You can change behavior, but it’s so darn hard

I’ve been meaning to get to this study, but I’ve been swamped. From NEJM, “A Cluster-Randomized Trial to Reduce Cesarean Delivery Rates in Quebec“:

BACKGROUND: In Canada, cesarean delivery rates have increased substantially over the past decade. Effective, safe strategies are needed to reduce these rates.

METHODS: We conducted a cluster-randomized, controlled trial of a multifaceted 1.5-year intervention at 32 hospitals in Quebec. The intervention involved audits of indications for cesarean delivery, provision of feedback to health professionals, and implementation of best practices. The primary outcome was the cesarean delivery rate in the 1-year postintervention period.

Cesarean section deliveries are occurring too often. So many hospitals intervened in Quebec over a five-year period to try and reduce the rates. More than 100,000 deliveries happened over the study. Here’s what happened:

C section

That’s actually a statistically significant result. So it’s a success. The overall rate went down 0.7% in the study group and up 0.3% in the control group. It also went down in the low-risk group, but not in the high-risk group, so it’s likely that the “correct” c-sections were the ones avoided.

But this took 1.5 years, a lot of manpower, and I assume a lot of money. And that’s how much things changed. Changing behavior is hard.


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