• Institute for Clinical Systems Improvement (ICSI). Routine prenatal care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Aug. 89 p. [290 references]

Does not apply to this measure

This measure is used to assess the percentage of vaginal birth after cesarean (VBAC) eligible women who receive general education describing risks and benefits of VBAC (e.g., the American College of Obstetricians and Gynecologists pamphlet on VBAC).

The priority aim addressed by this measure is to increase the percentage of vaginal birth after cesarean (VBAC) eligible women who receive documented education describing risks and benefits of VBAC.

Prenatal care; vaginal birth after cesarean (VBAC); patient education of risks and benefits

Total number of vaginal birth after cesarean (VBAC) eligible women whose medical records are reviewed (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Number of vaginal birth after cesarean (VBAC) eligible women with documentation of education of the risks and benefits of VBAC (see the related "Numerator Inclusions/Exclusions" field in the Complete Summary)

• A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

Unspecified

Current routine use

Internal quality improvement

Physician Group Practices/Clinics

Physicians

Group Clinical Practices

Women of childbearing age

Female (only)

Unspecified

Unspecified

Unspecified

• While the mother's risk of major complications (hysterectomy, uterine rupture, operative injury) with trial of labor is slightly higher (1.6%) than a scheduled repeat Caesarean delivery (0.8%), these risks are still quite low.
• Symptomatic rupture of the gravid uterus carries a 45.8% perinatal mortality and a 4.2% maternal mortality and occurs in 4.3 to 8.8% of women with a high vertical uterine scar.
• Incisions penetrating the muscular layer of the uterus may weaken this area and increase the risk of uterine rupture.
• A history of previous uterine dehiscence or rupture has a rate of repeat separation of 6.4% if previous uterine incision was in the lower segment and 32.1% if the scar is in the upper segment with complication rates assumed to be similar to those of the primary uterine rupture.

Unspecified

Unspecified

Staying Healthy

Effectiveness
Patient-centeredness

Users of care only

Women at a prenatal visit who are vaginal birth after cesarean (VBAC) eligible

Each month a minimum sample of prenatal visits is identified. This may be accomplished either by administrative search (Current Procedure Terminology [CPT-4] codes 59510, 59400, or International Classification of Diseases, Ninth Revision [ICD-9] code V22.0), or by other case identification at the medical group. From that sample, it would be best to identify 20 VBAC eligible women or total number in a month if less than 20.

Suggested time frame for data collection is monthly.

Patients associated with provider

Inclusions
Total number of vaginal birth after cesarean (VBAC) eligible* women whose medical records are reviewed

*Women without any of the following contraindications to VBAC:

• Previous classic cesarean delivery
• Some uterine surgery, e.g., hysterotomy, deep myomectomy, cornual resection, and metroplasty
• Previous uterine rupture or dehiscence
• Some maternal/fetal medical conditions, such as open neural tube defect and complete placenta previa
• Unknown uterine scar if there is a high likelihood of classical scar
• Rare psychological or social conditions that indicate the patient may not be a good candidate

Exclusions
Women with any of the contraindications to VBAC listed in the "Inclusions" (above)

All cases in the denominator are equally eligible to appear in the numerator

Clinical Condition
Encounter

Time window is a single point in time

Inclusions
Number of vaginal birth after cesarean (VBAC) eligible women with documentation* of education of the risks and benefits of VBAC

*Documented is defined as any evidence in the medical record that a clinician provided education to the VBAC eligible woman of the risks and benefits of VBAC.

Exclusions
Unspecified

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Episode of care

Administrative data
Medical record

Individual Case

Unspecified

Rate

Better quality is associated with a higher score

Unspecified

Internal time comparison

Unspecified

Percentage of VBAC eligible women who receive general education describing risks and benefits of VBAC (e.g., the American College of Obstetricians and Gynecologists pamphlet on VBAC).

Institute for Clinical Systems Improvement

The following Minnesota health plans provide direct financial support: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica, Metropolitan Health Plan, PreferredOne and UCare Minnesota. In-kind support is provided by the Institute for Clinical Systems Improvement's (ICSI) members.

Committee Members: Dale Akkerman, MD (Work Group Leader) (Park Nicollet Health Services) (OB/GYN); Tamara Johnston, MD (Northwest Family Physicians) (Family Medicine); Katie Klingberg, MD (Northpoint Health and Wellness) (Family Medicine); Kari Rabie, MD (Southside Community Health Services) (Family Medicine); Jennifer Schriever, MD (Sioux Valley Hospitals and Health System) (Family Medicine); Carol Stark, MD (Family HealthServices Minnesota) (Family Medicine); Peter Van Eerden, MD (Sioux Valley Hospitals and Health System) (Maternal-Fetal Medicine); Georgeanne Croft, CNM (HealthPartners Medical Group) (Nurse Midwifery); Amy Knox, CNM (Park Nicollet Health Services) (Nurse Midwifery); John A. Jefferies, MD (Mayo Clinic) (OB/GYN); Joan Kreider, MD (HealthPartners Medical Group) (OB/GYN); John Vickers, MD (HealthPartners Medical Group) (OB/GYN); Corinne Esch, RN, CDS (HealthPartners Medical Group) (OB/GYN Nursing); Nancy Jaeckels (Institute for Clinical Systems Improvement) (Implementation Advisor); Linda Setterlund, MA (Institute for Clinical Systems Improvement) (Facilitator)

Measure was not adapted from another source.

2005 Aug

2008 Aug

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems Improvement (ICSI). Routine prenatal care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Aug. 87 p.

• Institute for Clinical Systems Improvement (ICSI). Routine prenatal care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Aug. 89 p. [290 references]

This NQMC summary was completed by ECRI on October 18, 2005. This summary was updated by ECRI Institute on November 30, 2006, December 26, 2007, and again on October 20, 2008.

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

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