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dc.contributor.authorCáceres, Isabel A.
dc.contributor.authorArcaya, Mariana C
dc.contributor.authorDeclercq, Eugene
dc.contributor.authorBelanoff, Candice M.
dc.contributor.authorJanakiraman, Vanitha
dc.contributor.authorCohen, Bruce
dc.contributor.authorEcker, Jeffrey Lawrence
dc.contributor.authorSmith, Lauren A.
dc.contributor.authorSubramanian, S.V. Venkata
dc.date.accessioned2013-04-08T13:45:37Z
dc.date.issued2013
dc.identifier.citationCáceres, 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.en_US
dc.identifier.issn1932-6203en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:10508051
dc.description.abstractObjective: 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.en_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi:10.1371/journal.pone.0057817en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pubmed/23526952en_US
dash.licenseOAP
dc.titleHospital Differences in Cesarean Deliveries in Massachusetts (US) 2004–2006: The Case against Case-Mix Artifacten_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS ONEen_US
dash.depositing.authorSubramanian, S.V. Venkata
dc.date.available2013-04-08T13:45:37Z
dc.identifier.doi10.1371/journal.pone.0057817*
dash.contributor.affiliatedArcaya, Mariana
dash.contributor.affiliatedEcker, Jeffrey
dash.contributor.affiliatedSubramanian, Sankaran


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