David Lagrew

Executive Director Women’s Services
St. Joseph HOAG Health

David Lagrew Jr., MD,  is the Chief Integration and Accountability Officer for MemorialCare.  Prior to this assignment he was the Medical Director of the Women’s Hospital at Saddleback Memorial since 1988. That department, with over 40 Ob/Gyn's and 3,000 annual births, is the first LDRP hospital in California. Through his career, Dr. Lagrew's clinical work and publications have focused on cesarean section rates, antepartum testing and clinical computing. He also serves as the Medical Director of Informatics for the MemorialCare Physician Society which serves the five hospital system based in Southern Los Angeles and Orange Counties. Dr. Lagrew developed a perinatal database used in the MemorialCare system which has allowed analysis for Quality Improvement and numerous publications.

Dr. Lagrew completed his residency in obstetrics/gynecology at University of Kentucky School of Medicine (Lexington, Ky.) and a fellowship in maternal-fetal medicine at Long Beach Memorial/University of California, Irvine. He currently on the Board of Directors of Memorial Health Services, is the past Chief of Staff of Saddleback Memorial, Past President of the Orange County Perinatal Council and served on numerous committees on Maternal Quality. He is a Clinical Professor in the department of Obstetrics and Gynecology of the University of California, Irvine.

I believe we are in the beginning of radical changes in the delivery of obstetrical care with the development of evidence based protocols which are fueled by detailed process and outcome statistics from our electronic medical records. These changes will allow us to make rational clinical decisions which will improve the childbirth experience of all women of California.

Profile in Improvement

One of the challenges of modern obstetrics in the United States has been the rise in elective inductions.  In the case of nulliparous patients, an elective induction raises the chance of cesarean section and protracted labors.  After analyzing hospital induction rates the department of Obstetrics and Gynecology at Saddleback Memorial instituted quality improvement processes of feedback and scheduling requirements to prevent elective induction of labor in nulliparous patients prior to 41 weeks gestation.  The resultant effect of these changes reduced the percentage of such patients from 25.5% to 0.6% of nulliparous inductions and reduced the overall induction rate from 24.9% to 22.9%.