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Войти в исследования American journal of obstetrics and gynecology · 2014
Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Grobman William A, Bailit Jennifer L, Rice Madeline Murguia, Wapner Ronald J, Varner Michael W, Thorp John M, Leveno Kenneth J, Caritis Steve N, Iams Jay D, Tita Alan T, Saade George, Sorokin Yoram, Rouse Dwight J, Tolosa Jorge E, Van Dorsten J Peter, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Аннотация
OBJECTIVE: The purpose of this study was to determine whether hospital differences in the frequency of adverse obstetric outcomes are related to differences in care.
STUDY DESIGN: The Assessment of Perinatal EXcellence cohort comprises 115,502 women and their neonates who were born in 25 hospitals in the United States between March 2008 and February 2011. Hierarchical logistic regression was used to quantify the amount of variation in postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite adverse neonatal outcome among hospitals that is explained by differences in patient characteristics, hospital characteristics, and obstetric care provided.
RESULTS: The study included 115,502 women. For most outcomes, 20-40% of hospital differences in outcomes were related to differences in patient populations. After adjusting for patient-, provider-, and hospital-level factors, multiple care processes were associated with the predefined adverse outcomes; however, these care processes did not explain significant variation in the frequency of adverse outcomes among hospitals. Ultimately, 50-100% of the interhospital variation in outcomes was unexplained.
CONCLUSION: Hospital differences in the frequency of adverse obstetric outcomes could not be explained by differences in frequency of types of care provided.
STUDY DESIGN: The Assessment of Perinatal EXcellence cohort comprises 115,502 women and their neonates who were born in 25 hospitals in the United States between March 2008 and February 2011. Hierarchical logistic regression was used to quantify the amount of variation in postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite adverse neonatal outcome among hospitals that is explained by differences in patient characteristics, hospital characteristics, and obstetric care provided.
RESULTS: The study included 115,502 women. For most outcomes, 20-40% of hospital differences in outcomes were related to differences in patient populations. After adjusting for patient-, provider-, and hospital-level factors, multiple care processes were associated with the predefined adverse outcomes; however, these care processes did not explain significant variation in the frequency of adverse outcomes among hospitals. Ultimately, 50-100% of the interhospital variation in outcomes was unexplained.
CONCLUSION: Hospital differences in the frequency of adverse obstetric outcomes could not be explained by differences in frequency of types of care provided.
Предметные рубрики MeSH
AdultCohort StudiesDelivery, ObstetricFemaleHospitalsHumansInfant, NewbornInfectionsLabor, InducedLacerationsLogistic ModelsMaternal Health ServicesOutcome Assessment, Health CarePerineumPostpartum HemorrhagePregnancyPregnancy ComplicationsPregnancy OutcomeQuality of Health CareUnited StatesVenous ThromboembolismYoung Adult