Risk-adjustment of cesarean delivery rates: a practical method for use in quality improvement.
Risk-adjustment of cesarean birthrates has been hampered by inadequacies in the existing secondary data sources or by the need for extensive chart review. This study presents an efficient risk-adjustment model for cesarean birth, based on easily retrievable ICD-9 codes and clinical risk factors least influenced by physician practice style. Data are presented for mothers undergoing 7322 deliveries from 1997-1998 at a large academic medical center with a cesarean birth rate of 15.9%. Multiple logistic regression was used to predict the likelihood of cesarean delivery controlled for maternal age, 10 risk factors identified through ICD-9 coding, and 3 additional clinical variables (nulliparity, birth weight, and gestational age) derived from a perinatal (birth certificate) database. All risk factors were significant predictors of cesarean birth, producing an area under the receiver-operating characteristic curve of 0.86 and a 60-fold increase in cesarean delivery from highest to lowest deciles of predicted risk. This methodology can be used widely for quality improvement without the need for extensive chart review.
Peaceman
Alan M
AM
Division of Maternal and Fetal Medicine, Northwestern University Medical School, Chicago, Ill., USA. amp066@northwestern.edu
Feinglass
Joe
J
Manheim
Larry M
LM
D000046:Academic Medical Centers / Q000592:standards*; D000328:Adult; D002585:Cesarean Section / Q000592:standards / Q000706:statistics & numerical data*; D002641:Chicago; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D011336:Probability; D020379:Risk Adjustment; D012307:Risk Factors; D017749:Total Quality Management