Directors Corner | July 2021 | 2020 Hospital Performance on Leapfrog’s Maternity Care Standards

“Accountability: the quality or state of being accountable;  an obligation or willingness to accept responsibility or to account for one’s actions.”  Webster’s dictionary

Medical experts agree, and research has demonstrated, that the overuse of cesarean sections, episiotomies, and early elective deliveries can unnecessarily increase risks – some of which are both serious and long-term – to both mothers and babies.   Thus, expectant parents would be reasonably concerned if their chosen hospital fails to meet one or more of the standards associated with these procedures.

But what should expectant parents find even more disappointing than a hospital that doesn’t meet one or more of The Leapfrog Group’s national recognized standards for maternity care in hospitals?  “A lack of transparency,” you say?  That’s what I would say.  “A refusal to disclose their performance to expectant families?”  You betcha!  “An unwillingness to be accountable to the patients who put their trust in them?”  Absolutely.

That’s why we were particularly disappointed – although not in the least surprised – to see the results of the 2020 Leapfrog survey on hospital performance when it comes to, of all things, delivering babies.

A Bit of Background. Understanding three critical measures and standards is key to understanding why Leapfrog standards are so important.  Here’s a quick overview…

• Early Deliveries: Defined as scheduled C-sections or medical inductions performed prior to 39 completed weeks gestation without a medical reason, 92% of hospitals nationally achieve Leapfrog’s early elective delivery standard of 5% or less.  Coloradans deserve at least
• C-Sections: Leapfrog uses a nationally endorsed measure known as the “Nulliparous, Term, Singleton, Vertex (NTSV)” Cesarean Birth rate.  This measure exclusively examines the population of women least likely to need a C-section, offering a standardized way to compare hospital performance. To meet Leapfrog’s standard, based on the guidance of its national Maternity Care Expert Panel, hospitals must achieve the Healthy People 2020 NTSV cesarean birth rate target of 9% or lower.
• Leapfrog is the only organization in the US that tracks and reports rates of episiotomy by hospital. Today’s medical guidelines today urge against the routine use of episiotomy due to the risk of perineal tears, loss of bladder or bowel control, and pelvic floor defects  Based on guidance from its Maternity Care Expert Panel, Leapfrog’s standard for episiotomies is 5% or less.

So how do Colorado hospitals perform on these three data-driven, patient oriented measures.  Read more.

Profiling Colorado Hospitals’ Performance?  For each of the 77 Colorado hospitals that deliver babies, by clicking here you can see highlighted in RED those hospitals that either did not meet these three standards or else they declined to participate.   GREEN indicates either they met the standards or made substantial progress on each.

• The good news. 31 Colorado hospitals meet all three standards.  We applaud these hospitals and recognize them both for their performance and their transparency.  Not all met all three standards in years past.  As such, their commitment to quality improvement is commendable.

• What’s Disturbing.   A whopping 46 (yes, 60% of our hospitals!) either 1) did not meet these basic standards or else 2) unilaterally decided that expectant families really don’t need to be bothered with pesky details like quality; that they should be kept in the dark and just look at how nice the room is decorated.

So What’s the Excuse for Being Opaque? We’ve heard several over the years, including:

• It’s cumbersome. Really?  What about the increased risks of infection or blood clots, and many women experience longer recovery periods and complications with future pregnancies from unnecessary C-sections?  C-sections can also impact the health of babies, like breathing difficulties that require treatment in a newborn intensive care unit (NICU).  In the long-term, research shows that C-sections can cause chronic pelvic pain in some women, and babies born by C-section are at an increased risk of developing chronic childhood diseases like asthma and diabetes.    With regard to episiotomies, medical guidelines today urge against their routine use due to the risk of perineal tears, loss of bladder or bowel control, and pelvic floor defects.    Now THOSE THINGS are cumbersome.
• It’s expensive to report. Seriously?  It’s NOT as expensive as the above potential complications.  Quality in healthcare saves money.
• Lack of staff (at rural hospitals) to complete the Survey. Well, okay.  It’s challenging, sure.  But isn’t measuring and managing to such standards integral to providing, safe, high-quality services?

The Bottom Line.  Do we have room for improvement?   For those Colorado hospitals that report on these Leapfrog measures, they seem to be doing pretty well.  However, the bottom line is this:  For 60% of Colorado hospitals, we do not know how they are doing overall because some health systems simply refuse to tell us.

Having spent 38 years in hospitals, I would bet you a beer that if these hospitals met all three standards, they would tell us in the proverbial heartbeat.  So I have to conclude this:  THEY DON’T.

And THAT should concern every purchaser and consumer of maternity care considering giving birth at one of these opaque hospitals and health systems.

CBGH highly encourages all Colorado hospitals to complete the Leapfrog Hospital Survey that includes reporting maternity rates. Click here for more information. https://www.leapfroggroup.org/survey-materials

Afterword:  Where the data come from…

The Leapfrog maternity report uses final hospital data from the 2020 Leapfrog Hospital Survey, the flagship initiative of The Leapfrog Group (www.leapfroggroup.org). Over 2,200 hospitals have Survey data publicly reported, representing 75% of U.S. hospital beds. The Leapfrog Group is a nonprofit watchdog organization that serves as a voice for health care purchasers, using their collective influence to foster positive change in U.S. health care. For more than 20 years Leapfrog has been the nation’s premier advocate of health care transparency—collecting, analyzing, and disseminating data to inform value-based purchasing

The Leapfrog Hospital Survey is developed with guidance from volunteer Expert Panels and receives scientific guidance from the Johns Hopkins Armstrong Institute for Patient Safety and Quality. Quality and safety data by facility collected via the Survey on measures such as maternity care, medication safety, and infection rates is available at ratings.leapfroggroup.org.

The Survey results can be accessed for free at https://ratings.leapfroggroup.org/.

To learn more about Leapfrog’s maternity care measures, visit www.ratings.leapfroggroup.org/measure/hospital/maternity-care