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Joint Commission to Publicly Report Hospitals Performance in Relation to Cesarean Birth Rates

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The Joint Commission will begin publicly reporting hospitals with consistently high cesarean birth rates on Quality Check® the website that lists Joint Commission accreditation status, by July 1, 2020, using data reported by hospitals during the calendar years 2018 and 2019.

The “high rate” designation will be based on hospitals’ rates on the perinatal care (PC) Cesarean Birth measure PC-02 they report to The Joint Commission. It measures the rates of cesarean births among a subset of the general obstetric population of low-risk women having their first birth with a term, singleton baby in a vertex position (NTSV). Hospitals accredited by The Joint Commission are already required to report that data to the accreditor, but this will be the first time it will be visible to the public.

The Joint Commission will use the following three criteria to determine a hospital’s PC-02 rating based on data reported for 2018 and 2019:

  • ≥30 cases reported in both years
  • PC-02 rate >30% for the current year
  • Overall two-year average PC-02 rate >30%

Hospitals will be identified on Quality Check with either a plus (+) or minus (-) symbol for the PC-02 measure. The plus (+) symbol will signify the hospital has an acceptable rate. A minus (-) symbol will signify the hospital’s rate is consistently high and has a large enough sample size to make this determination.

Approximately 20 percent of hospitals met these three criteria using 2016–2017 data. For those hospitals identified as having high rates (-), The Joint Commission also will show those hospitals’ actual 2019 PC-02 rate. Note: 2018 and 2019 data will be used for the initial release.

The Joint Commission began to require accredited hospitals to collect and submit data on PC-02 in 2010. However, The Joint Commission deferred publicly reported hospitals’ rates on Quality Check, including the following:

  • optimal rate of cesarean section was not clear
  • questions remained about whether the measure needed risk-adjustment methodology beyond limiting to low-risk NTSV deliveries
  • relatively few reports of how hospitals had been able to reduce their cesarean section rates safely without increasing neonatal complications

Since 2010, PC-02 rates among all reporting hospitals have remained around 26 percent without evidence of trends toward improvement. Moreover, in 2017, 25 percent of the hospitals reporting had rates greater than 30 percent. This led The Joint Commission to re-examine its position on public reporting.

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