More on Quality and Safety

Many hospitals failing to meet performance standards for maternity care, Leapfrog says

Too many C-sections, episiotomies are being performed in U.S. hospitals, group finds.

Jeff Lagasse, Associate Editor

Many hospitals are still not meeting national performance targets when it comes to the quality of maternity care, according to a new study from the Leapfrog Group.

The findings come on the heels of Leapfrog's twice-yearly Hospital Safety Score, which assigns letter grades to hospitals based on their adherence to various safety standards. According to the report, 798 hospitals earned an 'A', 639 earned a 'B', 957 earned a 'C', 1162 earned a 'D' and only 15 earned an 'F.'

When it comes to maternity care, facilities were deficient in a number of different areas, such as the rate of episiotomies. A once-routine incision made in the birth canal during childbirth, it's now recommended only in a very narrow set of cases; Leapfrog's target for all hospitals is to perform the incision in 5 percent or less of all cases. Yet the rates were too high among 68 percent of hospitals.

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[Also: Hundreds of hospitals score top marks as Leapfrog gives out safety grades]

Too many C-sections were also being performed, the data showed. At 60 percent of reporting hospitals, the rates surpassed Leapfrog's target rate of 23.9 percent for all hospitals, and the variation was dramatic -- ranging from as low as 10 percent to as high as 54 percent in one unidentified east coast city.

Not all of the findings were dour. Four out of five hospitals meet Leapfrog's target of 5 percent for early elective deliveries, which are medically unnecessary inductions or C-sections performed at 39 weeks. That, the report said, means the facility is taking steps to minimize risks to the mother and child being delivered too soon.

[Also: Leapfrog: Only 15 hospitals scored F grades for patient safety; See the list]

Additionally, the early elective delivery rate has shrunk dramatically, with the national average at 2.8 percent, compared to the 17 percent reported in 2010.

But the study also shows many hospitals don't have adequate experience with high-risk deliveries. Low-weight infants born with complications are more likely to survive if the hospital has an experienced neonatal intensive care unit on-site, yet 78 percent of hospitals performing high-risk deliveries don't meet the Leapfrog standard.

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"This report underscores the importance of understanding the risks associated with specific delivery choices and of improving the quality of care during birth for the wellbeing of both mothers and their babies," said Kristin Torres Mowat, senior vice president of plan development and data operations at Castlight Health, in a statement.

Twitter: @JELagasse