Rate-based Calculation of Failure to Progress

A Proposed Quality Improvement Method

Published in: Obstetrics and Gynecology, v. 79, no. 4, Apr. 1992, p. 633-636

by Lee W. Van Voorhis, Robert C. Reiter, Joseph C. Gambone, Sally C. Morton

Read More

Access further information on this document at www.greenjournal.org

This article was published outside of RAND. The full text of the article can be found at the link above.

The rate of failure to progress as the indication for primary cesarean delivery used by the Joint Commission on Accreditation of Health care Organizations is based upon the total number of cesareans performed for this indication divided by the total number of primary cesareans. This denominator includes a large number of patients who are not at risk for the diagnosis of failure to progress, including cases of malpresentation or multiple gestation in which cesarean is performed without trial of labor. Each of these variables may vary dramatically between individual physicians and institutions. Inclusion of patients not at risk for failure to progress results in a misclassification bias, which renders this rate less meaningful for purposes of comparison and trend assessment. The authors describe a simple method that bases the rate of failure to progress upon the population at risk for this diagnosis; that is, the total number of vaginal deliveries plus primary cesareans for failure to progress minus vaginal births after cesarean. Such a methods controls for multiple differences in local practice standards and allows more meaningful assessment of trends and intra-institutional and inter-regional comparisons.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/research-integrity.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.