HPCI News: Transparency Helps Reduce Early Elective Deliveries

To: Members and Selected Others

The American College of Obstetricians and Gynecologists has advised against early elective deliveries* for over 30 years. They carry a risk for babies and mothers. Babies that are electively scheduled for delivery before 39 weeks have a higher likelihood of death, being admitted to a Neonatal Intensive Care Unit and a higher likelihood of having life-long health problems. Also, early elective deliveries represent a significant cost, with one study estimating that nearly $1 billion dollars could be saved annually in the U.S. if the rate of early elective deliveries was reduced to 1.7%.

Leapfrog was the first and remains the only national organization to publicly report results by hospital. The results of the Group's 2013 Leapfrog Hospital Survey shows a sharp decline in early elective deliveries since Leapfrog first began reporting this four years ago. The national average of 4.6% in 2013 stands in sharp contrast to the national average of 17% in 2010. This is the first time the national average for Leapfrog reporting hospital has hit the target rate of less than 5%. Comparative rates for non-reporting are not available. The New York Times recently published an opinion article entitled “Reducing Early Elective Deliveries.” It highlighted the importance of Leapfrog's measurement and reporting as a stimulus for improvement in maternity care. It stated:

"Measuring and publicizing rates of early elective delivery has helped in several ways. It revealed the dimensions of the problem. It tells hospitals how they are doing. It allows patients to choose safer hospitals, which exerts pressure for more safety. And it creates the basis for reimbursing hospitals in a way that discourages these deliveries."

Public reporting has accelerated efforts by a network of organizations working to eliminate unnecessary deliveries, including the National Business Group on Health, the March of Dimes and the Catalyst for Payment Reform. The Centers for Medicare & Medicaid Services' Partnership for Patients identified early elective deliveries as a top priority issue in 2012.

Examples of Early Elective Delivery Rates for 2010 and 2013 by Hospital:




Blessing Hospital, Quincy



OFS St. Francis Medical Center of Peoria



Mayo Clinic - Methodist Hospital, Rochester



St. Elizabeth Regional Medical Center, Lincoln



St. Luke's Hospital of Kansas City



Mercy Hospital St. Louis



Nebraska Methodist Hospital, Omaha



Note: The Iowa Healthcare Collaborative has set a goal of reducing early elective deliveries by 90%. However, comparative data is not available by hospital.

*Definition of early elective deliver: inductions or cesarean procedures performed prior to 39 completed weeks gestation without medical necessity.

Paul M. Pietzsch, MPH
HPCI - IHBA Office
4430 Ashley Park Drive
West Des Moines, Iowa 50265
(515) 778-6300

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