(214) The Impact of Stepwise Interventions on NTSV Cesarean Rates and on Racial Inequities

This retrospective review examined NTSV CS data over four years at a large tertiary institution, stratified by race. A stepwise series of interventions were implemented to improve patient outcomes (table 1). The impact of the interventions was assessed using chi-square tests. A sub-analysis focused on rates among self-identified Black individuals (Table 2).

Results:
In the primary analysis, there was no statistically significant change in NTSV CS rate across the intervention series. Amongst all individuals, the pre-intervention NTSV CS rate (three months prior) was 22.2% compared to 26.9% three months after the final intervention. In the sub-analysis of Black individuals, two interventions showed statistically significant differences: development of the hospital working group (p=0.014) and patient identification in safety rounds (p=0.004). However, for both, the rates increased post-intervention, indicating more cesarean deliveries. Amongst Black individuals, the pre-intervention NTSV rate (three months prior to interventions) was 6.7%, rising to 54.5% after the last intervention.

Conclusion:

Despite implementing a stepwise series of interventions aimed at reducing NTSV cesarean rates overall, and particularly among Black individuals, rates remained essentially unchanged. These findings suggest that no single intervention sufficiently lowers the NTSV CS rate, underscoring the need for continued innovation to address this important quality discrepancy.