Study: Wide Hospital Quality Gap on Maternity Care

[elleng]

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 on 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.

http://www.nytimes.com/aponline/2014/08/04/us/politics/ap-us-childbirth-complications.html?hp&action=click&pgtype=Homepage&version=WireFeed&module=pocket-region&region=pocket-region&WT.nav=pocket-region

[Warpy]

1. Low performance places need to be brought into compliance or shut down

Uncomplicated home birth is safer than some of those places. I lived in an area in Mass. where home birth with experienced midwives was overtaking hospital births because the OB-Gyn practice in the area was piss poor and they had successfully lobbied against other docs in the area gaining privileges for years.

Friends with complications went to a hospital an hour away rather than chance it at the local place.

[elleng]

2. Interesting.

How can one know in advance whether the birth will be 'uncomplicated?' My 2 daughters have given birth in the past 8 months, and as they both appeared initially to be uncomplicated, they both had what I'd call 'complications' in later hours. Both might have needed cesareans, and they ended up avoiding such due to talented docs (from what I could tell.)

[VA_Jill]

3. When I worked in neonatal

we used to have a saying, "Failure to progress is whatever the doc says it is." We had one OB whose C-section rate was far and away higher than that of all the other docs. He never got called on it either. I always said I wouldn't let him deliver my dog's puppies because I didn't trust him. If I had it to do over again, I'd have midwives, but there wasn't that option when I was having kids.

[hedgehog]

4. This is the real problem, right here.

We have a culture in which the doctor's word comes down from on high, and no one questions it. And you've heard of the Blue Code of Silence? That is nothing compared to the White Code - doctors know exactly who among them is doing a great job, and acceptable job and a terrible job, but until people start dying in obvious ways, nothing is said or done.

I think surgeons are the worst - too many get their up-dated training from medical supply outfits pushing their new equipment. The FDA oversees new drugs, but no one oversees new surgical procedures.

I think some medical society groups are moving to change things - for example - by requiring continuing education credits to maintain certification. Buried deep in the ACA are steps to identify good doctors and to look at what procedures are done, where they are done, and how effective different procedures are. For example - IIRC, there is a significantly higher rate of hysterectomies in the South East than in the North East. Why?

[VA_Jill]

5. You are SO right!

About a lot of things. I didn't work in surgery because I couldn't stand surgeons, and I got out of neonatal after awhile and found a home in critical care, which is a whole different animal…you get some respect from the docs there, and most of them treat you like a colleague because you're all in the trenches together. And the docs there have to keep up, or they don't last long. It's a tough place but critical care and step-down are the best places to be, IMO.