Hospital watchdog The Leapfrog Group has released the elective delivery rates of 773 hospitals online. The data reveals significant variation among hospitals in their early elective – meaning without medical reason – rates of Cesarean section and elective inductions, with some hospitals having 10 times the rate of others.
The data is from Leapfrog's 2010 annual hospital survey, which is based on hospital performance and hinges heavily on IT use.
[See how IT is used to rate hospitals in the survey: Leapfrog names 65 best hospitals in the country for 2010 ]
In the survey hospitals are asked to report the percentage of non-medically indicated births between 37 and 39 weeks gestation that were delivered electively by Cesarean section or induction. The Joint Commission has begun monitoring hospital performance on this quality measure as well. In April 2010, the comission added the elective deliveries measure to its perinatal core measure set.
"A baby's birth should not be scheduled before 39 weeks of pregnancy, unless their healthcare provider says it's medically necessary," says Alan R. Fleischman, MD, senior vice president and medical director of the March of Dimes, which is working with the Leapfrog group to get more information to women about the importance of each week of pregnancy.
[Learn about a tool that might be able to detect if it is medically necessary: Electronic health history tool being developed to detect pregnancy risks]
According to Leapfrog, hospital rates of early elective deliveries range from less than 5 percent to more than 40 percent. The 773 hospitals across the country that voluntarily provided Leapfrog with information on this measure reported more than 57,000 early elective deliveries by Cesarean section or induction during the reporting period.
The variation in hospital rates has long been talked about in the healthcare community, but Leapfrog's release of 2010 data is the first real evidence that the practice of scheduling newborn deliveries before 39 weeks without a medical reason is common and varied among hospitals even in the same state or community. For example, in the city of Los Angeles, hospitals reported rates as low as 4 percent and as high as 29 percent. In Boston, Leapfrog saw similar variation with some hospitals reporting near zero and others as high as 27 percent.
"Every hospital should publicly report on their rate and actively prevent the practice, and every woman planning to give birth should demand the information," said Leapfrog CEO Leah Binder.
Babies that are scheduled for delivery too early, may result in having a higher likelihood of death, being admitted to a Neonatal Intensive Care Unit (NICU), and life-long health problems.
Maureen Corry, executive director for Childbirth Connection, a national advocacy organization, says on the organization's website that Childbirth Connectionis "providing women with evidence-based resources on benefits, harms, and appropriate use of labor induction, including tips and tools for avoiding an unnecessary induction."
In 2010, Leapfrog's target for hospitals was a Cesarean section and/or induction rate of less than 12 percent of the total number of non-medically indicated deliveries occurring between the 37th and 39th week of gestation.
In 2011, Leapfrog will lower the target to 5 percent. This change was made in part because 50 percent of reporting hospitals were able to meet Leapfrog's 12 percent target in 2010 and 29 percent of reporting hospitals exceeded Leapfrog's target by reporting rates of 5 percent or less.
Hospital rates of elective deliveries scheduled too early are now available here.
