Cesarean delivery ratings may be misleading
Cesarean delivery ratings may be misleading
Hospital comparisons that fail to account for patient characteristics that increase the likelihood of cesarean delivery may be methodologically biased and may mislead health care purchasers, according to a study published in the June 24 issue of The Journal of the American Medical Association.
David Aron, MD, MS, of Case Western Reserve University in Cleveland, and colleagues studied the impact of adjusting hospital cesarean delivery rates for risk factors that may increase the likelihood of a cesarean delivery among 21 Cleveland-area hospitals. Hospitals and health plans are often ranked on rates of cesarean delivery, under the assumption that lower rates reflect more appropriate, efficient care. However, most rankings do not account for patient factors such as maternal age, breech presentation, placental abnormalities, and fetal distress that affect the likelihood of cesarean delivery.
The researchers found that after adjusting hospital rates for the presence of 39 clinical factors that may predispose to cesarean delivery, outlier status (having significantly higher or lower rates than the overall rates) changed for five of the 21 hospitals. In 12 hospitals, the relative difference in unadjusted and adjusted rates was greater than 10%.
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