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HEALTH CARE ORGANIZATION AND THE USE OF CESAREAN SECTION

医疗保健组织和剖腹产术的使用

基本信息

批准号：
3427327
负责人：
RANDALL SCOTT STAFFORD
金额：
$ 1.34万
依托单位：
WESTERN CONSORTIUM FOR PUBLIC HEALTH
依托单位国家：
美国
项目类别：
财政年份：
1988
资助国家：
美国
起止时间：
1988-08-01 至 1989-10-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/3427327
关键词：
cesarean section health care cost /financing health care model health care professional practice health care quality health care service utilization health insurance hospitals human population study managed care patient care management

项目摘要

The proposed research seeks to determine the institutional characteristics that lead to variations in medical practice patterns. This objective will be achieved by investigating the relationship between elements of health care organization and the use of cesarean section. Ideal for evaluating variations in practice patterns, cesarean section is the most common surgical procedure in U.S. hospitals. Considerable controversy surrounds its increasing use. Past research suggests that health care organization has a strong influence on cesarean section utilization. Previous studies, however, have failed to determine the independent effects of health care organization variables and have rarely controlled for the confounding effects of patient characteristics. The current study will fill an unmet need for research through an innovative approach to the analysis of cesarean section use. A database on obstetrical practices will be developed by combining information from hospital discharge abstracts and birth records for the 470,000 deliveries occurring in California in 1985. These two data sources are necessary because each contains important variables absent from the other. Despite potential drawbacks, the use of existing public data is both efficient and statistically powerful. A multivariate model of cesarean section use based on logistic regression will be developed to determine the independent effects of health care organization variables. Case-mix adjustment will include the medical characteristics of patients, an improvement over the use of demographic characteristics alone as proxies for the risk of cesarean section. This research will contribute to the study of variations in medical practice. It will also clarify current confusion regarding patterns of cesarean section use, evaluate potential policy strategies for controlling the increasing use of cesarean section, and develop general methods for employing public data in health services research.

拟议的研究试图确定机构导致医疗实践变化的特征模式。这一目标将通过调查卫生保健组织构成要素与卫生保健组织的关系剖宫产的使用。非常适合于评估实践模式中，剖宫产是最常见的外科手术在美国医院的程序。围绕着相当大的争议它的使用越来越多。过去的研究表明，医疗保健组织对剖宫产的影响很大利用率。然而，之前的研究未能确定卫生保健组织变量和卫生保健组织变量的独立影响很少控制患者的混杂影响特点。目前的研究将通过一项分析剖宫产应用的创新方法。一个产科实践数据库将通过以下方式开发出院摘要和出生记录中的信息 1985年在加利福尼亚州发生的47万次分娩。这些两个数据源是必需的，因为每个数据源都包含重要的变量不存在于其他变量中。尽管存在潜在的缺陷，但现有公共数据的使用既有效率，又有统计学意义很强大。剖宫产使用率的多因素模型将开发Logistic回归来确定独立的卫生保健组织变量的影响。病例组合调整将包括患者的医学特征，以及对单独使用人口统计特征的改进，如剖腹产风险的代用品。这项研究将有助于对医学变异的研究练习一下。它还将澄清当前对模式的困惑剖宫产使用率，评估潜在的政策战略控制剖宫产使用率的增加，并发展在卫生服务中使用公共数据的一般方法研究。