How much variation in CS rates can be explained by case mix differences?
How much variation in CS rates can be explained by case mix differences?
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DOI：
10.1111/j.1471-0528.2005.00501.x
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发表时间：
2005-05-01
影响因子：
5.8
通讯作者：
Thomas, J
中科院分区：
文献类型：
--
作者：
Paranjothy, S;Frost, C;Thomas, J
目的量化不同产科单位间剖宫产率的差异。设计横断面研究。英格兰和威尔士的全部216个产科单位。人口2000年5月至7月期间在这些产科单位分娩的妇女。方法建立Logistic回归模型，研究病例混合特征与(i)分娩前CS和（ii）分娩中CS的几率之间的关系。利用这些结果，计算每个产科单位按病例组合标准化的总体CS率。随机效应荟萃分析用于检验产科单位之间的异质性。主要结果测量分娩前和分娩中CS。结果产妇单位间病例混合差异的调整解释了34%的CS率差异。CS（分娩前和分娩中）的几率随着母亲年龄的增加而增加。少数民族妇女在分娩前患CS的几率较低，而在分娩时患CS的几率则较高。有过阴道分娩经历的女性发生CS的几率较低，尽管在分娩前和分娩时CS的发生率明显不同。结论病例组合调整对了解影响CS率的因素具有重要意义。这些因素包括组织和人员水平，以及妇女对分娩的偏好和临床医生的态度。了解这些因素如何影响CS率对于评估向妇女提供的产科护理的质量和适当性至关重要。
Objective To quantify the amount of variation in caesarean section (CS) rates between maternity units explained by case mix differences.Design Cross-sectional study.Setting All 216 maternity units in England and Wales.Population Women giving birth at these maternity units between May and July 2000.Methods Logistic regression models were developed to investigate the relationship between case mix characteristics, and odds of (i) CS before labour, (ii) CS in labour. Using these results, overall CS rates standardised for case mix were calculated for each maternity unit. Random-effects meta-analysis was used to examine heterogeneity between maternity units.Main outcome measures CS before labour and CS during labour.Results Adjustment for case mix differences between maternity units explained 34% of the variance in CS rates. Odds of CS (before and in labour) increased with maternal age. Women from ethnic minority groups had lower odds of CS before labour, and increased odds of CS in labour. Women with a previous vaginal delivery had lower odds of CS, although the magnitude of this for CS before and in labour is markedly different.Conclusions Case mix adjustment is important to enable understanding of the factors that influence the CS rate. These include organisational and staffing levels as well as women's preferences for childbirth and clinician's attitudes. An understanding of how these factors influence the CS rate is essential for evaluation of quality and appropriateness of obstetric care provided to women.