Newton E R, Higgins C S
Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio 78284.
J Reprod Med. 1989 Jun;34(6):407-11.
The variation in hospital-specific cesarean birth rates was examined using a multiple regression analysis in a national data base of deliveries in 1977. This data base included 222,285 singleton births in 282 hospitals representing all regions of the United States. The 32 independent variables included measures of medical risk, technologic sophistication, demographic characteristics and economic incentives. The incidences of medical risk factors, nonwhite race and ratio of obstetricians to fertile women were associated positively with hospital-specific cesarean delivery rates. Participation in health maintenance organizations and numbers of deliveries were correlated negatively with those rates. Hospital-specific cesarean delivery rates were not associated with technologic sophistication, malpractice premiums or reimbursement differences between routes of delivery. Pay source stratified models explained 45-63% of the variation in the hospital-specific cesarean rates. Sensitivity analysis revealed that even a 50% change in the incidence of any independent variable would change the cesarean delivery rate by less than 2%.
利用多元回归分析，对1977年全国分娩数据库中各医院的剖宫产率差异进行了研究。该数据库包含了美国282家医院的222,285例单胎分娩，这些医院代表了美国所有地区。32个自变量包括医疗风险、技术复杂性、人口统计学特征和经济激励措施等指标。医疗风险因素的发生率、非白人种族以及产科医生与育龄妇女的比例与各医院的剖宫产率呈正相关。参与健康维护组织以及分娩数量与这些比率呈负相关。各医院的剖宫产率与技术复杂性、医疗事故保险费或不同分娩途径的报销差异无关。按支付来源分层的模型解释了各医院剖宫产率45% - 63%的差异。敏感性分析表明，即使任何一个自变量的发生率变化50%，剖宫产率的变化也不到2%。
