HealthGrades analyzed all-payer data of approximately 14 million hospital delivery and neonate records from 2006 through 2008 at more than 1,600 hospitals in the 19 states which make their data available. To identify maternity care program performance, HealthGrades studied overall maternal complication rates for vaginal deliveries, C-sections, and patient-choice C-sections (non-clinically indicated C-sections), as well as neonatal mortality.
In the 19 states studied, 1,546 hospitals (of the 1,616 hospitals) were eligible to be considered for the maternity care rating. Of these eligible hospitals, 232 best performers ranked in the top 15% and were recognized with a 5-star rating in maternity care. Of these 5-star hospitals, 154 are recipients of the HealthGrades 2010/2011 Maternity Care Excellence AwardTM representing the top 10% of hospitals in the 19 states studied.
Our study found that best-performing (5-star rated) hospitals had fewer maternal complications and fewer neonatal mortalities. If all hospitals, among the 19 states studied, performed at the level of best-performing hospitals, 176,654 women may have avoided developing one or more inhospital major obstetric complications (2006 - 2008).
The study also found:
* The best-performing hospitals had a 51.30% lower maternal complication rate among women who had vaginal births compared to poor-performing hospitals, and a 74.34% lower complication rate among women who had C-sections. Patient-choice C-sections had the largest difference at 84.14% between best- and poor-performing hospitals.
* C-section rates average approximately 32.59% among the 19 states studied with a range between 22.04% and 37.80%.
* Of hospitals in the 19 states studied, nearly 80% of Maternity Care Excellence Award hospitals are in five states: California (42), Texas (26), New York (24), Florida (18) and New Jersey (13).
Maternity Care ratings are based on the analysis of four factors:
* Maternal complication rate among women undergoing single live-born vaginal or C-section deliveries
* Maternal complication rate among women undergoing "patient-choice" or non-clinically indicated C-section
* Newborn volume adjusted for low birth weight
* Newborn mortality rate stratified into eight birth weight categories
For each factor, hospitals are ranked and a percentile score is calculated. Lower maternal complication rates correspond to lower percentile rankings. For newborn volume, hospitals are assigned a percentile rank based on their overall volume of single live-born neonates combined with the percentage of neonates falling into the 1,000 to 1,749 gram birth weight categories compared to the national average. Hospitals with higher volumes and higher percentages of these low birth weight infants receive lower percentile ranks. Finally, newborn mortality is ranked based on a combined z-score for the mortality rates of the eight birth weight categories.
Based upon each hospital's overall score, HealthGrades applied the following rating system.
(5 stars) Best - Top 15% of all hospitals within 19 all-payer states
(3 stars) As Expected - Middle 70% of all hospitals within 19 all-payer states
(1 star) Poor - Bottom 15% of all hospitals within 19 all-payer states
For more detail on how the four factors were rated, see HealthGrades Hospital Report CardsTM Maternity Care Methodology 2010/2011 available at www.HealthGrades.com.