Impact of risk-adjusting cesarean delivery rates when reporting hospital performance.
Context. - Hospitals and health plans are often ranked on rates of cesarean delivery, under the assumption that lower rates reflect more appropriate, more efficient care.
However, most rankings do not account for patient factors that affect the likelihood of cesarean delivery.
- To compare hospital cesarean delivery rates before and after adjusting for clinical risk factors that increase the likelihood of cesarean delivery.
- Retrospective cohort study.
- Twenty-one hospitals in northeast Ohio.
- A total of 26127 women without prior cesarean deliveries admitted for labor and delivery from January 1993 through June 1995.
Main Outcome Measures
- Hospital rankings based on observed and risk-adjusted cesarean delivery rates.
- The overall cesarean delivery rate was 15.9% and varied (P<. 001) from 6.3% to 26.5% in individual hospitals.
Adjusted rates varied from 8.4% to 22.0%. The correlation between unadjusted and adjusted hospital rankings (ie, 1-21) was only modest (R=0.35, P=12).
Whereas 7 hospitals were classified as outliers (ie, had rates higher or lower [P<. 05] than overall rate) on the basis of both unadjusted and adjusted rates, outlier status changed for 5 hospitals (24%), including 2 that changed from outliers to nonoutliers, 2 that changed from nonout-liers to outliers, and 1 that changed from a high outlier to a low outlier. (...)
Mots-clés Pascal : Césarienne, Etude cohorte, Rétrospective, Exploration clinique, Méthodologie, Facteur risque, Evaluation, Femelle, Homme, Etats Unis, Amérique du Nord, Amérique, Chirurgie, Appareil génital femelle pathologie, Organisation santé
Mots-clés Pascal anglais : Cesarean section, Cohort study, Retrospective, Clinical investigation, Methodology, Risk factor, Evaluation, Female, Human, United States, North America, America, Surgery, Female genital diseases, Public health organization
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0321207
Code Inist : 002B25K. Création : 27/11/1998.