Evaluating risk-adjusted cesarean delivery rate as a measure of obstetric quality.
Evaluating risk-adjusted cesarean delivery rate as a measure of obstetric quality.
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DOI：
10.1097/aog.0b013e3181d9f4b6
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发表时间：
2010-05
影响因子：
7.2
通讯作者：
Lorch SA
中科院分区：
文献类型：
--
作者：
Srinivas SK;Fager C;Lorch SA
通过风险调整剖宫产率与所有妊娠(模型1)和单胎初产患者(模型2)的母婴结局的关系，验证风险调整剖宫产率作为产科质量的衡量标准。我们构建了一个以人群为基础的队列，由来自401家医院的845,651名患者组成，代表了2004至2005年间加州和宾夕法尼亚州的所有分娩。我们使用母亲和婴儿的出生证明和住院记录来评估风险调整后的剖腹产与不利的产妇结局、不利的新生儿结局以及来自卫生保健研究和质量机构(AHRQ)的四项产科病人安全指标的组合之间的相关性。在这两个模型中，风险调整后的剖宫产率与母亲和新生儿的综合结局以及AHRQ患者安全指标(产伤、器质性阴道分娩和剖宫产)呈负相关。在风险调整后的剖宫产率低于预期的107家医院中，约有60%的医院的六种不良结果中至少有一种的发生率高于预期，相比之下，风险调整后的剖宫产率高于预期的医院为19.6%，预期的医院为36.1%(p<；0.001)。在所有患者中，低于预期的、风险调整后的剖宫产率，或者当限制在更同质的单胎初产患者组时，与高于预期的不良母婴结局相关。风险调整后的剖宫产率高于预期并不会带来改善的结果。
To validate the risk- adjusted cesarean delivery rate as a measure of obstetric quality through its association with maternal and neonatal outcomes for all pregnancies (model 1) and in singleton primiparous patients (model 2). We constructed a population-based cohort of 845,651 patients from 401 hospitals representing all deliveries in California and Pennsylvania between 2004 and 2005. We used linked birth certificate and hospital admission records for mother and infant to estimate the correlation between risk-adjusted cesarean delivery and a composite of adverse maternal outcomes, adverse neonatal outcome, and four obstetric patient safety indicators from The Agency for Healthcare Research and Quality (AHRQ). In both models, risk-adjusted cesarean delivery rates were negatively correlated with both the maternal and neonatal composite outcomes and the AHRQ patient safety indicators for birth trauma, injury with instrumented vaginal delivery and cesarean delivery. Approximately 60% of the 107 hospitals with lower-than-expected risk-adjusted cesarean delivery rates had a higher-than-expected rate of at least one of the six adverse outcomes, compared to 19.6% of the hospitals with a higher-than-expected, risk-adjusted cesarean delivery rate and 36.1% of the hospitals with expected rates (p<0.001). Lower-than-expected, risk-adjusted cesarean delivery rates in all patients or when restricted to a more homogeneous group of term singleton primiparous patients are associated with higher-than-expected adverse maternal or neonatal outcomes. Higher-than-expected risk-adjusted cesarean delivery rates do not result in improved outcomes.