title: Anesthesia provider model, hospital resources, and maternal outcomes.
abstract: OBJECTIVE
  Determine the ability of anesthesia provider model and hospital resources to explain maternal outcome variation.
  
  
  METHODS
  1,141,641 obstetrical patients from 369 hospitals that reported at least one live birth in 2002 in six representative states.
  
  
  METHODS
  Logistic regression of death, anesthesia complication, nonanesthesia maternal complication, and obstetrical trauma for all patients and those having cesarean deliveries on anesthesia provider model, obstetrical and anesthesia, and patient variables.
  
  
  METHODS
  Data was assembled from information given by hospitals to state agencies and from a 2004 survey of obstetrical organization resources.
  
  
  RESULTS
  Anesthesia complication rates in anesthesiologist-only hospitals were 0.27 percent compared with 0.23 percent in certified registered nurse anesthetist (CRNA) only hospitals. Rates among other provider models varied from 0.24 to 0.37 percent with none statistically different from the anesthesiologist-only hospitals. A similar pattern was observed for rates of other outcomes. Multivariate analysis found no systematic differences between hospitals with anesthesiologist-only models and models using CRNAs. There was no consistent pattern of association of other hospital or patient characteristics with outcomes.
  
  
  CONCLUSIONS
  Hospitals that use only CRNAs, or a combination of CRNAs and anesthesiologists, do not have systematically poorer maternal outcomes compared with hospitals using anesthesiologist-only models.
authors.affiliation: Department of Health Services, UCLA School of Public Health, Los Angeles, CA, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Needleman
authors.forename: Ann F
authors.initials: AF
authors.lastname: Minnick
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000592:standards*; D002983:Clinical Competence; D003406:Credentialing; D036861:Delivery, Obstetric / Q000009:adverse effects; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008428:Maternal Mortality; D008962:Models, Theoretical; D009774:Obstetrics / Q000592:standards; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011787:Quality of Health Care; D014481:United States; D000078329:Workforce; D055815:Young Adult