The Application of the Ten Group Classification System (TGCS) in Caesarean Delivery Case Mix Adjustment. A Multicenter Prospective Study
| Autor: | Sandro Zicari, Cristina Di Leonardo, Giovanni Del Frate, Alberto Rossi, Simona Melazzini, Silvia Smiroldo, Diego Marchesoni, Attilio D'Atri, Giorgio Simon, Caterina Businelli, Laura Travan, Maria Parente, Daniele Domini, Sara Casarsa, Daniele Bassini, Silvio Giove, Valentina Soini, Sergio Demarini, Secondo Guaschino, Michela De Agostinis, Francesco De Seta, Raffaela Mugittu, Carlo Zompicchiatti, Monica Olivuzzi, Lorenzo Monasta, C. Gigli, Gianpaolo Maso, Claudio Fiscella, Santo La Valle, Marcella Montico, Monica Piccoli, Giorgio Tamburlini, Luca Ronfani, Salvatore Alberico, Valter Adamo |
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| Přispěvatelé: | Maso, Gianpaolo, Alberico, Salvatore, Lorenzo, Monasta, Ronfani, Luca, Montico, Marcella, Businelli, Caterina, Soini, Valentina, Piccoli, Monica, Carmine, Gigli, Daniele, Domini, Claudio, Fiscella, Sara, Casarsa, Carlo, Zompicchiatti, Michela De, Agostini, Attilio, D’Atri, Raffaela, Mugittu, Santo La, Valle, Cristina Di, Leonardo, Valter, Adamo, Smiroldo, Silvia, Giovanni Del, Frate, Monica, Olivuzzi, Silvio, Giove, Maria, Parente, Daniele, Bassini, Simona, Melazzini, Guaschino, Secondo, DE SETA, Francesco, Demarini, Sergio, Travan, Laura, Diego, Marchesoni, Rossi, Alberto, Simon, Giorgio, Zicari, Sandro, Giorgio, Tamburlin |
| Rok vydání: | 2013 |
| Předmět: |
Non-Clinical Medicine
Epidemiology lcsh:Medicine Logistic regression Labor and Delivery Pregnancy Odds Ratio Prospective Studies lcsh:Science Prospective cohort study Epidemiological Methods Multidisciplinary Obstetrics Obstetrics and Gynecology Gestational age Italy Area Under Curve symbols Medicine Female Risk Adjustment Health Services Research Public Health Obstetric Surgery Research Article Adult medicine.medical_specialty Birth weight symbols.namesake Hypertensive Disorders in Pregnancy medicine Chi-square test Humans Health Care Quality Management of High-Risk Pregnancies Health Care Policy cesarean section Receiver operating characteristic business.industry lcsh:R Cesarean Section Logistic Models Multivariate Analysis ROC Curve Biochemistry Genetics and Molecular Biology (all) Agricultural and Biological Sciences (all) Surgery Pregnancy Complications Survey Methods Bonferroni correction Relative risk lcsh:Q Health Statistics business |
| Zdroj: | PLoS ONE PLoS ONE, Vol 8, Iss 6, p e62364 (2013) |
| ISSN: | 1932-6203 |
| DOI: | 10.1371/journal.pone.0062364 |
| Popis: | BACKGROUND: Caesarean delivery (CD) rates are commonly used as an indicator of quality in obstetric care and risk adjustment evaluation is recommended to assess inter-institutional variations. The aim of this study was to evaluate whether the Ten Group classification system (TGCS) can be used in case-mix adjustment. METHODS: Standardized data on 15,255 deliveries from 11 different regional centers were prospectively collected. Crude Risk Ratios of CDs were calculated for each center. Two multiple logistic regression models were herein considered by using: Model 1- maternal (age, Body Mass Index), obstetric variables (gestational age, fetal presentation, single or multiple, previous scar, parity, neonatal birth weight) and presence of risk factors; Model 2- TGCS either with or without maternal characteristics and presence of risk factors. Receiver Operating Characteristic (ROC) curves of the multivariate logistic regression analyses were used to assess the diagnostic accuracy of each model. The null hypothesis that Areas under ROC Curve (AUC) were not different from each other was verified with a Chi Square test and post hoc pairwise comparisons by using a Bonferroni correction. RESULTS: Crude evaluation of CD rates showed all centers had significantly higher Risk Ratios than the referent. Both multiple logistic regression models reduced these variations. However the two methods ranked institutions differently: model 1 and model 2 (adjusted for TGCS) identified respectively nine and eight centers with significantly higher CD rates than the referent with slightly different AUCs (0.8758 and 0.8929 respectively). In the adjusted model for TGCS and maternal characteristics/presence of risk factors, three centers had CD rates similar to the referent with the best AUC (0.9024). CONCLUSIONS: The TGCS might be considered as a reliable variable to adjust CD rates. The addition of maternal characteristics and risk factors to TGCS substantially increase the predictive discrimination of the risk adjusted model. |
| Databáze: | OpenAIRE |
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