title: Risk-adjusted measurement of primary cesarean sections: reliable assessment of the quality of obstetrical services.
abstract: A two-hospital system reported widely disparate Cesarean section rates in its component institutions. Statistical analysis determined that the apparent discrepancy was due primarily to patient-related factors. When risk-adjusted, both hospitals' rates were indistinguishable from expected rates. Reporting Cesarean section rates without appropriate risk adjustment yields potentially misleading results. Since reliable risk adjustment currently exists only for primary Cesarean sections, primary rates should be reported separately from "raw" rates for other procedures.
authors.affiliation: Medalia HealthCare LLC, Seattle, Washington, USA.
authors.forename: D P
authors.initials: DP
authors.lastname: Pasternak
authors.forename: M
authors.initials: M
authors.lastname: Pine
authors.forename: K
authors.initials: K
authors.lastname: Nolan
authors.forename: R
authors.initials: R
authors.lastname: French
mesh_terms: D002585:Cesarean Section / Q000145:classification / Q000706:statistics & numerical data*; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data; D005260:Female; D006301:Health Services Needs and Demand; D006744:Hospital Bed Capacity, 100 to 299; D006745:Hospital Bed Capacity, 300 to 499; D006769:Hospitals, General / Q000592:standards*; D006801:Humans; D008329:Managed Care Programs; D009820:Ohio; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011247:Pregnancy; D019984:Quality Indicators, Health Care; D020379:Risk Adjustment; D019564:Unnecessary Procedures; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data