Dramatic Decline in Dangerous Early Elective Deliveries

March 3, 2014

The national rate of maternal early elective deliveries dropped for the third year in a row, with the national average for the first time hitting the target rate of less than 5 percent, announced nonprofit hospital quality watchdog The Leapfrog Group (Leapfrog). Leah Binder, President and CEO of Leapfrog, will release the new data at the Catalyst for Payment Reform’s National Summit on Maternity Care on March 3rd.

“This is one of the most extraordinary examples of progress in healthcare that I’ve seen in my career,” said Binder. “It shows that public reporting can galvanize change, and that saves lives.”

Early elective deliveries — inductions or cesarean procedures performed prior to 39 completed weeks gestation without medical necessity — carry risks to babies and mothers. They can also result in NICU admissions, increased length of stay, and higher costs to patients and payers. The American College of Obstetricians and Gynecologists (ACOG) has advised against these deliveries for over 30 years.

The results from the group’s 2013 Leapfrog Hospital Survey show a sharp decline in early elective deliveries since Leapfrog became the first to publicly report on this vital maternity care measure four years ago. The national average of 4.6 percent in 2013 stands in sharp contrast to the national average of 17 percent in 2010.

Year-over-year, the results have also been impressive, with the rate of early elective deliveries cut in half from 2012 alone (11.2 percent).  In 2013, 71 percent of the reporting hospitals met Leapfrog’s early elective deliveries target rate of less than 5 percent, compared to 46 percent of hospitals in the 2012 survey.  Leapfrog is also reporting a spike in its survey participation, with 969 hospitals reporting on early elective deliveries in 2013, up 200 hospitals from last year. 

Leapfrog was the first to publicly report rates of early elective deliveries by hospital. That public reporting accelerated longstanding efforts by a network of organizations working to eliminate unnecessary deliveries, including the Catalyst for Payment Reform, the National Business Group on Health and the March of Dimes.  At the Centers for Medicare & Medicaid Services, both the Partnership for Patients Program and the Strong Start for Mothers and Newborns Initiative identified early elective deliveries as a top priority issue early in 2012, and have both aligned their resources to achieving these results.

The 2013 data reveals that the vast majority of states are now reporting early elective delivery average rates of less than 10 percent, with standouts like California, Colorado, Maine and Massachusetts boasting rates at 3 percent or lower. Binder highlights dramatic improvements from states like South Carolina where payment reform penalties enacted by government and private sector stakeholders are effectively discouraging the practice of early elective deliveries. Despite nationwide and statewide successes, she notes widespread variation still exists.

“Some hospitals are still reporting early elective delivery rates higher than 20 and 30 percent, which means there is still work to be done,” added Binder.

A leader in maternity care data, Leapfrog  this year begins collecting data on cesarean section rates for hospitals reporting at least 50 births annually. Hospital rates of nulliparous term singleton vertex (NTSV) cesarean section delivery will be publicly reported on the Leapfrog Hospital Survey Results website (www.leapfroggroup.org/cp) in 2015.

“Just as we’ve seen early elective delivery rates drop after Leapfrog began publicly reporting them, we hope to spur national efforts to bring down the rate of C-sections,” said Binder. 

Rates of early elective deliveries by hospital, as well as statewide averages, are publicly available on www.LeapfrogGroup.org/TooEarlyDeliveries.

To live stream Leah Binder’s announcement at the Catalyst for Payment Reform’s National Summit on Maternity Care on March 3rd at 11 a.m. ET, register at: http://catalyzepaymentreform.givezooks.com/.


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