What is Optimal Birth BC?

A partnership between academic researchers, the BCPHP, and provincial health authorities to define and achieve optimal rates of cesarean birth in BC.
Funded by the Canadian Institutes of Health Research.

Optimal Birth BC was initiated in May 2008 to develop a sustainable framework--using cesarean delivery as a template--which will support both the uptake of evidence-based obstetrical health care in regional health authorities, and informed decision-making among pregnant women. EPIC stands for Evidence-based Practice Identification and Change. It extends traditional health care quality improvement methods through: use of existing evidence in published literature; development of a benchmarked database to identify areas where practice outcomes are not comparable among participant agencies; and collaboration among a network of experts in clinical care, research, and administration.

There are three cornerstones to EPIC:

i) Evidence - relies on systematic reviews of evidence
ii) Objectivity - uses data from participating institutions to identify practices for targeted intervention
iii) Collaboration - links institutions together in order to collectively share multi-disciplinary expertise and experience within.

i. Objectives

To identify determinants of variation in cesarean section rates within and among health authorities;
To study the impact of the EPIC approach as applied to cesarean section rates;
To identify and measure factors within regional health authorities that are associated with adoption of the EPIC framework;
To develop and evaluate a consumer-targeted education strategy aimed at improving knowledge of risks and benefits associated with cesarean section;
To build sustainable infrastructure in the BC Perinatal Health Program and Health Authorities, including ongoing surveillance, mentoring, and public education to ensure optimal rates of cesarean delivery.

ii. Outcomes

1. Planning

Time to develop EPIC teams
Composition of EPIC teams
Process and resources developed for education with respect to planned change
Measurable indicators identified for ongoing monitoring
Identification of facilitators and barriers to change
Development of communication aids by BCPHP - listserv, expansion of website to encompass a bulletin board, monthly teleconferences, newsletter, new data fields for perinatal database

2. Practice Change

Attributes of hospitals/health authorities that develop EPIC teams within three months vs. those that don't.
Practice change is based on syntheses of best evidence
Development of benchmarks for practice change
Proportion of staff aware of practice change and reasons for it
Uptake of practice change among relevant staff
Consistency of practice after change initiated within health authorities
New practice is consistently documented and monitored
PDSA cycles initiated every three months
Responsibility for quality improvement is included in job descriptions of nursing and physician leaders
Reource implications of EPIC are subsumed into operating budgets

3. Clinical Outcomes

Overall cesarean section rate among selected groups

Nulliparous women at term carrying a singleton fetus in cephalic position
Healthy multiparous women with one prior cesarean delivery
Maternal knowledge (re: risks/benefits) of cesarean section and procedures predisposing to cesarean section
Rates of maternal request for cesarean section