Risk adjustment models for interhospital comparison of CS rates using Robson’s ten group classification system and other socio-demographic and clinical variables 英文参考文献.docVIP

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Risk adjustment models for interhospital comparison of CS rates using Robson’s ten group classification system and other socio-demographic and clinical variables 英文参考文献.doc

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Risk adjustment models for interhospital comparison of CS rates using Robson’s ten group classification system and other socio-demographic and clinical variables 英文参考文献

Colaisetal.BMCPregnancyandChildbirth2012,12:54 /1471-2393/12/54 RESEARCH ARTICLE OpenAccess Riskadjustmentmodelsforinterhospital comparisonofCSratesusingRobson’stengroup classificationsystemandothersocio-demographic andclinicalvariables PaolaColais1*,MariaPFantini2,DaniloFusco1,ElisaCarretta2,ElisaStivanello2,JacopoLenzi2,GiuliaPieri2 andCarloAPerucci3 Abstract Background:Caesareansection(CS)rateisaqualityofhealthcareindicatorfrequentlyusedatnationaland internationallevel.TheaimofthisstudywastoassesswhetheradjustmentforRobson’sTenGroupClassification System(TGCS),andclinicalandsocio-demographicvariablesofthemotherandthefetusisnecessaryforinter- hospitalcomparisonsofCSrates. Methods:Thestudypopulationincludes64,423deliveriesinEmilia-RomagnabetweenJanuary1,2003and December31,2004,classifiedaccordingtotheTGCS.Poissonregressionwasusedtoestimatecrudeandadjusted hospitalrelativerisksofCScomparedtoareferencecategory.Analyseswerecarriedoutintheoverallpopulation andseparatelyaccordingtotheRobsongroups(groupsI,II,III,IVandV–Xcombined).Adjustedrelativerisks(RR)of CSwereestimatedusingtworisk-adjustmentmodels;thefirst(M1)includingtheTGCSgroupastheonly adjustmentfactor;thesecond(M2)includinginadditiondemographicandclinicalconfoundersidentifiedusinga stepwiseselectionprocedure.PercentagevariationsbetweencrudeandadjustedRRsbyhospitalwerecalculatedto evaluatetheconfoundingeffectofcovariates. Results:ThepercentagevariationsfromcrudetoadjustedRRprovedtobesimilarinM1andM2model.However, stratifiedanalysesbyRobson’sclassificationgroupsshowedthatresidualconfoundingforclinicalanddemographic variableswaspresentingroupsI(nulliparous,single,cephalic,≥37weeks,spontaneouslabour)andIII(multiparous, excludingpreviousCS,single,cephalic,≥37weeks,spontaneouslabour)andIV(multiparous,excludingpreviousCS, single,cephalic,≥37weeks,inducedorCSbeforelabour)andtoaminorextentingroupsII(nulliparous,single, cephalic,≥37weeks,inducedorCSbeforelabour)andIV(multiparous,excludingpreviousCS,single,cephalic, ≥37w