Population-based standardization (PBS) of institutional cesarean delivery rates

Journal of Perinatal Medicine
Amos GrünebaumDaniel Skupski

Abstract

Raw cesarean section rates are often compared among institutions with different patient populations. The purpose of this study was to develop an easily reproducible mathematical model that allows comparisons of cesarean delivery rates across different patient populations and institutions. We first calculated three institution's cesarean delivery rates for each of ten groups of patients based on age and parity. The population based adjusted total cesarean delivery rate was then calculated for each institution based on the distribution of patients in the 2004 national birth data (n=4,097,029) but using the three institutions' individual cesarean delivery rates. The adjusted for age and parity cesarean delivery rate was significantly lower from raw cesarean delivery rates in two of the three institutions (A: 28.2% adjusted vs. 36.5% raw; P=0; B: 28.2% adjusted vs. 30.4% raw, P=0.0411; C: 28.7% adjusted vs. 29.7% raw, NS) reflecting the older and more nulliparous patients in these two institutions. Our study confirms that raw cesarean delivery rate should not be used to compare quality of care within and among different institutions unless they are adjusted for different patient characteristics. We believe that using unadjusted ces...Continue Reading

References

Jul 6, 1995·The New England Journal of Medicine·A Epstein
Jun 11, 1999·Obstetrics and Gynecology·J L BailitA N Peaceman
Dec 22, 1999·American Journal of Obstetrics and Gynecology·J C Glantz
Nov 15, 2003·Journal of Clinical Epidemiology·Ilana F GareenDeidre Spelliscy Gifford

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Citations

Aug 12, 2015·BJOG : an International Journal of Obstetrics and Gynaecology·J P SouzaA M Gülmezoglu

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