Hospital Variation in Primary Cesarean Rates among Low Risk Women: Contribution of Individual and Hospital Factors in Florida
Methods: Population-based study using Florida’s linked birth certificate and hospital discharge records for the period of 2004-2011. The study population was comprised of 412,192 nulliparous, singleton, vertex, live births with labor, at 37-40 weeks gestation in 122 non-military delivery hospitals. Data were analyzed using multivariable logistic mixed effects regression with cesarean as the outcome.
Results: The cesarean rate in the study population was 23.9%, with hospital-specific estimates ranging from 12.8% to 47.3%. Strong risk factors for cesarean were advanced maternal age, obese BMI, medical risk conditions, labor induction, and hospital geographic location. Geographic location was a significant effect modifier for maternal BMI, medical conditions and labor induction (p<0.05). Although not a statistically significant change (p>0.05), the hospital variance estimate decreased by 24.6% after adjusting for all significant risk factors. This reduction was attributed to adjusting for hospital geographic location and, to a lesser extent, moderate risk factors such as time and day of delivery and maternal race/ethnicity.
Conclusions: In contrast to previous studies, our findings suggest that individual level risk factors in Florida contribute to some of the hospital variation in primary cesareans among low risk women, with varying extent by region. This study provides useful background information on mothers and hospitals in developing a new state quality improvement initiative.
Learning Areas:Assessment of individual and community needs for health education
Public health or related organizational policy, standards, or other guidelines
Public health or related research
Assess the contribution of individual and hospital level risk factors to the hospital variation in primary cesarean rates among low risk women in Florida
Keyword(s): Maternal and Child Health, Quality of Care
Qualified on the content I am responsible for because: I am a third-year doctoral student (candidate) in Epidemiology at USF. Since completion of my MPH coursework in 2010, I have held research assistantships and been involved in all stages of research studies from design and planning to data collection, management and analysis. In my current position, I am a data analyst for projects concerning maternal and infant health based on statewide birth certificate and hospital discharge linked records.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.