Hospital Differences in Cesarean Deliveries in Massachusetts (US) 2004–2006: The Case against Case-Mix Artifact

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Hospital Differences in Cesarean Deliveries in Massachusetts (US) 2004–2006: The Case against Case-Mix Artifact

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Title: Hospital Differences in Cesarean Deliveries in Massachusetts (US) 2004–2006: The Case against Case-Mix Artifact
Author: Cáceres, Isabel A.; Arcaya, Mariana C; Declercq, Eugene; Belanoff, Candice M.; Janakiraman, Vanitha; Cohen, Bruce; Ecker, Jeffrey Lawrence; Smith, Lauren A.; Subramanian, S.V. Venkata

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Citation: Cáceres, Isabel A., Mariana C. Arcaya, Eugene Declercq, Candice M. Belanoff, Vanitha Janakiraman, Bruce Cohen, Jeffrey Ecker, Lauren A. Smith, and S. V. Venkata Subramanian. 2013. Hospital differences in cesarean deliveries in Massachusetts (US) 2004–2006: The case against case-mix artifact. PLoS ONE 8(3): e57817.
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Abstract: 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.
Published Version: doi:10.1371/journal.pone.0057817
Other Sources: http://www.ncbi.nlm.nih.gov/pubmed/23526952
Terms of Use: This article is made available under the terms and conditions applicable to Open Access Policy Articles, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#OAP
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:10508051
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