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Poster Session 3

Category: Obstetric Quality and Safety

Poster Session 3

(880) Improvement in Labor Dystocia Adherence Varies Widely in a Statewide Quality Collaborative

Thursday, February 12, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Michelle Moniz, MD, MSc (she/her/hers)

Associate Professor
University of Michigan
University of Michigan, Michigan, United States

Coauthor(s)

DA

Daniel Almiral, PhD

Associate Professor
University of Michigan
Ann Arbor, Michigan, United States
RW

Rebecca Wardrop, PhD

Research Analyst
University of Michigan
Ann Arbor, Michigan, United States
Jourdan E. Triebwasser, MA, MD (she/her/hers)

Clinical Associate Professor
University of Michigan
Ann Arbor, Michigan, United States
Lisa Kane Low, CNM, PhD (she/her/hers)

Professor
University of Michigan
Ann Arbor, Michigan, United States
BT

Brian Torok, MD

Medical Director
Corewell Health
Troy, Michigan, United States
Molly J. Stout, MD, MS (she/her/hers)

Associate Professor
University of Michigan
Ann Arbor, Michigan, United States

Objective:
To characterize real-world patterns of adoption of ACOG/SMFM criteria for dystocia as the primary indication for unplanned cesarean birth.

Study Design:
Retrospective analysis of nulliparous, term, singleton, vertex births in the 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. During the eight quarter study period (4/2021-3/2023), all hospitals received BASE, OBI’s standard model of QI support. BASE includes 1) clinician education in dystocia criteria, 2) monthly hospital performance reports, 3) online toolkit, and 4) small financial incentives for hospital participation. Hospitals with any quarterly dystocia case count < 1 were excluded. We categorized each hospital’s performance by: 1) dystocia adherence rate in quarters 1, 5, and 8 (defined as high if >quarter 1 75th percentile; all others = low); and 2) dystocia adherence rate trend (increasing vs. no change, using the time variable’s coefficient in logistic regression models estimated for each site, for each year). Using a matrix, we grouped sites with similar adherence rate/trend combinations to identify distinct adoption phenotypes.

Results:
Of 70 OBI hospitals, 50 were eligible for analysis. Five performance phenotypes emerged (Table 1; Figure 1): High Adherence (n=10, yellow line-starts high, ends high); Rapid Adopters (n=11, teal line-starts low, rises rapidly, ends high); Regressors (n=9, light blue line-starts low, rises, then falls); Slow Adopters (n=11, burgundy line-starts low, rises steadily); and Non-Adopters (n=9, pink line-starts low, ends low).

Conclusion:
In a statewide dystocia initiative, hospital response to BASE QI support varied in timing, magnitude, and duration. An adaptive QI strategy that starts with BASE and “steps up” to more intensive QI support for hospitals that do not rapidly respond, and minimizes QI support resources allocated to high-performing sites, is critically needed to effectively and efficiently address heterogeneous QI needs on inpatient maternity units.