An intervention that promoted clinical audits, feedback, and best labor and delivery practices led to a significant reduction in the rate of cesarean deliveries among women with low-risk pregnancies giving birth at public hospitals in Quebec, Canada, according to a cluster randomized clinical trial (Chaillet N et al. N Engl J Med. 2015;372:1710-1721).
The 1.5-year QUARISMA (Quality of Care, Obstetrics Risk Management, and Mode of Delivery) intervention consisted of training physicians and nurses in evidence-based clinical practices, developing local audit committees, providing feedback to improve performance, and implementing best practices related to cesarean delivery. The control group had no intervention. Each of the 32 hospitals participating in the trial delivered at least 300 babies annually and had a cesarean delivery rate higher than 17%. A total of 105 351 women delivered in the year before the intervention or in the year after the intervention were included in the study.
Slomski A. Clinician Training Reduces Cesarean Rates in Low-Risk Pregnancies. JAMA. 2015;313(24):2416. doi:10.1001/jama.2015.6590