A population-based analysis of variation in Caesarean birth rates
| Autor: | Risto Erkkola, Jouni Merilänen, Juha Teperi, Elina Hemminki, Ilmo Keskimäki |
|---|---|
| Rok vydání: | 1995 |
| Předmět: |
medicine.medical_specialty
business.industry Obstetrics Birth weight 030231 tropical medicine Public Health Environmental and Occupational Health Population based 3. Good health Birth rate Clinical Practice 03 medical and health sciences 0302 clinical medicine Case mix index Caesarean Birth Medicine Referral system 030212 general & internal medicine business Hospital service |
| Zdroj: | The European Journal of Public Health. 5:116-122 |
| ISSN: | 1464-360X 1101-1262 |
| DOI: | 10.1093/eurpub/5.2.116 |
| Popis: | Our aim was to find hospital characteristics and indicators of clinical practice patterns associated with hospital Caesarean birth rates. The data were derived from the national Finnish Birth Registry for 1987 and 1988 (n=120,277). In addition to hospital-specific Caesarean birth rates, rates in geographically defined hospital service areas were used. This was done to control for selection due to referrals. Few hospital characteristics examined were associated with Caesarean birth rates. There was a negative relationship between the hospital service area-specific rate, but not between the hospital specific rate and the size and level of the hospital. This was due to a referral system in which small, level I hospitals manage mainly low-risk deliveries. High Caesarean birth rates were characterized by frequent operations among normal birth weight, full-term deliveries and for dystoda. The relative excess of Caesareans was seen only at times convenient for surgery. Low Caesarean birth rates were characterized by less Caesareans for all major indications and at all times of the day and week. We conclude that insufficient adaptation of clinical practice patterns to fit a low-risk case mix in a hospital may lead to unnecessary operations. High Caesarean birth rates are not characterized by aggressive management of risks, but by a dispersion of operations among the normal population. |
| Databáze: | OpenAIRE |
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