Association Between State-Wide Cardiac Quality Improvement Program and Costs Following Intervention for Coronary Artery Disease.

Background: Since 2010, all non-VA hospitals performing cardiac surgeries and percutaneous interventions in Washington State have participated in the Cardiac Care Outcomes Assessment Program (COAP), a data-driven, physician-led collaborative quality improvement (QI) collaborative. Prior literature has demonstrated QI programs such as COAP can avert avoidable utilization such as hospital readmissions. However, it is unknown whether such improvements translate into economic benefits.

Interpretable machine learning predicts postpartum hemorrhage with severe maternal morbidity in a lower-risk laboring obstetric population.

Background: Early identification of patients at increased risk for postpartum hemorrhage (PPH) associated with severe maternal morbidity (SMM) is critical for preparation and preventative intervention. However, prediction is challenging in patients without obvious risk factors for postpartum hemorrhage with severe maternal morbidity. Current tools for hemorrhage risk assessment use lists of risk factors rather than predictive models.

Effects of the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) Trial on Elective Induction and Obstetric Outcomes in Term Nulliparous Patients.

Objective: To evaluate the effect of publication of the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial on perinatal outcomes in singleton, term, nulliparous patients.

Methods: An interrupted time series analysis was performed using clinical data for nulliparous singleton births at 39 weeks of gestation or later at 13 hospitals in the Northwest region of the United States (January 2016-December 2020). A modified Poisson regression was used to model time trends and changes after the ARRIVE trial (August 9, 2018).

Customized GROW vs INTERGROWTH-21 birthweight standards to identify small for gestational age associated perinatal outcomes at term.

Background: Fetal growth restriction is associated with stillbirth and other adverse pregnancy outcomes, and the use of the correct weight standard is an essential proxy indicator of growth status and perinatal risk.

Objective: This study aimed to assess the performance of two international birthweight standards for their ability to identify perinatal morbidity and mortality indicators associated with small for gestational age infants at term.

Study Design: This retrospective cohort study used data from a multicenter perinatal quality initiative, including a multiethnic dataset of 125,826 births from 2012 to 2017.

Exclusive Breastfeeding in the Northwest: Disparities Related to Race/Ethnicity and Substance Use.

Background And Objectives: Mothers who are Black, Indigenous, and people of color (BIPOC) are disproportionately impacted by substance use in pregnancy and less likely to breastfeed. Our objectives were to assess relationships between substance use in pregnancy and exclusive breastfeeding at discharge (EBF) and race/ethnicity and EBF, and determine the extent to which substance use influences the relationship between race/ethnicity and EBF.

Methods: This is a retrospective cohort study of term mother-infant dyads using 2016 to 2019 data from a Northwest quality improvement collaborative, Obstetrical Care Outcomes Assessment Program.

A Simple Approach to Adjust for Case-Mix When Comparing Institutional Cesarean Birth Rates.

Objective: This study aimed to develop a validated model to predict intrapartum cesarean in nulliparous women and to use it to adjust for case-mix when comparing institutional laboring cesarean birth (CB) rates.

Study Design: This multicenter retrospective study used chart-abstracted data on nulliparous, singleton, term births over a 7-year period. Prelabor cesareans were excluded.

Comparison of Midwifery and Obstetric Care in Low-Risk Hospital Births.

Objective: To compare midwife and obstetrician labor practices and birth outcomes in women with low-risk pregnancies delivered in the hospital.

Methods: We conducted a retrospective cohort study of singleton births of 37 0/7-42 6/7 weeks of gestation at 11 hospitals between January 1, 2014, and December 31, 2018. Exclusions included intrapartum transfer from home-birth center, antepartum stillbirth, previous cesarean delivery, practitioner other than midwife or obstetrician, prelabor cesarean, prepregnancy maternal disease, and pregnancy complications or risk factors.

Maternal and newborn outcomes with elective induction of labor at term.

Background: A growing body of evidence supports improved or not worsened birth outcomes with nonmedically indicated induction of labor at 39 weeks gestation compared with expectant management. This evidence includes 2 recent randomized control trials. However, concern has been raised as to whether these studies are applicable to a broader US pregnant population.

Cervical Dilation on Admission in Term Spontaneous Labor and Maternal and Newborn Outcomes.

Objective: To examine associations between cervical dilation on admission and maternal and newborn outcomes in term spontaneous labor.

Methods: This is a retrospective cohort study of 11,368 singleton, term (37-43 6/7 weeks of gestation) spontaneously laboring women delivering in 14 hospitals in Washington State between 2012 and 2014 using chart abstracted data from the Obstetrics Clinical Outcomes Assessment Program. Women with prior cesarean delivery or ruptured membranes on admission were excluded.