Alternative strategies for controlling rising cesarean section rates.
Alternative strategies for controlling rising cesarean section rates.
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DOI：
10.1097/00132582-199010000-00001
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发表时间：
1990-10
期刊：
影响因子：
--
通讯作者：
R. S. Stafford
中科院分区：
文献类型：
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作者：
R. S. Stafford
美国的剖腹产率从 1970 年的 5.5% 增加到 1987 年的 24.4%。这种急剧增加引起了相当大的关注，导致出现了各种建议来控制剖腹产率的上升。已经采取或提出了六项策略来减少剖腹产的使用：（1）教育和同行评估，（2）外部审查，（3）公开传播剖腹产率，（4）改变医生付费，（5）改变医院付费，以及（6）医疗事故改革。这些策略的不同之处在于它们对临床决策过程、对医生自主权的影响以及实施方法的具体假设。教育工作得到了最广泛的推动。其中，旨在改变个别医院内部做法的正式计划似乎是最成功的。然而，尚未进行足够的研究来最终比较这六种策略的影响和可行性，表明需要进一步研究。
Cesarean section rates in the United States have increased from 5.5% in 1970 to 24.4% in 1987. This dramatic increase has generated considerable concern, leading to a variety of proposals to control rising use of cesarean section. Six strategies have been adopted or proposed to reduce cesarean section use: (1) education and peer evaluation, (2) external review, (3) public dissemination of cesarean section rates, (4) changes in physician payment, (5) changes in hospital payment, and (6) medical malpractice reform. These strategies differ in their specific assumptions regarding the process of clinical decision making, implications for physician autonomy, and methods of implementation. Educational efforts have been the most widely promoted. Of these, formal programs aimed at modifying practices within individual hospitals appear to be the most successful. However, insufficient research has been conducted to compare conclusively the impact and feasibility of these six strategies, pointing to the need for further study.