Effect of academic affiliation and obstetric volume on clinical outcome and cost of childbirth.
OBJECTIVE
To determine whether the academic affiliation and obstetric volume of the delivering hospital has an impact on clinical and economic outcomes.


METHODS
We performed a cross-sectional analysis of data for all births in the State of Maryland during 1996. Acute hospital discharge data were obtained from the publicly available Maryland Health Services Cost Review Commission database. Institutions were classified as community hospitals, community teaching hospitals, and academic medical centers. Principal outcome variables included cesarean birth and complication rates, total hospital charges, and length of stay.


RESULTS
A total of 63,143 cases were identified for analysis. The cesarean delivery rate was lower among academic medical centers, compared with community teaching hospitals and community hospitals (18.4% compared with 24.3% and 21.2%, respectively). After adjustment for patient case-mix, the adjusted odds ratio (OR) for cesarean birth was 0.66 at academic medical centers and 1.23 at community teaching hospitals compared with community hospitals (P <.01). Rates of episiotomy and serious complications were lower at academic medical centers compared with community hospitals. Adjusted total hospital charges were lower and length of stay was shorter for community hospitals compared with academic medical centers ($2937 compared with $3564 and 2.2 days compared with 2.5 days, respectively).


CONCLUSIONS
Hospital academic affiliation was an important predictor of clinical outcomes. Better clinical outcomes were found primarily among patients at academic medical centers, although these institutions demonstrated moderately higher resource utilization, compared with community hospitals.
Department of Obstetrics and Gynecology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA. fcisco@u.arizona.edu
F A
FA
Garcia
H B
HB
Miller
G R
GR
Huggins
T A
TA
Gordon
D000046:Academic Medical Centers / Q000191:economics* / Q000706:statistics & numerical data*; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000191:economics* / Q000592:standards*; D005260:Female; D017721:Hospital Costs; D006764:Hospitals, Community / Q000191:economics* / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008396:Maryland; D007744:Obstetric Labor Complications / Q000453:epidemiology; D009935:Organizational Affiliation; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D011247:Pregnancy; D014600:Utilization Review