title: Effect of repeated public releases on cesarean section rates.
abstract: OBJECTIVE
  Public release of and feedback (here after public release) on institutional (clinics and hospitals) cesarean section rates has had the effect of reducing cesarean section rates. However, compared to the isolated intervention, there was scant evidence of the effect of repeated public releases (RPR) on cesarean section rates. The objectives of this study were to evaluate the effect of RPR for reducing cesarean section rates.
  
  
  METHODS
  From January 2003 to July 2007, the nationwide monthly institutional cesarean section rates data (1,951,303 deliveries at 1194 institutions) were analyzed. We used autoregressive integrated moving average (ARIMA) time-series intervention models to assess the effect of the RPR on cesarean section rates and ordinal logistic regression model to determine the characteristics of the change in cesarean section rates.
  
  
  RESULTS
  Among four RPR, we found that only the first one (August 29, 2005) decreased the cesarean section rate (by 0.81 percent) and continued to have an impact period through the last observation in May 2007. Baseline cesarean section rates (OR, 4.7; 95% CI, 3.1 to 7.1) and annual number of deliveries (OR, 2.8; 95% CI, 1.6 to 4.7) of institutions in the upper third of each category at before first intervention had a significant contribution to the decrease of cesarean section rates.
  
  
  CONCLUSIONS
  We could not found the evidence that RPR has had the significant effect of reducing cesarean section rates. Institutions with upper baseline cesarean section rates and annual number of deliveries were more responsive to RPR.
authors.affiliation: Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Won Mo
authors.initials: WM
authors.lastname: Jang
authors.forename: Sang Jun
authors.initials: SJ
authors.lastname: Eun
authors.forename: Chae Eun
authors.initials: CE
authors.lastname: Lee
authors.forename: Yoon
authors.initials: Y
authors.lastname: Kim
mesh_terms: D002585:Cesarean Section / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D030881:Disclosure; D005260:Female; D006761:Hospitals / Q000145:classification / Q000706:statistics & numerical data; D006801:Humans; D033181:Information Dissemination; D016015:Logistic Models; D011247:Pregnancy; D015397:Program Evaluation; D011787:Quality of Health Care; D056910:Republic of Korea