Hospital Improves Maternity Care and Lowers Cost

Today’s Managing Health Care Costs Indicator is $3.5 billion

Maternity care really matters.  Earlier prenatal care, prenatal vitamins, and cigarette, alcohol and drug cessation help us have healthier children – and prevent excess health care costs. Still, maternity represents 20% or more of hospital admissions for many employers, and sick newborns often represent a quarter of all catastrophic care cases. 

Caesarian section delivery is shockingly common in the US – about 1/3 of all deliveries at this point.  The World Health Organization has recommended an optimal rate of 15%.  C-sections increase the likelihood of complications of subsequent deliveries –and they decrease the new mom’s ability to immediately bond with the newborn.  Once a woman has an initial c-section, it’s unlikely she’ll have a future vaginal delivery, as VBAC deliveries are increasingly rare.

Induction (intravenous drugs to start the labor process) is also quite common in the US– and can start the cascade toward C-sections – since if induction is begun before the cervix has started to dilate, it’s likely to lead to prolonged labor that is ended by Caesarian section.

The variation in elective induction is dramatic across different institutions – here’s a link to the Leapfrog Group’s website , where you can see elective induction rates by hospital. 

Health Affairs just published an article from Intermountain Health describing its focus on system variation (not merely variation of individual clinicians).   Intermountain’s efforts began over a decade ago – and cover a range of medical care.  I’ll focus here on the results of their maternity process improvement.

Intermountain recognized that 28% of their elective inductions in 2001 did not meet medical criteria –and imposed the following rule. 

When an expectant mother arrived at the hospital for an elective induction, nurses completed an electronic check sheet that summarized appropriateness criteria. If the patient met the criteria, the induction proceeded; if not, the nurses informed the attending obstetrician that they could not proceed without approval from the chair of the obstetrics department or from a perinatalogist—a specialist in high-risk pregnancies.

With the initiation of this rule, the percent of elective inductions which did not meet clinical criteria dwindled to 2%!  Intermountain’s c-section rate is 21% now – over a third lower than the national average.

The authors state that $50 million in annual medical costs have been averted through this simple program, and extrapolate that a national effort like this could save $3.5 billion per year.

This is a great example of making care better for moms and babies and saving money at the same time.  I often talk about how we have to make difficult choices to improve value in health care.  The only tradeoff necessary to lower inappropriate elective inductions, and thereby lower c-section rates and premature deliveries is a small decrease in physician autonomy.    Seems like a very good tradeoff indeed!