Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, USA.
Health Aff (Millwood). 2013 Mar;32(3):527-35. doi: 10.1377/hlthaff.2012.1030.
Cesarean delivery is the most commonly performed surgical procedure in the United States, and cesarean rates are increasing. Working with 2009 data from 593 US hospitals nationwide, we found that cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteenfold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals. Because Medicaid pays for nearly half of US births, government efforts to decrease variation are warranted. We focus on four promising directions for reducing these variations, including better coordinating maternity care, collecting and measuring more data, tying Medicaid payment to quality improvement, and enhancing patient-centered decision making through public reporting.
剖宫产在美国是最常见的手术之一，而且剖宫产率正在上升。我们使用了全国 593 家美国医院 2009 年的数据，发现医院之间的剖宫产率差异高达十倍，从 7.1%到 69.9%。即使是对于低风险妊娠的女性，预期变化范围会更小，但剖宫产率也相差了十五倍，从 2.4%到 36.5%。因此，实践模式的巨大差异可能是导致许多美国医院过度使用剖宫产的原因。由于医疗补助计划为近一半的美国分娩提供了资金，政府有理由努力减少这种差异。我们关注了减少这些差异的四个有希望的方向，包括更好地协调产妇护理、收集和衡量更多的数据、将医疗补助支付与质量改进挂钩，以及通过公开报告增强以患者为中心的决策。
