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CME Credit Offered
CME Credit Offered
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Recording available 2/16-5/2
Recording available 2/16-5/2
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 4

Category: Obstetric Quality and Safety

Poster Session 4

(1186) Cesarean Rate Reduction At Scale Is Possible with Intensive Hospital Quality Improvement Support

Thursday, February 12, 2026
3:30 PM - 5:00 PM  
Objective:
Large-scale efforts have had mixed success at reducing the U.S. nulliparous, term, singleton vertex (NTSV) cesarean rate. We evaluated average and hospital-specific cesarean rate trends during exposure to a “stepped up” quality improvement (QI) support intervention involving BASE (low-intensity QI support), followed by BASE + LEAD (moderate-intensity QI support).

Study Design:
We conducted an observational analysis of NTSV births from 1/2022-12/2024 in the all-payer registry of the Obstetrics Initiative (OBI), a statewide quality collaborative funded by Blue Cross Blue Shield of Michigan and Blue Care Network as part of the BCBSM Value Partnerships program. Hospitals with cesarean rates above the Joint Commission’s reporting threshold of 30% (n=20) received “BASE,” OBI’s standard QI support model (i.e., clinician webinars, monthly hospital performance reports, online toolkit, small financial incentive for hospital participation) in Stage 1 (Month 1-12), followed by BASE + LEAD, OBI’s moderate-intensity support model (i.e., BASE + consultation between an external QI specialist and maternity unit leaders to develop and execute a site-customized QI plan) in Stage 2 (Month 13-24). A generalized linear mixed Poisson model analyzed monthly NTSV cesarean rates during Stage 1 & 2, on average and by hospital.

Results:
Among n=22,467 NTSV births, the cesarean rate fell 5.0% on average (p < 0.001), from 33.4% at month 1 to 31.7% at month 12 to 28.4% at month 24, representing 298 averted cesareans (Fig 1). Response to the intervention varied: 18/20 hospitals showed an accelerated cesarean rate decrease in Stage 2 vs. Stage 1, but 2/20 did not, and 5/20 hospitals’ cesarean rates remained above 30% at Month 24, indicating a need for sustained or additional intervention.

Conclusion:
Cesarean rate reduction is possible at scale using stepped-up QI support. Future work should identify (i) which hospitals are more or less likely to require augmentation with LEAD at month 12, and (ii) whether additional supports (beyond LEAD) are needed, to achieve, accelerate, or sustain safe cesarean rate reduction.