原创力文档risk adjustment for inter-hospital comparison of caesarean delivery rates in low-risk deliveries风险调整跨基础剖腹产交付率进行比较,在低风险的交付.pdfVIP
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risk adjustment for inter-hospital comparison of caesarean delivery rates in low-risk deliveries风险调整跨基础剖腹产交付率进行比较,在低风险的交付
Risk Adjustment for Inter-Hospital Comparison of
Caesarean Delivery Rates in Low-Risk Deliveries
1 1 1 1 2 2
Elisa Stivanello *, Paola Rucci , Elisa Carretta , Giulia Pieri , Chiara Seghieri , Sabina Nuti , Eugene
3 4 1
Declercq , Martina Taglioni , Maria Pia Fantini
1 Department of Medicine and Public Health – Alma Mater Studiorum University of Bologna, Bologna, Italy, 2 Laboratorio MeS, Scuola Superiore Sant’Anna, Pisa, Italy,
3 Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, United States of America, 4 Medical Directorate, Azienda
Ospedaliero-Universitaria di Bologna, Bologna, Italy
Abstract
Background: Caesarean delivery (CD) rates have been frequently used as quality measures for maternity service
comparisons. More recently, primary CD rates (CD in women without previous CD) or CD rates within selected categories
such as nulliparous, term, cephalic singleton deliveries (NTCS) have been used. The objective of this study is to determine
the extent to which risk adjustment for clinical and socio-demographic variables is needed for inter-hospital comparisons of
CD rates in women without previous CD and in NTCS deliveries.
Methods: Hospital discharge records of women who delivered in Emilia-Romagna Region (Italy) from January, 2007 to June
2009 and in Tuscany Region for year 2009 were linked with birth certificates. Adjusted RRs of CD in women without a
previous Caesarean and NTCS were estimated using Poisson regression. Percentage differences in RR before and after
adjustment were calculated and hospital rankings, based on crude and adjusted RRs, were examined.
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