Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Letters

Reducing the rates of inappropriate labour induction

Craig Ramsay, Lloyd Matowe, Jeanette Ward and Jeremy Grimshaw
CMAJ April 17, 2001 164 (8) 1128;
Craig Ramsay
Health Services Research Unit University of Aberdeen Aberdeen, United Kingdom; Health Services Research Unit University of Aberdeen Aberdeen, United Kingdom; Needs Assessment & Health Outcomes Unit Sydney, Australia; Health Services Research Unit University of Aberdeen Aberdeen, United Kingdom
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lloyd Matowe
Health Services Research Unit University of Aberdeen Aberdeen, United Kingdom; Health Services Research Unit University of Aberdeen Aberdeen, United Kingdom; Needs Assessment & Health Outcomes Unit Sydney, Australia; Health Services Research Unit University of Aberdeen Aberdeen, United Kingdom
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jeanette Ward
Health Services Research Unit University of Aberdeen Aberdeen, United Kingdom; Health Services Research Unit University of Aberdeen Aberdeen, United Kingdom; Needs Assessment & Health Outcomes Unit Sydney, Australia; Health Services Research Unit University of Aberdeen Aberdeen, United Kingdom
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jeremy Grimshaw
Health Services Research Unit University of Aberdeen Aberdeen, United Kingdom; Health Services Research Unit University of Aberdeen Aberdeen, United Kingdom; Needs Assessment & Health Outcomes Unit Sydney, Australia; Health Services Research Unit University of Aberdeen Aberdeen, United Kingdom
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

Susan Harris and colleagues have described a clinical quality improvement (CQI) initiative to reduce the rates of inappropriate induction of labour.1 They claim that their initiative was associated with a sustained reduction in induction rates and recommend that “similar projects be undertaken at other institutions.” We are unconvinced that their data support these conclusions. Specifically, the authors provide only descriptive data without statistical testing. We reanalysed the data using time-series regression models, which allow assessment of and adjustment for preintervention time trends.2,3 Although our reanalysis has limited statistical power owing to the small number of data points, we found a decreasing trend in induction rates before the intervention (0.45% decrease per 6 months, p = 0.10) and no evidence of a continuing trend after the intervention (0.11% decrease, p = 0.64). However, there was evidence of an overall shift in pre- to post-intervention rates (absolute reduction of 2.6% in the 6 months following the intervention, p = 0.06). This could be due to a small intervention effect, although we are uncertain of its clinical significance. We invite the authors to consider conducting a more powerful time-series analysis by disaggregating their data into shorter intervals that still allow stable point estimates of performance.

The authors state that their CQI initiative was “very time-consuming,” representing “a significant cost to the institution.” Hospitals have limited resources to spend on quality improvement. There are substantial opportunity costs if hospitals adopt unproven methods. If we are to generate a robust evidence base for quality improvement activities, we should demand that quality improvement strategies be evaluated with the same scientific standards that are used to evaluate any clinical intervention. This paper fails to provide compelling evidence that CQI works or provides good value for money. Further evaluation is required before widespread adoption of CQI can be recommended.

References

  1. 1.↵
    Harris S, Buchinski B, Grzybowski S, Janssen P, Mitchell GWE, Farquharson D. Induction of labour: a continuous quality improvement and peer review program to improve the quality of care. CMAJ 2000;163(9):1163-6.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    Cook TD, Campbell DT. Quasi-experimentation: design and analysis issues for field settings. Chicago: Rand McNally; 1979.
  3. 3.↵
    Draper N, Smith H. Applied regression analysis. 2nd ed. New York: J. Wiley & Sons; 1981.
PreviousNext
Back to top

In this issue

CMAJ
Vol. 164, Issue 8
17 Apr 2001
  • Table of Contents
  • Index by author

Article tools

Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Reducing the rates of inappropriate labour induction
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Reducing the rates of inappropriate labour induction
Craig Ramsay, Lloyd Matowe, Jeanette Ward, Jeremy Grimshaw
CMAJ Apr 2001, 164 (8) 1128;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Reducing the rates of inappropriate labour induction
Craig Ramsay, Lloyd Matowe, Jeanette Ward, Jeremy Grimshaw
CMAJ Apr 2001, 164 (8) 1128;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Building research infrastructure across a health service
  • A safe return to sport and the right to play during COVID-19
  • Simple-language tool to guide patients in recovery after prolonged treatment in the intensive care unit
Show more Letters

Similar Articles

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of the resources on this site in an accessible format, please contact us at cmajgroup@cmaj.ca.

Powered by HighWire