title: Impact of health policy based on the self-management program on Cesarean section rate at a tertiary hospital in Taiwan.
abstract: OBJECTIVE
  In 2005, a self-management program, based on the global budget system that met the criteria for reducing Cesarean delivery rates, was introduced to obstetric practices in Taiwan. The purpose of this study was to examine the impact of different national health policies on the Cesarean delivery rate at a tertiary hospital.
  
  
  METHODS
  We constructed a Poisson regression model and conducted an interrupted time series analysis to detect the effects of the implementation of each health policy on Cesarean deliveries. We used data collected at two points before the implementation of the global budget system (GBS) policy (in 2001 and 2002), and at two points after the implementation of the hospital-based self-management (HBSM) policy (in 2005 and 2010). All monthly data were collected at these time points.
  
  
  RESULTS
  Between June 2001 and August 2010, the rate of improvement of vaginal birth after Cesarean section (VBAC) during Period 1 revealed that VBAC may have long-term effects (p < 0.001). While there may have been a remarkable immediate improvement in the VBAC rate (p = 0.0276) in Period 3, the long-term effect of VBAC seemed to have decreased during the same period (p = 0.0003). Following the synergistic impacts of health policy implementation during Period 3, the immediate improved total Cesarean section (C/S) rate seemed to be maintained at an average value (p = 0.0183).
  
  
  CONCLUSIONS
  Over the long term, the C/S rate seemed to reach a plateau; the immediate effect on the VBAC rate was a significant increase consistent with that of the initial health policy implementation.
authors: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. cliu1218.tw@yahoo.com.tw
authors: Ching-Ming
authors: CM
authors: Liu
authors: Yu-Jr
authors: YJ
authors: Lin
authors: Yu-Yun
authors: YY
authors: Su
authors: Shuenn-Dyh
authors: SD
authors: Chang
authors: Po-Jen
authors: PJ
authors: Cheng
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006291:Health Policy; D006801:Humans; D016012:Poisson Distribution; D011247:Pregnancy; D012648:Self Care; D013624:Taiwan; D062606:Tertiary Care Centers; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data