Physician contribution to a cesarean delivery risk model.
OBJECTIVE
The purpose of this study was to assess the contribution of physician management to the probability of cesarean delivery.


METHODS
A prospective cohort study was performed of all live births who weighed > or =500 g for a 2-year period (1999-2000) at a large metropolitan hospital (n = 10,027 births). Factors that were associated significantly with cesarean delivery at one time excluded cases in which cesarean delivery was a necessary or probable outcome. In the planned vaginal delivery sample (n = 7940 births), a risk-adjusted logistic regression model was used to assess the prediction of cesarean delivery. To test for the effect of physician-management physician, we used the subset of physicians with > or =45 deliveries in the 2-year time period (n = 6563 deliveries).


RESULTS
When physician-management physician data were added to the use of forward stepwise regression, entry order was abnormal position, nulliparity, birth weight of >4000 g, and physician. The model's predictive ability improved from 43.8% to 50.2%.


CONCLUSIONS
Physician management adds a significant independent effect to the cesarean delivery risk model.
Luthy
David A
DA
Center for Perinatal Studies and Quality Integration and Improvement, Swedish Medical Center, Seattle, WA, USA. david_luthy@pediatrix.com
Malmgren
Judith A
JA
Zingheim
Rosalee W
RW
Leininger
Christopher J
CJ
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008427:Maternal Health Services; D008875:Middle Aged; D015233:Models, Statistical; D009774:Obstetrics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment / Q000706:statistics & numerical data*; D012307:Risk Factors; D014861:Washington