产妇保健中的风险调整：间接标准化的应用。
Risk adjustment in maternity care: the use of indirect standardization.
机构信息
Department of Family Practice and Community Medicine, University of Pennsylvania Health System, University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Int J Womens Health. 2010 Aug 20;2:255-62. doi: 10.2147/IJWH.S9494.
PURPOSE
Annual US national rates of family physicians providing maternity care are decreasing and rates of cesarean delivery are increasing. Family physicians tend to have lower cesarean delivery rates than obstetrician specialists, but this association is usually explained by an assumed lower pre-delivery risk for cesarean delivery. This study was developed to compare the estimated risk of cesarean delivery in patients of the two specialties.
METHODS
A retrospective cohort study within an urban teaching hospital compared 100 family- physician treated subjects to 300 subjects treated by obstetrician-specialists. Risk factors for cesarean delivery were identified, and an indirect standardization procedure was used to compare the pre-38 week of gestation risk of cesarean delivery in the two groups.
RESULTS
The patients treated by family physicians had a projected pre-38 week of gestation risk of cesarean delivery (17.4%) that was similar to the actual rate of cesarean delivery in the obstetrician-specialist group (16.7%). The Standardized Cesarean Delivery Ratio was 1.04.
CONCLUSION
Lower cesarean delivery rates provided by family physicians may not be simply due to case-mix issues. Additional studies comparing the pre-delivery estimation of cesarean delivery risk would be helpful in measuring the relative levels of obstetric risk of patients treated by different maternity-care provider types.
目的
美国每年提供产妇护理的家庭医生的比例正在下降，而剖宫产率却在上升。家庭医生的剖宫产率通常低于产科专家，但这种关联通常归因于剖宫产的预期较低的分娩前风险。本研究旨在比较这两种专业的患者的剖宫产估计风险。
方法
在一家城市教学医院内进行了一项回顾性队列研究，将 100 名接受家庭医生治疗的患者与 300 名接受产科专家治疗的患者进行了比较。确定了剖宫产的风险因素，并采用间接标准化程序比较了两组在 38 周妊娠前的剖宫产风险。
结果
接受家庭医生治疗的患者的剖宫产预计在 38 周前的风险（17.4%）与产科专家组的实际剖宫产率（16.7%）相似。剖宫产标准化比值为 1.04。
结论
家庭医生提供的较低的剖宫产率可能不仅仅是由于病例组合问题。比较剖宫产风险的分娩前预测的额外研究将有助于衡量不同的产妇护理提供者类型治疗的患者的产科风险的相对水平。
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