Leapfrog Group: Hospitals can--and must--improve C-section rates

Hospitals' cesarean section rates vary broadly, according to the Leapfrog Group, with fewer than half of providers reaching the healthcare-quality watchdog's target rate.

Leapfrog this month released the first national data on C-section rates and found only 39.1 percent of 1,122 hospitals met the group's target rate of 23.9 percent or lower, a statistic CEO Leah Binder called a major disappointment.

"The other finding I found compelling was there's such variation among hospitals," Binder (pictured right) told FierceHealthcare in an exclusive interview. "The variation is astounding and we didn't find any particular pattern among hospitals [that] would seem more likely to have a high rate. It just suggests that hospitals have not really focused on C-section rates as an issue and they need a strategy to address this problem right away."

Improving these rates is "completely possible," Binder added, citing a successful California initiative to reduce rates. "When hospitals set a goal and bring leadership and insights to the table and really insist on bringing these rates down, they succeed," she said. "There needs to be leadership and determination and some good thinking but basically it really is doable." As evidence, she pointed to the fact that many states, such as Utah, have been able to keep their rates low. The wide variation among states and hospitals, she said, further demonstrates the importance of reporting at a national level.

Now that data have been reported, Binder is optimistic rates will drop in hospitals with high rates, she told FierceHealthcare. Hospitals that declined to report at all are a far greater concern, she said. "I would encourage them to reconsider their decision to suppress public reporting."

Regardless of the actual numbers, the decision to report and publish the data in the first place represents a huge step in efforts to reduce C-section rates, according to Debra Bingham, R.N., vice president of nursing research, education and practice for the Association of Women's Health, Obstetric & Neonatal Nurses.

"For the general public, there hasn't been a clear recognition of the fact that many women are having cesarean surgery, which is major surgery, that don't need it," Bingham (pictured left) told FierceHealthcare. "It's very exciting to have hospitals who are willing to step up and publicly acknowledge their need to improve, and I'm very pleased to see Leapfrog is trying to lead that type of effort."

Historically, the industry has perceived high C-section rates as a minor problem. "I don't think there's adequate appreciation that major surgery affects a woman's reproductive life," she said, citing potential complications such as chronic abdominal pain from unnecessary C-sections as well as the high cost of the procedures. Reducing unnecessary care is a major priority for the healthcare industry, but an August study published in JAMA Internal Medicine suggested hospital performance measures overlook how care overuse affects care quality, FierceHealthcare previously reported.

Hospitals can continue to improve rates by providing more support for women during the labor process, both at the clinical level and in public discourse surrounding pregnancy, Bingham added. "[Nurses] have been embracing and promoting activities such as helping women have more freedom of labor…it seems simple, but it's really powerful," she said.