title: Quality of obstetric care and risk-adjusted primary cesarean delivery rates.
abstract: OBJECTIVE
  The purpose of this study was to examine the association between risk-adjusted primary cesarean delivery rates and maternal and neonatal outcomes.
  
  
  METHODS
  California birth certificate data that were linked to hospital discharge data for 2001 were used to create a primary cesarean delivery rate risk-adjustment model. Two hundred eighty-five hospitals were divided into 3 groups that were above, below, or within expected rate confidence intervals. Maternal and neonatal outcomes were compared within each of the 3 hospital groupings.
  
  
  RESULTS
  Of the 285 hospitals, 27% had primary cesarean delivery rates that were above expected confidence intervals; 34% had primary cesarean delivery rates that were below expected confidence intervals, and 39% had primary cesarean delivery rates that were within expected confidence intervals. Neonatal asphyxia rates were higher in hospitals that had lower than expected rates of cesarean deliveries (0.05%, 0.1%, 0.07% for above, below, and within the confidence intervals, respectively; P < .0001). Maternal infection rates (2.1%, 2.3%, 1.8%, respectively; P < .0001) and third-degree tears (2.3%, 3.0%, 2.6%, respectively; P < .0001) were also higher in hospitals for which the cesarean delivery rates were above or below the expected rates.
  
  
  CONCLUSIONS
  Risk-adjusted primary cesarean delivery rates are a good marker for maternal and neonatal outcomes.
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bailit
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Love
authors.forename: Neal V
authors.initials: NV
authors.lastname: Dawson
mesh_terms: D000328:Adult; D002140:California; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D011787:Quality of Health Care; D020379:Risk Adjustment; D018570:Risk Assessment