For the study, researchers assessed billing data for a national sample of more than 750,000 births in 2010. The researchers grouped hospitals into three categories -- high performing, low performing and average performing -- based on complication rates related to the woman giving birth, not based on the health of the infant.
Researchers adjusted for health disparities among patients, and they did not identify hospitals in their final report.
The researchers found that about 23% of women who deliver vaginally at low-performing hospitals experienced a major complication, compared with a rate of about 15% at average-performing hospitals and just 10% at high-performing hospitals. According to the study, the most common complications were unusual bleeding and tearing.
Similarly, the researchers found that about 21% of women who delivered via cesarean section at low-performing hospitals experienced a major complication, compared with a rate of 9% at average-performing hospitals and a rate of less than 5% at high-performing hospitals. They determined that the most-common complications associated with C-sections were unusual bleeding and infection.
Efforts To Develop Hospital Comparison Database
According to the AP/Bee, several medical groups are developing databases that will allow women and families to easily compare hospital quality. However, there is no such database currently.
For example, the American Congress of Obstetricians and Gynecologists is developing a hospital comparison database would use clinical data compiled from electronic health records, although it likely will not be ready for consumer use for another three to five years.
Barbara Levy, vice president for health policy at ACOG, said she did not "discount the findings" from the Health Affairs study but noted that researchers relied on billing data rather than clinical data. Levy said that billing data is several steps removed from how a patient actually was treated and that clinical data would present more accurate findings.
Levy said, "I think there is a convincing conclusion that there are differences" among hospitals, but she added that "this kind of a study" cannot accurately show "how substantial the differences are" and "how dramatic the complications are" (Alonso-Zaldivar, AP/Sacramento Bee, 8/5).