THE IMPACT OF SPECIALTY ON CESAREAN SECTION RATES

人们已经认识到，非临床因素，如患者的 社会经济地位，她接待她的诊所类型 产前护理，以及她是否由主治医生接生 产科医生或住院医生会影响她成为 通过剖腹产分娩。也有一些人表示， 接受她治疗的医生的专业意愿 影响她收到的分娩类型。具体地说，家庭 受过“以家庭为中心”的产科培训的医生 在密歇根州的试点研究中观察到了外科治疗 肯塔基州将以一倍的速度通过剖腹产来接生病人- 第三，产科医生在相同的设施中，当患者 两个专业在风险因素方面是匹配的。这项研究将在 家庭医生剖腹产率不同的假设 和产科医生一起检查医生的专业知识和其他 已知的影响剖宫产率的变量 多点回顾性研究。来自东北的机构， 中西部和南部将审查这四年的产科记录 1988年1月至1991年12月期间和交货路线 将对每个专科的医生进行检查。使用多变量 方差分析，医生专业将与其他专业比较 可能影响剖宫产的人口学和临床因素 费率。此外，还将比较产妇和新生儿的结局。 对于两个专科之间风险状况不同的患者 确定医生专业是否会影响产科质量 关心。由于家庭医生和产科医生的培训不同 值得注意的是，两者之间的剖腹产率差异 专业可能会建议对医生的培训进行更改， 可能有助于遏制最近全国剖腹产迅速上升的趋势 分段费率。或者，剖腹产率的差异 这两个专科之间的差异可能反映了患者的选择偏见 那些期望和态度倾向于剖腹产的患者 更有可能为他们的产科选择特定的专科医生 关心。进一步研究患者的态度和期望 以及这些属性如何影响产科护理也将是有用的。

It has been recognized that non-clinical factors such as a patient's socio-economic status, the type of clinic where she receives her prenatal care, and whether she is delivered by an attending obstetricians or a resident influence the likelihood that she will be delivered by Cesarean section. There is also some suggestion that the specialty of the physician from whom she receives her care will influence the type of delivery she receives. Specifically, family physicians who are trained in "family centered" obstetrics rather than surgical care have been observed in pilot studies in Michigan and Kentucky to deliver their patients by Cesarean section at a rate one- third less for obstetricians in the same facilities when patients of the two specialties are matched for risk factors. This study will expand on the hypothesis that Cesarean section rates differ for family physicians and obstetricians by examining physician specialty along with other variables which are known to influence cesarean section rates in a retrospective multi-site study. Institutions from the northeast, midwest, and south will review obstetric records for the four year period of January, 1988 through December, 1991 and the route of delivery will be examined for physicians of each specialty. Using multivariate analysis of variance, physician specialty will be compared with other demographic and clinical factors that may influence Cesarean section rates. Additionally, maternal and neonatal outcomes will be compared for patients of varying risk status between the two specialties to determine if physician specialty influences the quality of obstetric care. Since the training of family physicians and obstetricians differs significantly, differences in Cesarean section rates between the two specialties may suggest alterations in the training of physicians which may be useful in curtailing the recent rapid rise in national Cesarean section rates. Alternatively, differences in Cesarean section rates between the two specialties may reflect selection bias by patients such that patients whose expectations and attitudes favor a Cesarean section are more likely to select a particular specialist for their obstetric care. Further research into the attitudes and expectations of patients and how these attributes influence obstetric care would also be useful.