Wide quality gap found in hospital maternity care

Rate of childbirth complications for moms varies, study finds

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WASHINGTON — Where a woman delivers her baby can make a major difference to her own health — a quality gap that remains largely hidden from mothers-to-be.

A new study comparing hospitals nationwide finds that women who delivered at low-performing facilities suffered more than twice the rate of major complications for vaginal births. For cesarean section deliveries, the disparity was even greater: nearly a fivefold difference, according to the study in Monday’s issue of Health Affairs.

But try to figure out which hospital in your area provides better care and odds are you’ll be frustrated. There’s no comprehensive database that women and their families can rely upon to find the best hospitals ahead of time.

That appears to be changing. Spurred in part by the new research, medical groups such as the American Congress of Obstetricians and Gynecologists are working on a consumer-friendly database that will tap clinical information from electronic medical records. That effort could take another three to five years.

Monday’s study comes amid a national effort to improve medical quality, and hopefully reduce costs, by using data to compare care providers. Those lagging usually try to improve. Research-based approaches have been used successfully in other industries.

The study did not identify hospitals.

Led by anesthesiology professor Laurent Glance of New York’s University of Rochester medical school, researchers analyzed billing data for a national sample of more than 750,000 deliveries in 2010.

About 4 million women give birth every year in the United States, and having a baby is the single most common reason for a hospital stay. While pregnancy-related deaths are rare, complications are about as common as for heart surgery.

The study did not look at outcomes for babies. It grouped hospitals into three quality categories — low, average and high — according to their rates of complications for the mother. To allow an apples-to-apples comparison, the researchers adjusted for differences in the health status of patients served by the hospitals.

At the low-quality hospitals, an average of nearly 23 percent of women delivering vaginally experienced a major complication, compared with about 10 percent of women at high-quality facilities. The rate of complications at average-quality hospitals was 15 percent. Unusual bleeding and tearing were the most common complications of vaginal birth.

For cesarean birth, the quality gap was wider. At low-quality hospitals, an average of nearly 21 percent of women undergoing a cesarean delivery experienced a major complication, compared with a rate of fewer than 5 percent at high-quality hospitals. The rate of cesarean complications at average-quality hospitals was nearly 9 percent. Unusual bleeding and infection were the most common complications of cesarean birth.

“The bottom line is that there’s a lot of variation,” Dr. Glance said. “It’s an opportunity to go out there and try to make things better.”

Speaking for doctors who deliver babies, the American Congress of Obstetricians and Gynecologists said much more work needs to be done to make such data useful for individuals. Barbara Levy, the group’s health policy expert, called it a “very preliminary” study.

“I don’t discount the findings,” Dr. Levy said. “I think there is a convincing conclusion that there are differences. But how substantial the differences are, and how dramatic the complications are, we can’t really tell from this kind of a study.”

A key limitation of the study is that it uses billing data, Dr. Levy said. Her organization and other medical groups are working on a database that will use clinical data extracted from electronic medical records, after the patients’ personal information is removed.

Billing information can be several steps removed from what actually happened to a patient, she explained. Clinical data is closer to the source, but it’s not now available on a large scale. Electronic medical records companies are collaborating on the database, but it could take three to five years before the public has access.

“Ultimately, our goal is that women and their families should be able to know the quality of care they are getting,” Dr. Levy said.

United States - North America


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