IHA Daily Briefing: Aug. 9

Induced Labor at 39 Weeks May Make C-section Less Likely
FDA Alert on Misuse of Pregnancy Test
MAPS PSO Member Value: Safe Table Events
Additional CMS Rule on ACA Risk-Adjustment Program

Induced Labor at 39 Weeks May Make C-section Less Likely
New research, led by a physician with Northwestern Medicine, indicates that healthy first-time mothers whose labor was induced in the 39th week of pregnancy were less likely to deliver by cesarean section, compared to those who waited for labor to begin naturally.

The study, funded by the National Institutes of Health, also found that infants born to women induced at 39 weeks were no more likely to experience stillbirth, newborn death or other severe complications, compared to infants born to uninduced women. The study results, which were presented earlier in brief form in the American Journal of Obstetrics & Gynecology, now appear in detail in the Aug. 9 New England Journal of Medicine.

“There’s a lot of controversy around the consequences of inducing labor. People were convinced that it increased the risk of cesarean delivery, but the reality was actually unknown,” said Dr. William Grobman, a professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “This study provides evidence that inducing labor at 39 weeks actually reduces cesarean delivery.”

In the study, more than 6,100 women from 41 sites around the country were divided into two groups: one that waited for labor to begin on its own and one that would undergo an elective induction at 39 weeks of gestation. Among the study’s key results:

  • Lower rates of cesarean delivery among the elective induction group (19 percent) compared to non-induction group (22 percent);
  • Lower rates of preeclampsia and gestational hypertension group (9 percent) compared to the non-induction group (14 percent); and
  • Lower rates of respiratory support among newborns in the induction group (3 percent) compared to the non-induction group (4 percent).

“This new knowledge gives women the autonomy and ability to make more informed choices regarding their pregnancy that better fit with their wishes and beliefs,” Grobman said. “Induction at 39 weeks should not be routine for every woman, but it’s important to talk with their provider and decide if they want to be induced and when."

FDA Alert on Misuse of Pregnancy Test
The U.S. Food and Drug Administration (FDA) is alerting women and physicians about serious adverse events related to the improper use of tests intended as an aid in detecting if a pregnant woman’s water has broken (also known as a rupture of the membranes containing amniotic fluid). A rupture of the membranes (ROM) can pose immediate and severe risks to the patient and developing fetus without proper patient management and timely intervention.

The FDA has issued a Letter to Health Care Providers saying that the labeling for these tests specifies that they should not be used on their own to independently diagnose a ROM in pregnant women. These tests have only been cleared for marketing by the FDA to be used by healthcare providers in conjunction with other clinical assessments to make critical patient management decisions regarding whether a ROM has occurred.

The FDA says it has received information that indicates healthcare providers may be relying solely on ROM test results when making critical patient management decisions, despite manufacturers’ labeling instructions that ROM tests should not be used on their own to independently assess whether a ROM has occurred.

MAPS PSO Member Value: Safe Table Events
The Midwest Alliance for Patient Safety (MAPS) Patient Safety Organization (PSO) held its latest Safe Table event on surgical fires and vaping challenges on Aug. 8. MAPS PSO designs these members-only meetings for healthcare providers to share and collaborate—an important opportunity for hospital and health system leaders to improve patient safety and a distinct advantage of MAPS PSO, an IHA company.

During Safe Table events, participants discuss patient safety experiences and best practices, and they learn from experts and each other in a safe environment. Over 45 MAPS members attended Wednesday’s Safe Table to exchange ideas and lessons learned in a safe environment. At the event, MAPS featured leaders from an IHA-member healthcare system who shared their training methods, challenges and unidentified member stories with MAPS members.

Facilitated group discussions led to members finding new resources for operating room education. In addition, issues of patient and visitor vaping in hospitals and outpatient waiting rooms led to a discussion on updating signage, smoking policies and the need to create community education on the dangers of vaping.

All Safe Table events are considered Patient Safety Work Product (PSWP). Members are educated on and acknowledge the code of confidentiality by signing an agreement that they will not reveal specific details about any member stories or conversations. The PSWP is federally protected under a PSO.

The next MAPS Safe Table will be on Oct. 30 and will address innovative approaches to opioid prescribing and pain management. Don’t miss these unique opportunities to learn from experts and share ideas with colleagues across the state.

For more information about MAPS PSO benefits and membership, contact Carrie Pinasco, MAPS Director. Visit www.alliance4ptsafety.org.     

Additional CMS Rule on ACA Risk-Adjustment Program
The Centers for Medicare & Medicaid Services (CMS) yesterday issued a notice of proposed rulemaking, “Patient Protection and Affordable Care Act; Methodology for the HHS-operated Permanent Risk Adjustment Program for 2018 Proposed Rule.” CMS proposes to adopt the risk adjustment methodology that the Dept. of Health and Human Services previously established for the 2018 benefit year which uses the statewide average premium in the payment transfer formula.

“[Wednesday’s] proposed rule continues our effort to help stabilize the individual and small group markets,” said CMS Administrator Seema Verma. “Our goal has been, and will continue to be, to stabilize the market and provide American consumers with more affordable health coverage options.”

CMS says the proposed rule “further explains the justification for utilizing statewide average premium in the calculation of risk adjustment transfers, and expands on the reasoning behind operating the HHS-operated risk adjustment program in a budget-neutral manner.”