Published in NJBIZ
By Beth Fitzgerald
New Jersey hospitals that provide maternity care are making progress implementing clinical best practices for the care of mothers and newborns, but more work needs to be done, according to the Leapfrog Group, the national nonprofit hospital safety watchdog which on Monday released its 2014 Maternity Care Report.
Most of New Jersey’s 72 acute care hospitals participate in the Leapfrog Hospital Survey, which monitors hospital performance nationwide across a wide range of quality and safety criteria. The maternity care report covers 47 New Jersey hospitals that provide maternity care.
The most dramatic improvement since Leapfrog began gathering hospital maternity data in 2010 has been the decline in the rate of early, elective deliveries. These are cases where labor is induced or the infant is delivered via caesarian section, absent medical necessity, prior to 39 weeks of gestation.
In 2014, the New Jersey hospitals in the Leapfrog maternity report averaged 4 percent early elective deliveries, while the national average was 3.4 percent.
When Leapfrog started reporting early elective deliveries in 2010, the national average was 17 percent.
Leapfrog said that, in 2010, New Jersey’s average early elective delivery rate was 15.7 percent.
“New Jersey has reduced that to 4 percent, which is really great to see,” said Leapfrog spokeswoman Erica Mobley said. “Most of the New Jersey hospitals are really doing great at not performing early elective deliveries.”
Leapfrog also reported how well hospitals care for high-risk infants, who arrive prematurely with very low birth weight. Mobley said Leapfrog looked at the performance of New Jersey’s 21 hospitals that are equipped with neo-natal intensive care units to handle high-risk babies.
Leapfrog found that six of the 21, or less than 30 percent, fully met the Leapfrog’s standards for high-risk infant care.
Another issue considered by Leapfrog is the hospital’s rate of episiotomies, which are surgical incisions to facilitate the baby’s delivery.
The average New Jersey episiotomy rate is about 17.5 percent, which is above the Leapfrog standard of 12 percent; the national average is 11.3 percent
Mobley said New Jersey dropped slightly last year “but episiotomies are still being performed far too frequently in the state of New Jersey.”
She said a panel of maternity experts works with Leapfrog to develop maternity care standards and “Recent research is showing that 12 percent is too high, so for 2015 we will be lowering the episiotomy standard to 5 percent.”
She said episiotomies once were a very common practice in childbirth but “it can lead to increased recovery time and greatly increased risk of complications,” such as infections. She said most experts are now recommending episiotomies for a “very narrow set of cases, usually referring to the placement of the baby as it is entering the birth canal.”
Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute and a board member of the Leapfrog Group, was encouraged by New Jersey’s performance in the Leapfrog maternity care report.
“We’re happy to see that in all three measures, New Jersey hospitals have improved since last year,” Schwimmer said. “It is especially good to see that where Garden State hospitals focused on reducing early elective deliveries –– deliveries performed before 39 weeks gestation when there is no medical necessity –– they have succeeded in meeting the Leapfrog target of no more than five percent.”
New Jersey consumers, like those across the nation, can go to the Leapfrog website and find out how their hospital performs on key aspects of maternity care. And Leapfrog is hoping families will use this information when deciding where to give birth.
“Maternity care is one of the best opportunities that people have to actually choose a hospital,” Mobley said. “It’s not like a heart attack, where you want to get to the closest hospitals as quickly as possible and not take the time to research your options.”
The Leapfrog Group was founded in 1998 by a group of large U.S. employers seeking to leverage their role as major health care purchasers in order to improve the quality and affordability of healthcare. Leapfrog evaluates and reports on the safety and quality performance of U.S. hospitals for the benefit of consumers, employers and other health care purchasers.
New Jersey’s largest health insurer, Horizon Blue Cross Blue Shield of New Jersey, awards bonuses of up to $250,000 year to hospitals based on their Leapfrog performance.
Leah Binder, chief executive of Leapfrog, said, “For many employers, labor and delivery account for nearly 25 percent of all hospitalizations, which makes these maternity metrics extremely valuable, as they have the power to help employees make smart health care choices.”
Mobley said when women are planning the delivery of a child “we encourage them to talk to their doctor and look at the state and see: Is there a hospital that is available to me that has a low elective delivery rate and a low episiotomy rate? And if I know I may have a high-risk delivery, are they equipped to handle that? It is really beneficial for women who are expecting to take the time to look at this data.”
And she said Leapfrog encourages employers “to look at this report and try to steer their employees toward the highest-performing hospitals.”