title: The use of quality control performance charts to analyze cesarean delivery rates nationally.
abstract: OBJECTIVE
  To examine the use of quality control performance charts to analyze cesarean rates nationally.
  
  
  METHODS
  Information on cesarean rates was obtained for all 19 Irish maternity hospitals receiving state funding in 2009. All women who underwent cesarean delivery of a live or stillborn infant weighing 500 g or more between January 1 and December 31 were included. Deliveries were classified as elective or emergency. Individual hospitals were not identified in the analysis.
  
  
  RESULTS
  The mean rates per hospital of elective and emergency cesarean were 12.9±2.6% (n=9337) and 13.8±3.0% (n=9989), respectively-giving an overall mean rate of 26.7±4.2% (n=19326) per hospital. Cesarean rates were normally distributed. Using a quality control performance chart with a cutoff 2 standard deviations from the mean, 1 hospital was above the normal range for both total and elective cesareans, indicating that its pre-labor obstetric practices warrant clinical review. Another hospital had a mean emergency cesarean rate above the normal range, indicating that its labor ward practices warrant review.
  
  
  CONCLUSIONS
  Quality control performance charts can be used to analyze cesarean rates nationally and, thus, to identify hospitals at which obstetric practices should be reviewed.
authors.affiliation: University College Dublin Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland. michael.turner@ucd.ie
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Turner
mesh_terms: D002585:Cesarean Section / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007494:Ireland; D011247:Pregnancy; D011785:Quality Assurance, Health Care / Q000379:methods*; D011786:Quality Control; D019984:Quality Indicators, Health Care