| Evaluating risk-adjusted cesarean delivery rate as a measure of obstetric quality. | |
| | |
MedLine Citation:
|
PMID: 20410776 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: To validate the risk-adjusted cesarean delivery rate as a measure of obstetric quality through its association with maternal and neonatal outcomes for all pregnancies (model 1) and in primiparous patients with singleton pregnancies (model 2). METHODS: We constructed a population-based cohort of 845,651 patients from 401 hospitals representing all deliveries in California and Pennsylvania between 2004 and 2005. We used linked birth certificate and hospital admission records for mother and neonate to estimate the correlation between risk-adjusted cesarean delivery and a composite of adverse maternal outcomes, adverse neonatal outcomes, and four obstetric patient safety indicators from the Agency for Healthcare Research and Quality (AHRQ). RESULTS: In both models, risk-adjusted cesarean delivery rates were negatively correlated with both the maternal and neonatal composite outcomes and the AHRQ patient safety indicators for birth trauma, injury with instrumented vaginal delivery, and cesarean delivery. Approximately 60% of the 107 hospitals with lower-than-expected risk-adjusted cesarean delivery rates had higher-than-expected rates of at least one of the six adverse outcomes, compared with 19.6% of the hospitals with higher-than-expected risk-adjusted cesarean delivery rates and 36.1% of the hospitals with expected rates (P<.001). CONCLUSION: Lower-than-expected risk-adjusted cesarean delivery rates in all patients or when restricted to a more homogeneous group of primiparous patients with term singleton pregnancies are associated with higher-than-expected adverse maternal or neonatal outcomes. Higher-than-expected risk-adjusted cesarean delivery rates do not result in improved outcomes. |
| | |
Authors:
|
Sindhu K Srinivas; Corinne Fager; Scott A Lorch |
Related Documents
:
|
6860526 - Postoperative ileus, pregnancy-related cholinesterase deficiency and suxamethonium afte... 644366 - Are current rates of cesarean justified? 15971476 - Reproductive outcome after strassman metroplasty in women with a bicornuate uterus. 10904816 - Ventral midline caesarean section for dystocia secondary to failure to dilate the cervi... 21400626 - Systematic labelling of twin pregnancies on ultrasound: limitations and guidance. 9646596 - Late termination of pregnancy in cases of severe abnormalities in the fetus. |
Publication Detail:
|
Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.; Validation Studies |
Journal Detail:
|
Title: Obstetrics and gynecology Volume: 115 ISSN: 1873-233X ISO Abbreviation: Obstet Gynecol Publication Date: 2010 May |
Date Detail:
|
Created Date: 2010-04-22 Completed Date: 2010-05-18 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0401101 Medline TA: Obstet Gynecol Country: United States |
Other Details:
|
Languages: eng Pagination: 1007-13 Citation Subset: AIM; IM |
Affiliation:
|
Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. ssrinivas@obgyn.upenn.edu |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
California Cesarean Section / statistics & numerical data* Comorbidity Female Humans Obstetrics / standards* Outcome Assessment (Health Care) Parity Pennsylvania Pregnancy Pregnancy Complications / epidemiology, surgery Pregnancy Outcome* Quality Indicators, Health Care* Risk Adjustment |
| Grant Support | |
ID/Acronym/Agency:
|
K12HD001265/HD/NICHD NIH HHS; R01 HS 015696/HS/AHRQ HHS; R40 MC05474//PHS HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months.
Next Document: Factors associated with cesarean delivery in nulliparous women with type 1 diabetes.