Focus and Health Care

Early elective deliveries declining at GR hospitals

Nationwide drive to have uncomplicated pregnancies reach full term is succeeding.

March 29, 2013
| By Pete Daly |
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As noted in a recent report from Kaiser Health News, doctors have been warned for decades about the dangers of delivering babies early without a medical reason. But reducing the amount of unnecessary early elective deliveries, or EEDs, has proven to be easier said than done — until now.

Added pressure has been put on doctors and hospitals in the last couple of years to avoid EEDs, in part, at least, by the Patient Protection and Affordable Care Act, and results are starting to surface.

In late February, The Leapfrog Group announced the national rate of EEDs has dropped for the second year in a row. Leapfrog based that conclusion on statistics it collected for its annual Leapfrog Hospital Survey. The Leapfrog Group (www.leapfroggroup.org) is a national nonprofit organization representing major employers that purchase a large share of U.S. health care insurance.

According to Leapfrog, EEDs “can be dangerous, resulting in (neonatal intensive care) admissions, increased length of stay, and higher costs to patients and payers.”

EEDs include both induced vaginal births and cesarean sections done before the full 39 weeks of gestation without valid medical necessity.

According to Samantha Kauffman, in 1965 the rate of C-sections was 4.5 percent, but by 2010, it had reached 32.8 percent. Kauffman, an RN and the perinatal education coordinator at Spectrum Health Gerber Memorial in Fremont, published that statistic in December in her blog that appears on the Spectrum Health website.

Both induced and C-section EEDs have been decreasing since 2010, when the Leapfrog Group became the first nationwide organization to publically report hospital rates. Leapfrog set a target rate of EEDs in U.S. hospitals of less than 5 percent and just announced that, for 2012, 46 percent of the 773 reporting hospitals met that target rate, compared to 39 percent in 2011.

“Since The Leapfrog Group started drawing attention to the issue, we have seen encouraging improvements in hospital performance,” said Leah Binder, president/CEO of The Leapfrog Group. “Our data shows that 75 percent of hospitals improved this year, and the national average dropped from 14 percent to 11.2 percent — evidence of the commitment many hospitals are making to put babies and mothers first. Still, much more work is needed.”

Though Leapfrog is still the only organization reporting EED rates by hospitals, other groups are working to educate women, health care providers and hospitals about the importance of reducing these high-risk births. Groups including Childbirth Connection, Institute for Healthcare Improvement, March of Dimes, Catalyst for Payment Reform, the Joint Commission, Partnership for Patients, and CMS as part of its Strong Start Initiative have brought national and regional attention to this pressing health care issue.

Leapfrog released some Grand Rapids hospital statistics in February that initially raised eyebrows, but a careful review of those stats caused the eyebrows to drop back down. Metro Health Hospital in Wyoming had an EED rate of 4.2 percent, according to Leapfrog, while Spectrum Health-Butterworth was pegged at 14.1 percent and Saint Mary’s at 5.9 percent.

A check with Leapfrog, however, revealed that those statistics were actually from calendar year 2011, and Spectrum spokespersons said the hospital system had dramatically reduced its EED rate since putting a new strategy into place late in 2011.

Cindy Reistroffer, director of Women’s and Infant Services at Spectrum Health Hospitals in Grand Rapids, said the policy of discouraging EEDs is “one of the things we’ve done very well and we’ve gotten some real good results.”

“We were at the higher level,” she added, “but now we’re at a 3.31 percent” rate.

From June through October last year, the rate of EEDs at Spectrum Health-Butterworth was zero, “which really has brought our overall averages down,” said Reistroffer.

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