Hospital Differences in Cesarean Deliveries in Massachusetts US 2004–2006: The Case against Case-Mix ArtifactReport as inadecuate




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Objective

We examined the extent to which differences in hospital-level cesarean delivery rates in Massachusetts were attributable to hospital-level, rather than maternal, characteristics.

Methods

Birth certificate and maternal in-patient hospital discharge records for 2004–06 in Massachusetts were linked. The study population was nulliparous, term, singleton, and vertex births NTSV n = 80,371 in 49 hospitals. Covariates included mother-s age, race-ethnicity, education, infant birth weight, gestational age, labor induction yes-no, hospital shift at time of birth, and preexisting health conditions. We estimated multilevel logistic regression models to assess the likelihood of a cesarean delivery

Results

Overall, among women with NTSV births, 26.5% births were cesarean, with a range of 14% to 38.3% across hospitals. In unadjusted models, the between-hospital variance was 0.103 SE 0.022; adjusting for demographic, socioeconomic and preexisting medical conditions did not reduce any hospital-level variation 0.108 SE 0.023.

Conclusion

Even after adjusting for both socio-demographic and clinical factors, the chance of a cesarean delivery for NTSV pregnancies varied according to hospital, suggesting the importance of hospital practices and culture in determining a hospital-s cesarean rate.



Author: Isabel A. Cáceres, Mariana Arcaya, Eugene Declercq, Candice M. Belanoff, Vanitha Janakiraman, Bruce Cohen, Jeffrey Ecker, Lauren

Source: http://plos.srce.hr/



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