Evidence map›Paper›PMID 28213600›Full record

SynthesisBMJ open2017

Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis.

Ilir Hoxha, Lamprini Syrogiannouli, Xhyljeta Luta, Kali Tal, David C Goodman, Bruno R da Costa, Peter Jüni

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
49citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

49 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Non-clinical interventions for reducing unnecessary caesarean section.The Cochrane database of systematic reviews · 2018
    Pooled it
  5. Pooled it
  6. Trial
  7. Article
  8. Article
  9. Article
  10. Article
  11. Article
  12. Review
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Review
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Ilir HoxhaInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.ORCID 0000-0003-4262-1406
Lamprini SyrogiannouliInstitute of Primary Health Care, University of Bern, Bern, Switzerland.
Xhyljeta LutaInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Kali TalInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
David C GoodmanInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Bruno R da CostaInstitute of Primary Health Care, University of Bern, Bern, Switzerland.
Peter JüniApplied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Medicine, University of Toronto, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveFinancial incentives may encourage private for-profit providers to perform more caesarean section (CS) than non-profit hospitals. We therefore sought to determine the association of for-profit status of hospital and odds of CS.

designSystematic review and meta-analysis. DATA SOURCES: MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from the first year of records through February 2016. ELIGIBILITY CRITERIA: To be eligible, studies had to report data to allow the calculation of ORs of CS comparing private for-profit hospitals with public or private non-profit hospitals in a specific geographic area. OUTCOMES: The prespecified primary outcome was the adjusted OR of births delivered by CS in private for-profit hospitals as compared with public or private non-profit hospitals; the prespecified secondary outcome was the crude OR of CS in private for-profit hospitals as compared with public or private non-profit hospitals.

results15 articles describing 17 separate studies in 4.1 million women were included. In a meta-analysis of 11 studies, the adjusted odds of delivery by CS was 1.41 higher in for-profit hospitals as compared with non-profit hospitals (95% CI 1.24 to 1.60) with no relevant heterogeneity between studies (τ

conclusionsCS are more likely to be performed by for-profit hospitals as compared with non-profit hospitals. This holds true regardless of women's risk and contextual factors such as country, year or study design. Since financial incentives are likely to play an important role, we recommend examination of incentive structures of for-profit hospitals to identify strategies that encourage appropriate provision of CS.

Indexed as

Cesarean SectionHospitals, ProprietaryHospitals, PublicHospitals, VoluntaryHumanscaesarean sectionfinancial incentivesfor-profit hospitalhealth servicesmedical practice variationnon-profit hospital

Identifiers

PMID28213600
PMCPMC5318567

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.