Exposing Variation in Maternity Care Quality, Health Outcomes, and Value: A Data Visualization Challenge
Submission DeadlineSubmissions are Closed
- First Place: $2,500 plus a "meet and greet" with healthcare information technology pioneer JD Klienke at the Health 2.0 Spring Fling Conference in San Diego
Big Yellow Star
Team MembersDamien Leri, Ian Bennett
Over the last two decades the rates of cesarean section have dropped in the mid 1990's, when effort was paid to reduce their rates, and have subsequently risen dramatically. Over the same period there have been no corresponding reductions in maternal-infant mortality outcomes. The costs of these procedures can be measured in dollars and cents. Within this site we present publicly available data to highlight this process and to bring awareness to this issue. While there is controversy as to the optimal cesarean rate, there is evidence that the current rate is higher than necessary for maternal or perinatal safety and that geographic variation does not reflect differences in women's risks, values, or preferences.
The Problem: Maternity care is a major segment of the health care system. With over 4 million births annually, 23% of those discharged from U.S. hospitals are childbearing women and newborns, making maternity care by far the most common hospital condition and a leading reason for outpatient visits. Charges for maternal-newborn care far exceed those for any other hospital condition, involving $98 billion in hospital fees alone in 2008.
Cesarean section, major surgery with risks that include wound infection, hemorrhage, rehospitalization, life-threatening complications in subsequent pregnancies, and neonatal respiratory problems, is the most common operating room procedure in the United States. The 2009 cesarean rate of 32.9% marked the 13th consecutive year of increase and a record-level national rate. The cesarean rate varied across states in 2007, from a low of 22% in Utah to a high of 38% in New Jersey. It reached 49% in Puerto Rico. Where facility and provider-level data are available, marked variation in cesarean rates has also been demonstrated, and studies suggest that little of the variation has to do with the health, risk status, or preferences of women.
Intermountain Healthcare, widely regarded as a leader in the maternity care quality movement, recently estimated that the U.S. would save $3.5 billion in hospital fees alone if the national c-section rate matched the Intermountain rate of 21%.
Additionally, the Intermountain analysis does not take into consideration the fact that charges for both vaginal and cesarean births also vary across states. For example, a recent analysis by Childbirth Connection using data from AHRQ’s Health Costs and Utilization Project demonstrated that California hospitals charge 50-66% more for vaginal and cesarean births than the average U.S. hospital does.
Reducing the excess use of cesarean section and reining in cost variation is just one step toward vast improvement in the quality and value of maternity care in the U.S. In 2010, health care leaders convened by Childbirth Connection described a consensus “2020 Vision for a High Quality, High-Value Maternity Care System” and issued a “Blueprint for Action,” charting the path toward that vision.
Successful implementation of the Blueprint will require commitment by state-level policy makers and advocates, who need robust and nimble information systems to identify areas for improvement and measure progress. Many important maternity care data, especially facility- and provider-level data, are inconsistently collected and reported. Other data are available but remain tucked away in disparate databases and reports.
Create a data visualization tool that demonstrates geographic variation in access, procedures use, outcomes, and/or costs in maternity care to galvanize state and regional action for quality improvement.
We are looking for entries that make the data engaging and relevant for policy makers, grassroots advocates, the media, and other stakeholders. High priority data include cesarean rates, hospital charges, proportion of midwife-attended births, geographic availability of birth centers, geographic availability of facilities supporting vaginal birth after cesarean, rates of elective delivery, payer source (private or Medicaid), and racial and ethnic disparities in access, outcomes, and procedure use. We encourage developers to incorporate other data as well, enabling multiple or dynamic visualizations.
Data sets that were encouraged for this challenge:
- National Inpatient Sample of HCUP: http://www.hcup-us.ahrq.gov/nisoverview.jsp
- VitalStats (birth certificate data): http://www.cdc.gov/nchs/VitalStats.htm
- National Survey of Family Growth: http://www.cdc.gov/nchs/nsfg/abc_list.htm
- Pregnancy Risk Assessment Monitoring System (requires application to use data): http://www.cdc.gov/prams/index.htm
- State Health Facts from Kaiser (maternity coverage): http://www.statehealthfacts.org/profileind.jsp?ind=687&cat=7&rgn=1
- Maternity Practices in Infant Nutrition and Care (mPINC) (breastfeeding data): http://www.cdc.gov/breastfeeding/data/mpinc/index.htm
- VBAC Policy database: http://ican-online.org/vbac-ban-info
- Childbirth Connection's Listening to Mothers data: http://arc.irss.unc.edu/dvn/dv/odvn/faces/StudyListingPage.xhtml?mode=1&collectionId=629
- List of AABC-accredited birth centers: http://www.birthcenters.org/find-a-birth-center/
- List of Baby-Friendly Hospitals: http://babyfriendlyusa.org/eng/03.html
- State web sites with facility-level maternity data include:
- California: http://www.calhospitalcompare.org/
- Massachusetts: http://hcqcc.hcf.state.ma.us/Default.aspx
- New York: http://hospitals.nyhealth.gov/index.php
- Virginia (also provides provider-level data):http://www.vhi.org/ob_reports.asp
- Wisconsin: http://www.wicheckpoint.org/
- Other states may be available. One blogger has obtained hospital-level c-section rates for the 15 states for which data were attainable: http://www.theunnecesarean.com/blog/2010/9/1/cesarean-rate-posts-on-the-unnecesarean.html
- Staff of Childbirth Connection
- J.D. Klienke
- Medical Economist and author, Catching Babies
- Jessie Gruman
- Center for Advancing Health