Evaluation of Hospital Cesarean Delivery-Related Profits and Rates in the United States.
Evaluation of Hospital Cesarean Delivery-Related Profits and Rates in the United States.
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DOI：
10.1001/jamanetworkopen.2021.2235
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发表时间：
2021-03-01
影响因子：
13.8
通讯作者：
Tsugawa Y
中科院分区：
文献类型：
--
作者：
Sakai-Bizmark R;Ross MG;Estevez D;Bedel LEM;Marr EH;Tsugawa Y
在利润较高的医院接受护理的患者，与利润较低的医院相比，剖腹产的概率是否更高？在这项使用2010年至2014年出院数据的全国代表性横断面研究中，在每次手术利润较高的医院分娩的女性与接受剖宫产的可能性增加相关。这些研究结果表明，经济激励和美国剖腹产率之间的关联。这项横断面研究的出院数据来自美国医院的国家数据库，研究了医院从剖宫产手术中获得的利润与剖宫产率之间的关系。美国医院的高剖宫产率表明该手术的潜在过度使用;然而，美国过度使用剖宫产手术的根本原因尚未完全了解。调查患者水平的剖宫产概率与剖宫产每次手术的利润之间的关系。这项观察性横断面研究使用了2010年至2014年期间在美国分娩新生儿的剖宫产低风险女性的全国代表性出院数据样本。数据来自医疗保健研究和质量机构编制的医疗保健成本和利用项目的全国再入院数据库。于二零一九年八月至二零二零年五月期间进行数据清理及分析。医院级剖腹产利润中位数，定义为每家医院计算的剖腹产费用与成本之差。我们的主要结局是个体水平的剖宫产概率。我们使用分层回归模型，根据患者和医院特征以及年度固定效应进行调整，研究了剖宫产手术的医院水平利润中位数（定义为剖宫产手术费用和成本之间的差异）与剖宫产手术利润中位数的相关性。我们的分析共纳入了13215853例分娩（平均[SE]年龄，27.4 [0]岁），其中2202632例（16.7%）为剖宫产分娩。在调整了潜在的混杂因素后，当孕妇在剖宫产手术利润更高的医院分娩时，她们更有可能进行剖宫产。在最高利润四分位数（调整后比值比，1.08; 95%CI，1.02-1.14; P = .005）和第二高利润四分位数（调整后比值比，1.07; 95%CI，1.02-1.13; P = .007）的医院接受护理的妇女，与在最低利润四分位数的医院接受护理的妇女相比，剖宫产的概率更高。在这项对美国全国代表性医院出院数据的横断面研究中，每次剖宫产手术利润较高的医院与通过剖宫产分娩新生儿的概率增加相关。这些研究结果突出了经济激励在决定美国高剖宫产率方面的潜在影响。
Do patients who receive care at hospitals that make higher profits have a higher probability of cesarean delivery compared with hospitals that make less profits? In this cross-sectional, nationally representative study using hospital discharge data between 2010 and 2014, women delivering at hospitals with higher profits per procedure were associated with an increased probability of undergoing cesarean delivery. These findings suggest an association between financial incentives and the US cesarean delivery rate. This cross-sectional study of discharge data from a national database of US hospitals examines the association of profits hospitals received from cesarean procedures and rates of cesarean delivery. A high cesarean delivery rate in US hospitals indicates the potential overuse of this procedure; however, underlying causes of the excessive use of cesarean procedures in the US have not been fully understood. To investigate the association between the probability of cesarean delivery at the patient-level and profit per procedure from cesarean deliveries. This observational, cross-sectional study used a nationally representative sample of hospital discharge data from women at low risk for cesarean birth who delivered newborns between 2010 and 2014 in the US. Data were gathered from the Nationwide Readmissions Database from the Healthcare Cost and Utilization Project, compiled by the Agency for Healthcare Research and Quality. Data cleaning and analyses were conducted between August 2019 and May 2020. Hospital-level median value of profits from cesarean deliveries, defined as the difference between the charge and the cost for cesarean delivery calculated for each hospital. Our primary outcome was the individual-level probability of undergoing a cesarean delivery. We examined the association with the hospital-level median value of profits per procedure for cesarean delivery (defined as the difference between the charge and the cost for cesarean delivery) using hierarchical regression models adjusted for patient and hospital characteristics and year-fixed effects. A total of 13 215 853 deliveries were included in our analyses (mean [SE] age, 27.4 [0] years), of which 2 202 632 (16.7%) were cesarean deliveries. After adjusting for potential confounders, pregnant women were more likely to have a cesarean birth when they delivered at hospitals with higher profits per procedure from cesarean deliveries. Women cared for at hospitals with the highest (adjusted odds ratio, 1.08; 95% CI, 1.02-1.14; P = .005) and second-highest profit quartiles (adjusted odds ratio, 1.07; 95% CI, 1.02-1.13; P = .007) had higher probabilities of a cesarean delivery compared with those cared for at hospitals in the lowest profit quartile. In this cross-sectional study of US nationally representative hospital discharge data, hospitals with higher profits per cesarean procedure were associated with an increased probability of delivering newborns through cesarean birth. These findings highlight the potential influence financial incentives play in determining a high cesarean delivery rate in the US.
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DOI：
10.1377/hlthaff.2012.1030
发表时间：
2013-03
期刊：
Health affairs (Project Hope)
影响因子：
--
作者：
Kozhimannil KB;Law MR;Virnig BA
通讯作者：
Virnig BA
影响因子：
3.5
作者：
DRANOVE, D
通讯作者：
DRANOVE, D
影响因子：
3
作者：
Kozhimannil, Katy B.;Graves, Amy J.;Snowden, Jonathan M.
通讯作者：
Snowden, Jonathan M.
影响因子：
4.3
作者：
Ayres-De-Campos, Diogo;Cruz, Joana;Vicente, Lisa
通讯作者：
Vicente, Lisa
影响因子：
7.2
作者：
Deneux-Tharaux, Catherine;Carmona, Elodie;Breart, Gerard
通讯作者：
Breart, Gerard