Hospital contribution to variation in rates of vaginal birth after cesarean

被引：21

作者：

Triebwasser, Jourdan E. ^{[1
,6
]}

Kamdar, Neil S. ^{[1
,2
,3
,4
]}

Lange, Elizabeth S. ^{[1
]}

Moniz, Michelle H. ^{[1
,4
]}

Basu, Tanima ^{[4
]}

Syrjamaki, John ^{[5
]}

Thomason, Alexandra C. ^{[1
]}

Smith, Roger D. ^{[1
]}

Morgan, Daniel M. ^{[1
,4
]}

机构：

[1] Univ Michigan, Dept Obstet & Gynecol, Ann Arbor, MI 48109 USA

[2] Univ Michigan, Dept Surg, Ann Arbor, MI 48109 USA

[3] Univ Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USA

[4] Univ Michigan, Inst Healthcare Policy & Innovat, Ann Arbor, MI 48109 USA

[5] Univ Michigan, Dept Urol, Ann Arbor, MI 48109 USA

[6] Univ Penn, Dept Obstet & Gynecol, Perelman Sch Med, Philadelphia, PA 19104 USA

来源：

JOURNAL OF PERINATOLOGY | 2019年 / 39卷 / 07期

基金：

美国医疗保健研究与质量局;

关键词：

LOGISTIC-REGRESSION; DELIVERY;

D O I：

10.1038/s41372-019-0373-2

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

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 tenfold (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.

引用

页码：904 / 910

页数：7

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