Cesarean delivery rates vary tenfold among US hospitals; reducing variation may address quality and cost issues.
Cesarean delivery rates vary tenfold among US hospitals; reducing variation may address quality and cost issues.
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DOI：
10.1377/hlthaff.2012.1030
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发表时间：
2013-03
期刊：
影响因子：
--
通讯作者：
Virnig BA
中科院分区：
文献类型：
--
作者：
Kozhimannil KB;Law MR;Virnig BA
剖宫产是美国最常见的外科手术，而且剖宫产率正在上升。通过分析2009年全美593家医院的数据，我们发现剖宫产率在不同医院之间相差10倍，从7.1%到69.9%不等。即使是低风险怀孕的女性，剖宫产率也相差了15倍，从2.4%到36.5%。因此，在实践模式的巨大差异可能是驱动昂贵的过度使用剖宫产在许多美国医院。由于医疗补助计划支付了美国近一半的新生儿，政府减少差异的努力是有道理的。我们将重点放在减少这些差异的四个有希望的方向上，包括更好地协调产妇护理，更多的数据收集和测量，将医疗补助支付与质量改进联系起来，以及通过公开报告加强以患者为中心的决策。
Cesarean delivery is the most commonly performed surgical procedure in the United States, and cesarean rates are increasing. Working with 2009 data from 593 US hospitals nationwide, we found that cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteen-fold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals. Because Medicaid pays for nearly half of US births, government efforts to decrease variation are warranted. We focus on four promising directions for reducing these variations, including better coordination of maternity care, more data collection and measurement, tying Medicaid payment to quality improvement, and enhancing patient-centered decision making through public reporting.
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