ArticleBMC health services research2006
Risk adjustment for inter-hospital comparison of primary cesarean section rates: need, validity and parsimony.
Article in BMC health services research, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- "An unnecessary cut?" multilevel health systems analysis of drivers of caesarean sections rates in Italy: a systematic review.BMC pregnancy and childbirth · 2020Pooled it
- More is more? The role of surgeon in the volume-outcome relationship: an Italian population-based cohort study.BMJ open · 2025Article
- Direct standardization method according to Robson classification for comparison of cesarean rates.BMC pregnancy and childbirth · 2023Article
- The National Outcomes Evaluation Programme in Italy: The Impact of Publication of Health Indicators.International journal of environmental research and public health · 2022Article
- Trend in primary caesarean delivery: a five-year experience in ABRUZZO, ITALY.BMC health services research · 2018Article
- Predictive modeling of emergency cesarean delivery.PloS one · 2018Article
- Case mix adjustment of health outcomes, resource use and process indicators in childbirth care: a register-based study.BMC pregnancy and childbirth · 2016Article
- Differential misclassification of confounders in comparative evaluation of hospital care quality: caesarean sections in Italy.BMC public health · 2014Article
- Determinants of cesarean delivery: a classification tree analysis.BMC pregnancy and childbirth · 2014Article
- Risk adjustment for cesarean delivery rates: how many variables do we need? An observational study using administrative databases.BMC health services research · 2013Article
- Risk adjustment models for interhospital comparison of CS rates using Robson's ten group classification system and other socio-demographic and clinical variables.BMC pregnancy and childbirth · 2012Article
- P.Re.Val.E.: outcome research program for the evaluation of health care quality in Lazio, Italy.BMC health services research · 2012Article
- Risk adjustment for inter-hospital comparison of caesarean delivery rates in low-risk deliveries.PloS one · 2011Article
- Variation in rates of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study.BMJ (Clinical research ed.) · 2010Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCesarean section rates is often used as an indicator of quality of care in maternity hospitals. The assumption is that lower rates reflect in developed countries more appropriate clinical practice and general better performances. Hospitals are thus often ranked on the basis of caesarean section rates. The aim of this study is to assess whether the adjustment for clinical and sociodemographic variables of the mother and the fetus is necessary for inter-hospital comparisons of cesarean section (c-section) rates and to assess whether a risk adjustment model based on a limited number of variables could be identified and used.
methodsDischarge abstracts of labouring women without prior cesarean were linked with abstracts of newborns discharged from 29 hospitals of the Emilia-Romagna Region (Italy) from 2003 to 2004. Adjusted ORs of cesarean by hospital were estimated by using two logistic regression models: 1) a full model including the potential confounders selected by a backward procedure; 2) a parsimonious model including only actual confounders identified by the "change-in-estimate" procedure. Hospital rankings, based on ORs were examined.
results24 risk factors for c-section were included in the full model and 7 (marital status, maternal age, infant weight, fetopelvic disproportion, eclampsia or pre-eclampsia, placenta previa/abruptio placentae, malposition/malpresentation) in the parsimonious model. Hospital ranking using the adjusted ORs from both models was different from that obtained using the crude ORs. The correlation between the rankings of the two models was 0.92. The crude ORs were smaller than ORs adjusted by both models, with the parsimonious ones producing more precise estimates.
conclusionRisk adjustment is necessary to compare hospital c-section rates, it shows differences in rankings and highlights inappropriateness of some hospitals. By adjusting for only actual confounders valid and more precise estimates could be obtained.
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