Impact of Risk-Adjusting Cesarean Delivery Rates When Reporting Hospital Performance

摘要: Context.—Hospitals and health plans are often ranked on rates of cesarean delivery, under the assumption that lower reflect more appropriate, efficient care. However, most rankings do not account for patient factors affect the likelihood delivery.Objective.—To compare hospital delivery before after adjusting for clinical risk increase delivery.Design.—Retrospective cohort study.Setting.—Twenty-one hospitals in northeast Ohio.Patients.—A total 26127 women without prior deliveries admitted for labor from January 1993 through June 1995.Main Outcome Measures.—Hospital based observed risk-adjusted delivery rates.Results.—The overall rate was 15.9% varied (P<.001) 6.3% to 26.5% individual hospitals. Adjusted rates varied 8.4% 22.0%. The correlation between unadjusted adjusted hospital (ie, 1-21) only modest (R=0.35, P=.12). Whereas 7 were classified as outliers (ie, had higher or [P<.05] than overall rate) basis both adjusted rates, outlier status changed for 5 (24%), including 2 changed outliers nonoutliers, 2 nonoutliers outliers, 1 a high outlier low outlier.Conclusions.—Cesarean across single metropolitan region. fail increase the may be methodologically biased misleading to public.