Belly Up

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Tuesday, February 15, 2011

Naming Names

Wouldn't it be nice if hospitals just posted this info at the entrance!
Below I have listed the primary c-section rates for a number of local (to me anyway) area hospitals for 2008, the latest year compiled and published.  These numbers are self reported to the state health department by each hospital and are risk adjusted, meaning the numbers do not include repeat c-sections, c-sections done on moms carrying multiples, breech positioning, previas, or other higher risk situations.  Basically, the percentage shown is just the rates for low risk moms.   A good estimate of the total  percentage of c-sections being performed at any given hospital can be gotten simply by doubling the number.  Not perfect, but that will get you a ball park.

Hospital                                                                         City                                   % 
   
Baylor Med Ctr-IrvingIrving22.74
Baylor Med Ctr at CarrolltonCarrollton20.3
Las Colinas Med CtrIrving28.22
Med Ctr-LewisvilleLewisville21.96
Med Ctr-ArlingtonArlington26.35
Baylor Med Ctr-FriscoFrisco20.63
Baylor Regional Med Ctr-GrapevineGrapevine24.23
Baylor University Med CtrDallas24
Centennial Med CtrFrisco22.08
Med City Dallas HospitalDallas25.98
Methodist Dallas Med CtrDallas13.12
Methodist Richardson Med CtrRichardson14.81
Parkland Memorial HospitalDallas12.35
Texas Health Presbyterian Hospital DallasDallas27.67
Texas Health Presbyterian Hospital-PlanoPlano31.53
Baylor All Saints Med Ctr-Fort WorthFort Worth21.1

Here is the link to full data for the state of Texas:
http://www.dshs.state.tx.us/THCIC/publications/Hospitals/IQIReport/Chart33.pdf

The two hospitals with the lowest c-section rates are Parkland and Methodist, both of which are county hospitals where mostly uninsured and those not eligible for Medicaid deliver.  Overall this is a higher risk population.  Many moms in this group, be it due to income or issues of legal residence, may not receive much or any prenatal care and may have other issues in their lives that could potentially adversely affect their pregnancy.  However, the c-section rates at these hospitals are low despite this higher risk population of clients.  Conversely, the hospitals with the highest rates of surgical birth are in the more wealthy suburban areas.  Without going too far on the basis of one statistic, there does seem to exist some correlation between c-sections rates and the ability of an OB to get paid for doing them.  This would be horrible if moms delivering at county hospitals were getting inferior care evidenced by higher maternal and fetal death rates, but I have seen no research showing that to be the case.  Instead it seems these hospitals get the job done safely for all parties but more often in the cheaper (and by that I mean vaginally) way.  Unfortunately this then also suggests that profit motive (perhaps on the part of the hospitals, the OBs, or even the OBs' liability insurance) may lead to a large percentage of the surgeries that are performed on insured women.  At minimum it helps demonstrate that a lot of women are having major surgery performed unnecessarily.

Oh course I am not running out to drop my health insurance coverage, but something to think about.

3 comments:

  1. There was an interesting article in the Dallas Morning News back in 2006 about Parkland. Here is a reprint I found online: http://www.redorbit.com/news/health/534133/parkland_is_brimming_with_babies/index.html?source=r_health

    It confirms your suspicion that the patients at Parkland are NOT receiving inferior care:
    "In 2002, Parkland's neonatal mortality rates -- deaths that occur within the first 28 days of life -- were far lower than the national average, which stood at 4.7 deaths per 1,000 U.S. births. At Parkland, the mortality rate for newborns whose mothers received prenatal care was 2.7 per 1,000 births. For black babies, the hospital's mortality rate was about half the national average, and for Hispanic babies, the rate was a third better than the rest of the nation."

    I also found it interesting that Parkland relies heavily on midwives for the less-complicated deliveries. Midwives deliver about 40% of Parkland's babies. I think the stat nationwide is about 10%.

    With all the changes coming to health care coverage in the coming years, I wonder if more hospitals will start moving towards Parkland's model... I think that would be a good thing, not just for the bottom line but for the health of new moms and babies!

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  2. Thanks for this info! I was actually going to comment about that Parkland article too. I wondered why these stats weren't more well known among the local community(I don't hear many people talking about how wonderful Parkland is). Anyways, these c-section rates are much higher than I thought.
    Darrell

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  3. I know that number is not right for Baylor All Saints Fort Worth. One of their administrators told me the c-section rate was 35-40% for the OBs and 11% for the midwives. She was quick to remind me that the OBs got all the high risk "patients." It's just so hard to see a "low" number when it doesn't give the full story. Also, the midwives only attend a fraction of the births at that hospital. All these numbers are considerably lower than I think they really are. Opinion? Do you agree? Do you know how they arrive at these numbers? Especially with the no-VBAC policy at so many of these hospitals. I just don't see how their rates are this low. I don't feel that there is transparency at all.

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