The Leapfrog Group, an employer-driven hospital quality watchdog, announced that 2011 results from its annual survey indicate hospitals are making progress in eliminating early elective newborn deliveries.
According to the survey, 39% of reporting hospitals kept their early elective delivery rate to 5% or less, compared to 30% of reporting hospitals last year.
According to Leapfrog, wide variation remains among hospitals. Rates of early elective deliveries ranged from less than 5%, which is Leapfrog’s target for all hospitals, to more than 40%. Leapfrog’s 2011 data is the first indication that hospitals overall are improving.
Leapfrog CEO Leah Binder noted that of the hospitals that reported an elective delivery rate in 2010 and 2011, 65% improved their performance.
“This is extremely promising news,” Binder said in a news release. “But there is still work to be done. We are seeing far too may newborns delivered early and without a medical reason, and there are still a number of hospitals who refuse to make this information public.” Only hospitals that participate in Leapfrog’s annual hospital survey have made this information public.
Experts — including from the American College of Obstetricians and Gynecologists, Childbirth Connection, the Institute for Healthcare Improvement and the March of Dimes — say a baby needs at least 39 completed weeks to fully develop. Medical reasons may justify scheduling a delivery earlier, but these are rare, according to the news release.
Billie Lou Short, MD, chief of neonatology at Children’s National Medical Center, said 19% of admissions at Children’s in 2011 were newborns who fell into the category of “early term” and had morbidity related to early delivery. She said such morbidities include respiratory distress, temperature instability, increased bilirubin resulting in in-hospital treatment, infection, longer hospital stays and a higher mortality rate.
In 2011, 757 hospitals voluntarily reported their rate of early elective deliveries through the Leapfrog Hospital Survey. The average rate across all reporting hospitals fell from 17% in 2010 to 14% in 2011. Several states have an average rate at or below the national average, including California, Colorado, and Massachusetts. Ohio reported the lowest average rate at 7.6%.
Other states reported average rates well above the national average. For example, the average rate of elective delivery at hospitals reporting from Alabama was 22.5%.
Leapfrog also announced a series of initiatives to eliminate early elective deliveries. Leapfrog will be joined by the IHI, Childbirth Connection, Catalyst for Payment Reform (CPR), and employer and regional business coalition members to make available tools that encourage healthcare consumers, employers, health plans, hospitals and policymakers to take action.
IHI will join Leapfrog in hosting two national webinars for healthcare professionals. The webinars take place Feb. 15 and Feb. 28 and will focus on the importance of the reliable determination of gestational age as a component of the Institute for Healthcare Improvement’s Perinatal Bundle Sequence. Featured speakers are Barbara Rudolph, PhD, MSSW, Leapfrog’s senior science director; Sue Gullo, RN, BSN, MS, IHI director; and Peter Cherouny, MD, chairman of the Perinatal Improvement Community.
Among other resources, Childbirth Connection provides evidence-based resources on benefits, harms and appropriate use of labor induction, including tips and tools for avoiding an unnecessary induction, at www.childbirthconnection.org/induction.
These new data on early elective deliveries come from Leapfrog’s 2011 annual hospital survey, in which hospitals are asked to report the percentage of non-medically indicated births between 37 and 39 completed weeks of gestation, delivered electively by induction or by cesarean section before the mother has gone into active labor or has experienced spontaneous rupture of membranes.
Hospital rates of elective deliveries are now available for viewing at www.leapfroggroup.org/tooearlydeliveries.
The Joint Commission also monitors hospital performance on this quality measure, and most recently the U.S. Department of Health and Human Services announced this measure will be included in the first set of quality measures for voluntary use by state Medicaid agencies, although reporting is not scheduled to begin until December 2013.