Hospital contribution to variation in rates of vaginal birth after cesarean
| Autor: | Daniel M. Morgan, Tanima Basu, Elizabeth Langen, Alexandra C Thomason, Roger Smith, Neil Kamdar, John D. Syrjamaki, Jourdan E. Triebwasser, Michelle H. Moniz |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Michigan
medicine.medical_specialty Blue shield Hospitals Low-Volume Vaginal birth Article Insurance Claim Review 03 medical and health sciences 0302 clinical medicine Pregnancy 030225 pediatrics Claims data Odds Ratio medicine Humans 030212 general & internal medicine Retrospective Studies Insurance Health Cesarean Section Obstetrics business.industry Obstetrics and Gynecology Retrospective cohort study Odds ratio Patient Acceptance of Health Care medicine.disease Vaginal Birth after Cesarean Hospitals 3. Good health Quartile Pediatrics Perinatology and Child Health comic_books Female business comic_books.character |
| Zdroj: | Journal of perinatology : official journal of the California Perinatal Association |
| ISSN: | 1476-5543 0743-8346 |
| Popis: | Objective: To determine the influence of delivery hospital on the rate of vaginal birth after cesarean (VBAC). Study Design: This retrospective cohort study used claims data from Blue Cross and Blue Shield of Michigan. Women with a prior cesarean and a singleton livebirth between 2012 and 2016 were included. We calculated the hospital-specific risk-standardized VBAC rates and median odds ratio as a measure of variation. Result: Hospital-level adjusted rates varied nearly 10-fold (3.7%-35.5%). Compared to the lowest volume hospitals (1st quartile), the likelihood of VBAC increased for those in the 2nd (adjusted OR 2.75 [95% CI 1.23-6.17]), 3rd (adjusted OR 3.73 [95% CI 1.59-8.75]), and 4th quartiles (adjusted OR 2.9 [95% CI 1.11-7.72]). The median OR suggested significant variation by hospital after adjustment. Conclusion: The delivery hospital itself explains a large amount of the variation in rates of VBAC after adjustment for patient and hospital characteristics. |
| Databáze: | OpenAIRE |
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