Variation in the rates of operative delivery in the United States

Steven L. Clark, Michael A. Belfort, Gary Hankins, Janet A. Meyers, Frank M. Houser

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

Objectives: This study was undertaken to examine the national and regional rates of operative delivery among almost one quarter million births in a single year in the nation's largest healthcare delivery system, using variation as an arbiter of the quality of decision making. Study Design: We compared the variation in rates of primary cesarean and operative vaginal delivery in facilities of the Hospital Corporation of America during the year 2004. Results: In 124 facilities representing almost 220,000 births during a 1-year period, the primary cesarean and operative vaginal delivery rates were 19% ± 5% (range 9-37) and 7% ± 4% (range 1-23). Within individual geographic regions, we consistently found variations of 200-300% in rates of primary cesarean delivery and variations approximating an order of magnitude for operative vaginal delivery. Conclusion: Within broad upper and lower limits, rates of operative delivery in the United States are highly variable and suggest a pattern of almost random decision making. This reflects a lack of sufficient reliable, outcomes-based data to guide clinical decision making.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Volume196
Issue number6
DOIs
StatePublished - Jun 2007
Externally publishedYes

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Decision Making
Parturition
Delivery of Health Care
Clinical Decision-Making

Keywords

  • cesarean delivery
  • operative vaginal delivery
  • quality of care

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Variation in the rates of operative delivery in the United States. / Clark, Steven L.; Belfort, Michael A.; Hankins, Gary; Meyers, Janet A.; Houser, Frank M.

In: American Journal of Obstetrics and Gynecology, Vol. 196, No. 6, 06.2007.

Research output: Contribution to journalArticle

Clark, Steven L. ; Belfort, Michael A. ; Hankins, Gary ; Meyers, Janet A. ; Houser, Frank M. / Variation in the rates of operative delivery in the United States. In: American Journal of Obstetrics and Gynecology. 2007 ; Vol. 196, No. 6.
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