And by the way, Leapfrog Group is not the only organization drilling into public reporting of perinatal quality measures. The Joint Commission is getting ready to roll out five public reports, covering not just rates of elective delivery, but also Cesarean sections, antenatal steroids, healthcare associated bloodstream infections in newborns and exclusive breast milk feeding.
Some success, but more to do
In one year, Leapfrog's survey has shown a measured decrease in the number of women who were persuaded to have early elective inductions or Cesarean without medical indication. For example, 65% of participating hospitals improved; but the numbers are still poor.
As we reported last week, of the 757 hospitals that agreed to participate and disclose their rates, inappropriate early scheduled births averaged 14% – much higher than the National Quality Forum-endorsed threshold of 5%, which was achieved by 39% of the hospitals reporting.
About 140 hospitals had rates of 20% or higher and 32 had rates so high, the spreadsheet just said "greater than 40%."
Another major challenge is to encourage more hospitals, especially those with major maternal care programs, to respond to the survey.
Rudolph says there are many reasons why so many hold back. Sometimes, she says, "the chief medical officer doesn't agree with the measure or decides it's not fair or that it doesn't include everything it should.