The effect of physician characteristics on clinical behavior: cesarean section in New York State.
The effect of physician characteristics on clinical behavior: cesarean section in New York State.
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医生特征对临床行为的影响：纽约州的剖腹产手术。
DOI：
10.1016/0277-9536(93)90336-3
复制
发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Wojtowycz,MA
中科院分区：
文献类型：
--
作者：
Tussing,AD;Wojtowycz,MA
这项研究调查了1986年发生在纽约州的65,784例产科分娩，由1740名不同的医生参加。剖宫产率、难产和胎儿窘迫报告率是根据医生从医学院毕业的年份、美国或外国医学毕业生（FMG）、医生性别、委员会认证和专业任命来计算的。估计概率回归，其中因变量是个体分娩是阴道分娩还是剖宫产。粗剖宫产率、交叉表和概率回归均显示医师特征显著影响剖宫产率。无论是总体上还是在所有其他相关因素得到控制的情况下，fmg明显更有可能通过剖宫产分娩。根据美国和非美国，fmg的剖宫产率有所不同。出生地，受教育的国家或地区。与其他人不同的是，作者没有发现更多刚毕业的医生有更高的剖宫产率。事实上，当其他因素得到控制时，她们的难产率要低得多。当其他因素得到控制时，女医生的剖宫产率总体上略低，但难产率较高。委员会认证的产科医生的剖宫产率明显较高，而拥有教授职位的医生剖宫产率较低，尽管因果关系的方向并不总是明确的。作者的结论是，医生特征对临床行为的影响是一条富有成效的调查路线，特别是与fmg有关的结果值得进一步调查。
This study examines 65,784 obstetric deliveries occuring in 1986 in New York State, attended by 1740 different physicians. Cesarean section rates, and rates of reporting of dystocia and fetal distress, are calculated by physicians' year of graduation from medical school, U.S. or foreign medical graduate (FMG), physician sex, board certification, and professional appointment. Probit regressions are estimated, in which the dependent variable is whether an individual delivery is vaginal or cesarean section. Crude cesarean section rates, cross-tabulations, and probit regressions all show physician characteristics to influence cesarean section rates significantly. FMGs are significantly more likely to deliver by cesarean section, both overall and when all other relevant factors are controlled for. Cesarean section rates by FMGs vary somewhat according to U.S. vs non-U.S. birthplace, and country or area where educated. Unlike others, the authors fail to find more recently graduated physicians to have higher cesarean section rates. Indeed, their rates for dystocia are significantly lower, when other factors are controlled for. Women physicians have a slightly lower cesarean section rate overall when other factors are controlled for, but a higher rate for dystocia. Board certified obstetricians have significantly higher, and physicians with professorial appointments lower cesarean section rates, though the direction of causation is not always clear. The authors conclude that the effect of physician characteristics on clinical behavior is a fruitful line of inquiry, and that in particular the results pertaining to FMGs warrant further investigation.
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DOI：
10.1001/jama.1990.03440240076019
发表时间：
1990
期刊：
JAMA
影响因子：
--
作者：
F. Notzon
通讯作者：
F. Notzon
减少教学医院的剖腹产率。
影响因子：
9.8
作者：
L. Sanchez;A. Kaunitz;H. Peterson;B. Martinez;R. Thompson
通讯作者：
R. Thompson
影响因子：
158.5
作者：
GOYERT, GL;BOTTOMS, SF;NEHRA, PC
通讯作者：
NEHRA, PC
剖腹产率上升的原因：1978 年至 1984 年
影响因子：
7.2
作者：
P. Shiono;D. McNellis;G. Rhoads
通讯作者：
G. Rhoads
1990 年美国剖腹产率：更新。
DOI：
10.1111/j.1523-536x.1992.tb00367.x
发表时间：
1992
期刊：
Birth
影响因子：
--
作者：
S. Taffel;P. Placek;C. Kosary
通讯作者：
C. Kosary