Below is a
list of the items needed to complete the application for the American College
of Nurse-Midwives, Healthy Birth Initiative: Reducing Primary Cesareans Quality
Improvement (QI) multi-hospital learning collaborative. There is a link to a survey which must be
completed at Survey Monkey, and all other application materials (Letter of
Application and Participation Agreement) should be submitted via the ACNM
portal at http://midwife.org/RPC-Applications-Upload (Note: you will have to log in to your ACNM account in order to access this page).
We expect to
schedule telephone interviews with teams who are finalists during the weeks of
Timeline for Applications to Reducing Primary
Cesareans Collaborative – 2018
Application period opens
May 15, 2017
Applications accepted on a rolling basis
May 15-July 21, 2017
Final deadline for applications:
Survey completed on Survey Monkey
Letter of application (LOA) uploaded to ACNM
Participation agreement uploaded to ACNM portal
July 21, 2017
Interviews to be scheduled for finalists
August 7-15, 2017
Notification to accepted hospital teams
Early September 2017
SAVE THE DATE
for Mandatory Kickoff meeting in Portland, OR
October 25, 2017
We will only review complete applications.
Please double check that these three items are submitted as part of your
Survey on Survey Monkey: https://www.surveymonkey.com/r/ACNMRPCSurvey
of Application (LOA) not more
than 3 pages, 11 pt. font. Please upload your LOA to the ACNM portal: http://midwife.org/RPC-Applications-Upload
letter to include the following:
Name and Address
want to participate in ACNM’s Reducing Primary Cesareans Collaborative
description of your hospital’s experience in leading obstetric quality
improvement efforts, including the topics for recent obstetric quality
Please list at
least two people from your team who will be designated as co-leaders of this
initiative, serve as the key points of contact to the RPC, and participate in
required training from IHI as part of the collaborative. Please describe their
experience and skills.
exist in your department to support quality improvement (QI)? What support will the team receive from your QI
participated in the ACNM Benchmarking program? If so in which years?
your OB department collects or obtains clinical statistics for quality improvement
What are the
current strengths within the OB department that would support your success in
What are the
current challenges within the OB department that would need to be addressed in
order to change the current culture in the OB department?
List of your
team members, including their role and contact information:
agreement (copy and paste from text below, sign, and then save as a PDF and
upload to the ACNM portal) signed by appropriate
Senior Hospital Leadership (for example, COO, VP for Quality, Chief Clinical or
Nursing Officer. Agreement should be
uploaded via ACNM portal: http://midwife.org/RPC-Applications-Upload
Administrative Commitment to
ACNM’s Reducing Primary Cesareans
Learning Collaborative, 2018
Nearly one third of births in the US are delivered by cesarean section
each year. After a 60% increase in cesarean births from 1996 to 2009, reaching
a high of 32.9%, there was a slight decline to 32.7% in 2013. While
cesarean birth can be a lifesaving procedure in situations when vaginal
delivery is not a safe option, for most low-risk women giving birth for the
first time, cesarean deliveries create more risk, including hemorrhage, uterine
rupture, abnormal placentation, and respiratory problems for infants.
Furthermore, mothers who have had cesarean sections have increased chance of
these risks in subsequent cesarean deliveries.
In addition to these risks, mothers who undergo cesareans have longer
recovery times, slower returns to productive activities, and difficulty
This trend has received worldwide
attention from various stakeholders as a maternal and child quality issue. In
2000, the American Congress of Obstetricians and Gynecologists (ACOG) published
a report on the trend in cesarean births, with a proposed national goal of
15.5%. More recently, the federal Healthy People 2020 guideline
established a target rate cesarean delivery rate of no more than 23.9% for
low-risk women without a prior cesarean. These births to low risk, first time
mothers are referred to as NTSV births.
Concern about high cesarean rates
is driven by both quality concerns and costs.
For example, national data shows that, on average, a cesarean birth
costs $3,432 to $7,000 more than a vaginal birth.  In
response, a range of stakeholders, including professional societies and
purchasers, have now focused attention on this issue.
and other midwifery organizations developed the Physiologic Birth Consensus statement aimed at supporting women to give birth
without intervention, unless medically indicated. Recognizing the need for
additional learning tools and support for clinicians seeking to promote healthy
births, ACNM developed The Healthy Birth InitiativeTM (HBI), a
long-term program led by ACNM and representatives from leading maternity care
organizations. HBI provides the tools and resources to put the Physiologic
Birth Consensus statement into practice. It focuses on promoting physiologic
birth and avoiding unnecessary medical interventions, including cesareans, in
order to achieve the best childbirth outcomes for mothers and babies. The program provides resources and
tools to help women, their families and health care providers achieve healthy
childbirth. In addition,
HBI provides information about evidence-based research to hospital
quality managers and policy leaders, which can drive quality improvement and
support mandated reporting for national quality measurement programs.
College of Nurse-Midwives will be accepting applications for its third year of
a multi-state, multi-hospital initiative aimed at reducing primary cesarean
births in low risk women through the support of physiologic labor and birth.
The collaborative is called Reducing Primary Cesareans, or “RPC.” Twenty two hospitals from across the
U.S. participated in the first and
second years of the collaborative during 2016 and 2017. These hospitals have
already achieved reductions in their NTSV rates of up to 18%. At a median reduction of 6%, for the hospitals
participating in the 2016 collaborative, this would represent savings of
between $618,000 and $1.5 million.
selected to participate in the learning collaborative work with
a multi-disciplinary team of RPC quality improvement experts
to identify areas of improvement
and track process and outcome measures. Hospitals implement one of three change
bundles that are designed to reduce NTSV cesareans by promoting key principles
of physiologic birth. The three bundles are aimed at: promoting progress in
labor; promoting comfort in labor; and implementing intermittent auscultation
(fetal monitoring). More information about the bundles can be found at www.birthtools.org. In addition,
hospitals collect and submit data to the ACNM RPC Data Center, which produces
key measures so hospitals can track their progress.
Hospitals participating in the collaborative will work with national experts
to change clinical
practice at your facility. They will:
in learning community and share best practices
coaching from our clinical experts
data to and get access to reports from our data center that allow you to track
access to materials and tools that have enabled others to succeed
hospital is applying to participate in the 2018 Collaborative. Please review
the commitment required and indicate your support by signing this agreement.
Two co-leaders for this project who will serve as
the primary points of contact to the broader collaborative, and who will
complete some free online courses offered by IHI if they do not already have
training and experience in quality improvement.
by the co-leaders at a mandatory , full day initial kick-off meeting. This is
being held in conjunction with Midwifery Works in the last week of October 2017
in Portland, OR.
at quarterly training webinars, led by RPC faculty (1 hour per webinar)
at monthly, mandatory coaching calls with several
other hospitals who are implementing the same bundle as your team, facilitated
by a RPC coach. (2 hours per call)
collection and analysis activities. In 2017, there are 19 key data elements to
be uploaded in the aggregate for your hospital’s NTSV deliveries (does not
involve personal health information (PHI)) on a monthly basis. We are currently
reviewing these data elements for parsimony, and will confirm any changes to
the current data elements by October, 2017. Some data may be extracted from
existing reports, and other data may require chart review to collect. (Time estimate
of 4 hours per month; this will vary by hospital
based upon how data is currently collected).
meetings plus other interdisciplinary meetings at your hospital. (Time estimate
of 2-5 hours/month)
Costs of participation:
In 2018, there will be a $7,500 annual fee for participants to defray
ACNM’s costs of supporting this project. Each
institution is responsible for all expenses related to travel to the kick off
Please review and sign the following agreement:
undersigned, agree to provide the administrative support needed to participate
in the 2018 cycle of the American College of Nurse-Midwives HBI Reducing
Primary Cesareans Collaborative. This support includes ensuring adequate time
and other resources are available to the team as described below:
time for co-leaders to work with RPC coaches and other teams in the
collaborative for the project period from January 1, 2018 through June 30, 2019
at by two co-leaders at the full day
kickoff meeting on October 25, 2017 in Portland, OR
a clinical improvement team comprised of between 3 and 5 clinical staff to
participate in the RPC collaborative throughout the project period. At a
minimum, the team must include a clinical provider leader (nurse-midwife,
physician, nurse practitioner or registered nurse), an administrative leader,
and a representative from quality improvement. Provide an opportunity for all
members of the improvement team to meet at least twice a month to engage in
improvement activities. Practices that have previously participated suggest
dedicating between 4-6 hours per month.
towards implementing the components of one of the three RPC change bundles
in, and contribute to, the RPC Learning Collaborative, including practice
representation at all quarterly webinars and monthly coaching sessions:
information technology support for your team to connect via Go To Meeting for
support from Electronic Medical Records or other staff to automate (when
possible) data extraction and uploading to the RPC Data Center
below, the parties agree that they have reviewed this participation agreement.
We acknowledge that failure to meet the participation requirements may result
in failure of the team to achieve the goals they set and potentially your team
being asked to leave the project.
 This measure refers to first-time pregnancies
(Nulliparous) that have reached at least 37 weeks gestation (Term), with one
fetus (Singleton) in the head-down position (Vertex).