February 20, 2012

Illinois Hospitals Make Progress in Eliminating Early Elective Deliveries

MBGH leads multi-stakeholder efforts to drive statewide maternity care improvements

Cary Conway, Media Consultant

CHICAGO – The 2011 results from the annual Leapfrog Hospital Patient Safety Survey indicate that over 71% of Illinois hospitals have reduced their rates of early elective deliveries in the last twelve months, with 40% of reporting hospitals in Illinois bringing their early elective delivery rate to 5% or less.  While progress has been made in eliminating unnecessary, early elective newborn deliveries in Illinois, there is still significant room for improvement, according to employer-driven hospital quality watchdog The Leapfrog Group and its Illinois regional leader, the Midwest Business Group on Health (MBGH).

Maternity care is the number one reason for hospitalization among most employee populations. The highest cost for maternity care is when a pre-term infant (those born at <39 completed weeks of gestation), is treated in the neonatal intensive care unit of a hospital, due to having underdeveloped brain, lung or other health problems. These children, if they survive, often have life-long, costly, complex health conditions.*

Elective C-sections and inductions are performed on women of all backgrounds and incomes. They are often conducted to address the needs of physicians, who want to avoid weekends or other inconvenient times, as well as to accommodate the requests of patients, who may want to deliver on certain days or holidays or just to end the pregnancy due to discomfort. These elective procedures are distinct from early deliveries performed due to clinically-appropriate reasons that necessitate early birth to avoid clinical and health problems facing the mother or the infant.

When early elective delivery rates were first published last year by the Leapfrog Group, MBGH issued a “Call for Action” for hospitals and physicians to reduce non-medically related elective deliveries in the state. In 2011, MBGH joined Quality Quest for Health of Illinois, the Illinois Chapter of the March of Dimes and the Perinatal Quality Collaborative of Illinois to convene a series of summits for employers, government agencies, health plans, hospitals, physicians, consumer groups and others to discuss how to build on and coordinate existing efforts to achieve better outcomes in maternity care. These summits were funded under a grant program to promote community improvements sponsored by the National Business Coalition on Health and United Health Foundation.

The summits identified the following issues that need to be addressed to reduce early elective deliveries:

  • Development of a standard and statewide performance clinical data definitions and collection efforts, leading to provider and public reporting of performance;
  • Adoption by every maternity hospital of elective delivery clinical policies aligned with best practices;
  • Designing and implementing payment reform to align financial incentives with best practice and full term births;
  • Promoting malpractice relief for providers following best practices; and
  • Conducting consumer education and outreach, including worksite programs, to increase knowledge of the importance of full term births and best practice for maternity care.

“There is wide variation among reporting hospitals throughout Illinois,” said Larry Boress, president and CEO of MBGH. “While we’re pleased to see improvement, there is much more work to do since over 60% of our maternity centers did not reach the targeted 5% rate and many hospitals do not even disclose their patient safety performance to the public. By shining a light on this problem, we encourage physicians to advise patients, who desire early deliveries for convenience, of the serious lifelong health and cost ramifications to their infants of such actions.”

Ken Nunes, MD, executive medical director of The Women’s Care Center, University of Chicago Medical Center, which reduced its early elective delivery rate from 33% to 2%, noted, “It’s hard to ignore the growing body of evidence over the past five years that there are risks to newborn babies when electively delivered between 37 and 39 weeks gestational age. In an effort to improve outcomes among newborns at the University of Chicago, we implemented a written protocol to deter this practice. With education and departmental support, we have seen a dramatic reduction, with a rate below the national target of 5%.”

National Partnerships to Eliminate Early Elective Deliveries

MBGH will participate with Leapfrog in a series of initiatives to eliminate early elective deliveries. Leapfrog will be joined by the Institute of Healthcare Improvement, Childbirth Connection, Catalyst for Payment Reform (CPR), and employer and regional business coalition members to make available tools that encourage health care consumers, employers, health plans, hospitals, and policymakers to take action.

This new data on early elective deliveries come from Leapfrog’s 2011 annual hospital survey, where hospitals are asked to report the percentage of non-medically indicated births between 37 and 39 completed weeks gestation delivered electively by induction or by cesarean section before the mother has gone into active labor or has experienced spontaneous rupture of membranes. Consumers, providers and employers can compare hospital rates of elective deliveries on a special website: www.leapfroggroup.org/tooearlydeliveries.

About The Leapfrog Group

A coalition of public and private purchasers of employee health benefits, The Leapfrog Group was founded a decade ago to work for improvements in health care safety, quality, and affordability. Maternal/child care represents a major component of health benefits programs for these health care purchasers, and Leapfrog’s purchaser members share concerns about the quality of obstetrics and neonatal intensive care. Early elective deliveries represent a significant cost in the U.S. health care system, with one study estimating that nearly $1 billion dollars could be saved annually in the U.S. if the rate of early elective deliveries were reduced to 1.7%.  www.leapfroggroup.org

About the Midwest Business Group on Health

Celebrating more than 30 years of advancing value in health care and health benefits management, the non-profit Midwest Business Group on Health (MBGH) is one of the nation's leading business groups of private and public employers. MBGH's more than 100 members represent over 3 million lives, spending more than $3 billion on health care benefits annually. MBGH member benefits include educational workshops for health benefits management, networking opportunities, research, demonstration projects and community initiatives. MBGH is a founding member of the National Business Coalition on Health.  www.mbgh.org

*Source: March of Dimes Toolkit, “Elimination of Non-medically indicated (Elective) Deliveries Before 39 Weeks Gestational Age”. 2010 March of Dimes Toolkit.