemic. This was primarily because both strong and weak property rights institutions in host countries conveyed positive signals to investors, which may have incentivized them to continue their investments even amidst the pandemic-induced crisis. Analyzing a time-series cross-sectional dataset of 126 developing countries covering the period 2009–2021, our findings reveal a U-shaped relationship between FDI and property rights. This implies that COVID-19’s impact manifested as a weak negative force on FDI inflows in host countries with weak property rights as well as those with strong property rights. Conversely, host countries with moderately strong property rights tended to suffer a substantial reduction in FDI.

Determinants of loan repayment performance: A study of microfinance institutions in Nepal

The study’s main goal is to empirically examine the association between loan repayment performance among microfinance institutions (MFIs) in Nepal regarding institutional characteristics (ICs), client characteristics (CCs), and loan characteristics (LCs). Further, the study emphasizes a causal relationship between the variables that directly corresponds with the regression research model for organic validity. For this, the researcher has chosen twenty Nepalese microfinance institutions along with 217 respondents for the study, respectively. The study found that institutional factors, client characteristics, and loan characteristics were positively and significantly associated with the loan repayment performance of Nepalese MFIs. The above-mentioned variables remain pivotal to determining the loan repayment performance of Nepalese MFIs, including institutional policy formation, loan and savings product design, and corporate culture formation for senior-level management. The results of the study will be effective for Banks and Financial Institutions (BFIs), Microfinance Institutions (MFIs), regulatory authorities, Human Resources (HR) analysts, and planners to take corrective actions to improve the repayment performance of MFIs for credit risk management.

Fair value and investment property in accounting literature: a review

Purpose This study aims to provide a timely review concerning the determinants and economic consequences of fair value reporting in real estate industry, as these topics have been gaining momentum in accounting literature recently. Design/methodology/approach Diverse editorial sources (e.g. Elsevier, Emerald, Meridian Allenpress, Springer, Sage, Taylor & Francis and Wiley-Blackwell) were consulted to identify relevant studies for this review. Keywords used to collect studies include “fair value” and “IAS 40” or “investment property” and “fair value or “fair value and real estate.” This search yields 33 studies published between 2009 and 2023. Findings The synthesis of reviewed papers suggests that studies were mainly conducted in the European countries after the mandatory adoption of international financial reporting standards (IFRS) in 2005 and the Australian setting. The first stream of research deals with the choice of fair value approach. Reported empirical findings suggest that corporate size and market-to-book ratio are negatively associated with fair value choice, whereas ownership dispersion increases the likelihood of choosing fair value approach. The empirical evidence concerning the determinants of fair value magnitude suggests the type of appraiser represents a key predictor of the extent of fair value use. The second stream of research examines the impact of fair value reporting in real estate industry. Findings suggest that empirical evidence is still limited with respect to creditors, managers and financial analysts; fair value reporting is generally associated with higher level of value relevance for investors; and the use of Level 3 inputs in fair value estimates for investment properties is associated with high degree of estimation uncertainty for external auditors leading to increased audit risk and fees. Practical implications With respect to regulators, this review emphasizes that the beneficial impacts of fair value reporting are linked to institutional characteristics (e.g. legal system, the degree of market development), the reliability concerns regarding fair value estimates and the independence of appraiser. Because real estate industry is generally characterized by the lack of active market, regulators may adopt regulations requiring the independence external appraiser. Originality/value This literature review represents a historical record and an introduction for accounting scholars, in emerging economies and other settings, where fair value accounting has gained wide acceptance among the investment community. It also offers guidance for future research avenues.

Navigating spirituality in vegan fashion consumption: Purification and transgression tolerance

This study examines how consumers navigate their spiritual needs for transcendence in everyday consumption. While extant literature shows that both spiritual utilities and tensions emerge in sacred consumption, we build on and extend this research by illuminating how consumers navigate sacralisation and problematise profane consumption objects and practices. We employed Mary Douglas’s pollution theory to examine how consumers navigate cultural meanings of purity and transgressions. Through a qualitative study of vegan fashion consumption, we found that consumers negotiate the meaning of purity to govern everyday consumption practices in ways that resemble characteristics of religious institutions (e.g. faith and doctrines). Vegan consumers tolerate consumption transgressions through practices and rituals to sustain their faith within what is regarded as a polluted marketplace. Our study contributes to a novel perspective on consumer spirituality in regulating sacred and secular consumption and moralising relationships with the material world.

Concepts and signs of international human rights institutions

The article analyzes various approaches to the interpretation of the concept of an international human rights institution. The author’s definition of the concept of an international human rights institution is proposed, which should be understood as an international association endowed by the relevant states and (or) other entities with its own international legal personality, based on an international treaty or other document provided for by the norms of international law, the purpose of which is achieving goals related to the protection of the rights and freedoms of a person, and which, as a rule, has its own system of bodies acting on a permanent basis. It was noted that in the process of forming the institute of international organizations, the main attention of the states was focused on the creation of international intergovernmental organizations, which have executed and continue to execute a significant influence on the course of world events. International interstate organizations are one of the three important institutions through which interstate cooperation is carried out. Created in accordance with special international treaties, they have international legal personality and a clearly defined organizational structure, reflect the main goals, tasks and competence and act in accordance with the norms of international law. Despite the fact that international human rights institutions have a subsidiary character to national protection bodies, they provide considerable influence by making appropriate decisions based on the results of consideration of individual appeals from victims whose rights and freedoms are violated. The process of applying for the protection of rights and freedoms to international human rights institutions is a kind of one of the forms of activity of the relevant legal entity. The article highlights the main characteristics of international human rights institutions, which include: 1) contractual basis, 2) existence of defined goals, 3) appropriate organizational structure, 4) existence of independent rights and obligations, 5) possibility of considering applications from victims of rights violations and freedoms and the adoption of relevant decisions (conclusions, recommendations), 6) the possibility of influencing the defendant state, which violates the rights and freedoms of a person, 7) the permanent nature of the activity.

Institutional investor horizons and stock price crash risk

This study examines how institutional investor investment horizons impact stock price crash risk for China’s A-share firms from 2007 to 2019. Long-term investments by institutions significantly mitigate risk by curbing managerial myopia, enhancing transparency, and improving accountability, thus deterring self-serving behavior. Moreover, long-term shareholding and professional investment indeed strengthen institutional investor supervision and corporate governance, reducing stock price crash risk. This paper also discusses institutional investor characteristics, such as herding behavior, information competition, and cliques, as well as external environmental factors, such as investor protection and external monitoring, on institutional investor horizons. Furthermore, effective internal governance, such as diversity of board sources and the diligence of audit committees, can amplify the risk reduction effects of long-term institutional investment.

Evaluation of Statewide Program to Reduce Cesarean Deliveries Among Nulliparous Individuals With Singleton Pregnancies at Term Gestation in Vertex Presentation.

To evaluate the effect of statewide efforts to reduce nulliparous, term, singleton, vertex (NTSV) cesarean delivery rates in California. This was a population-based study of all NTSV births in California from 2015 to 2019. In 2015, all California hospitals with NTSV cesarean delivery rates above the 23.9% Healthy People 2020 target were invited to join a CMQCC (California Maternal Quality Care Collaborative)-sponsored, 3-year, multifaceted collaborative or a system-level quality collaborative to safely support vaginal birth. We examined the cesarean delivery rate overall and by participation or nonparticipation in a collaborative program. Secondarily, for hospitals that started with an NTSV cesarean delivery rate above 23.9%, we compared patient-level, hospital-level, and obstetric management characteristics between hospitals that met the Healthy People 2020 target (cesarean delivery rate below 23.9%) in 2019 and those that did not. There were 758,268 NTSV births at 238 hospitals. Annual mean NTSV cesarean delivery rates decreased among all racial and ethnic groups statewide and among all patients, regardless of payer, maternal age, or body mass index (BMI). The decrease in cesarean delivery was driven largely by a decrease in the frequency of cesarean delivery performed for labor dystocia (14.9% in 2015 to 12.8% in 2019) and from cesarean delivery before the onset of labor (4.2% in 2015 to 3.3% in 2019). For hospitals that started with an NTSV cesarean delivery rate above 23.9%, NTSV cesarean delivery rates among 80 hospitals participating in the CMQCC had a mean±SD decline of 6.9±5.9%, 13 hospitals participating in the system-level collaborative had a 5.0±4.5% decline, and those not participating in any collaborative had a 2.1±6.0% decline. In multivariable analysis, there was no association between meeting the Healthy People target and any of the hospital-level factors or aggregated patient-level characteristics. Rates of induction of labor increased in both groups and were not associated with a change in cesarean delivery rates. Hospitals in California between 2015 and 2019 with a wide variation in institutional and patient characteristics successfully reduced their NTSV cesarean delivery rates. Reduction in the NTSV cesarean delivery rate at hospitals that started above the Healthy People target was not associated with differences in patient characteristics but rather a reduction in cesarean deliveries for labor dystocia and cesarean deliveries performed before the onset of labor.