Inter-hospital variations in health outcomes in childbirth care in Sweden: a register-based study.

OBJECTIVE

The objective of this study was to estimate case mix adjusted variations in central indicators of health outcomes in childbirth care and to assess whether hospitals who perform well on one indicator also perform well on others.

DESIGN

Register-based study using regional administrative data, linked to clinical data and population data.

SETTING

Twenty-one hospitals in seven Swedish regions covering 67% of deliveries in Sweden.

PARTICIPANTS

The study included 139 756 women who gave birth in 2011 and 2012.

INTERVENTION(S): N/A.

MAIN OUTCOME MEASURE(S): Four indicators of health outcomes were studied: obstetric anal sphincter injuries (OASIS), haemorrhage >1000 ml, postpartum infection and Apgar <4 at 5 min. Variations between hospitals were estimated using fixed effects logistic regression, adjusted for numerous sociodemographic and clinical characteristics.

RESULTS

Significant variations after case mix adjustment were observed for all four indicators. If all hospitals had performed as the average of the top five hospitals for each indicator, a total of 890 OASIS, 2700 haemorrhages, 1500 postpartum infections and 180 instances of low Apgar would have been avoided. A certain degree of correlation was observed between different indicators of outcomes. However, no hospital had a statistically significant higher or lower rate across all four indicators of health outcomes.

CONCLUSIONS

The significant variations in all four indicators demonstrate a potential for improvement in performance at all studied hospitals. Hospital performance was not consistent across different indicators of outcomes and all hospitals have potential for improvement in certain aspects of labour management.