title: Institutional influences on the primary cesarean section rate in Utah, 1992 to 1995.
abstract: OBJECTIVE
  Our purpose was to evaluate institutional and organizational influences on cesarean section rates in Utah and to adjust such rates for differences in patient acuity.
  
  
  METHODS
  Data on cesarean section rates were derived from the Utah Hospital Discharge Database and adjusted for patient acuity by correcting raw cesarean rates for those patients undergoing cesarean section meeting regional gestational age transport criteria.
  
  
  RESULTS
  When analyzed by means of 1-way analysis of variance, the following factors had a significant negative correlation (P < .05) with cesarean section rate: presence of a newborn intensive care unit and maternal-fetal medicine subspecialists, presence on the medical staff of obstetrician-gynecologist(s) as opposed to family physicians only, delivery volume >1500/y, urban location, and 24-hour in-house anesthesiology. When cesarean rates were corrected for acuity, facilities with maternal-fetal medicine specialists and a newborn intensive care unit had significantly lower rates (P < .001) and more uniform rates than otherwise similar institutions.
  
  
  CONCLUSIONS
  More medically sophisticated physicians and institutions have lower cesarean rates when patient acuity is taken into account.
authors.affiliation: Intermountain Health Care, Utah State Department of Health, and University of Utah School of Medicine, Salt Lake City, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Clark
authors.forename: W
authors.initials: W
authors.lastname: Xu
authors.forename: T F
authors.initials: TF
authors.lastname: Porter
authors.forename: D
authors.initials: D
authors.lastname: Love
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D008505:Medical Staff, Hospital; D009774:Obstetrics; D010820:Physicians; D010821:Physicians, Family; D011247:Pregnancy; D014589:Utah