Population-based standardization (PBS) of institutional cesarean delivery rates
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Amos Grünebaum
Abstract
Background: Raw cesarean section rates are often compared among institutions with different patient populations. The purpose of this study was to develop an easily reproducible mathematical model that allows comparisons of cesarean delivery rates across different patient populations and institutions.
Study design: We first calculated three institution's cesarean delivery rates for each of ten groups of patients based on age and parity. The population based adjusted total cesarean delivery rate was then calculated for each institution based on the distribution of patients in the 2004 national birth data (n=4,097,029) but using the three institutions' individual cesarean delivery rates.
Results: The adjusted for age and parity cesarean delivery rate was significantly lower from raw cesarean delivery rates in two of the three institutions (A: 28.2% adjusted vs. 36.5% raw; P=0; B: 28.2% adjusted vs. 30.4% raw, P=0.0411; C: 28.7% adjusted vs. 29.7% raw, NS) reflecting the older and more nulliparous patients in these two institutions.
Conclusions: Our study confirms that raw cesarean delivery rate should not be used to compare quality of care within and among different institutions unless they are adjusted for different patient characteristics. We believe that using unadjusted cesarean delivery rates without appropriate adjustments in quality assurance and when comparing data with other institutions and the national rate is erroneous and misleading.
©2008 by Walter de Gruyter Berlin New York
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Artikel in diesem Heft
- Prenatal long-chain polyunsaturated fatty acid status: the importance of a balanced intake of docosahexaenoic acid and arachidonic acid
- Population-based standardization (PBS) of institutional cesarean delivery rates
- Impact of high maternal hemoglobin at first antenatal visit on pregnancy outcomes: a cohort study
- Retrospective audit of outcome of regional anesthesia for delivery in women with thrombocytopenia
- The association between maternal characteristics and different types and levels of discordance in triplet pregnancies
- Obstetric gel shortens second stage of labor and prevents perineal trauma in nulliparous women: a randomized controlled trial on labor facilitation
- Fetal electrocardiographic monitoring during labor in relation to cord blood levels of the brain-injury marker protein S-100
- Nuchal cord in post-term pregnancy – relationship to suspected intrapartum fetal distress indicating operative intervention
- Risk assessment of trisomy 21 by maternal age and fetal nuchal translucency thickness in 7096 unselected pregnancies in Slovenia
- The association of hypotonia and depression in the term and near-term neonate with metabolic acidemia
- 17-Hydroxyprogesterone in premature infants as a marker of intrauterine stress
- Prenatal hypoxia preconditioning improves hypoxic ventilatory response and reduces mortality in neonatal rats
- Mortality and morbidity of neonates born at <26 weeks of gestation (1998–2003). A population-based study
- Conception without the development of a human being
- Intraplacental choriocarcinoma with fetomaternal hemorrhage: a case study and literature review
- Computerized FHR traces in post-term pregnancies
- Uterine activity monitoring during labor
- Congress Calendar
