The University of Chicago Pritzker School of Medicine, Chicago, Illinois.
NorthShore University HealthSystem, Evanston, Illinois.
Birth. 2019 Jun;46(2):300-310. doi: 10.1111/birt.12406. Epub 2018 Nov 8.
Cesarean delivery rates in the United States vary widely between hospitals, which cannot be fully explained by hospital or patient factors. Cultural factors are hypothesized to play a role in cesarean overuse, yet tools to measure labor culture are lacking. The aim of this study was to revise and validate a survey tool to measure hospital culture specific to cesarean overuse.
A panel of clinicians and researchers compiled an item bank from validated surveys, added newly created items, and performed four rounds of iterative revision and consolidation. Obstetricians, family physicians, midwives, anesthesiologists, and labor nurses were recruited from 79 hospitals in California. Exploratory factor analysis was used to reduce the number of survey items and identify latent constructs to form the basis of subscales. Confirmatory factor analysis examined reliability in 31 additional hospitals. Poisson regression assessed associations between hospitals' mean score on each individual item and cesarean rates.
A total of 1718 individuals from 70 hospitals were included in the exploratory factor analysis. The final Labor Culture Survey (LCS) consisted of 29 items and six subscales: "Best Practices to Reduce Cesarean Overuse," "Fear of Vaginal Birth," "Unit Microculture," "Physician Oversight," "Maternal Agency," and "Cesarean Safety."
The revised LCS is a valid and reliable tool to measure constructs shown to be associated with cesarean rates. These findings support prior research that has shown that hospital culture is measurable, and that clinician attitudes are predictive of clinician behaviors. Unique to our survey is the construct of labor and delivery unit microculture.
美国各医院之间的剖宫产率差异很大，这不能完全用医院或患者因素来解释。文化因素被认为在剖宫产过度使用中起作用，但缺乏衡量劳动文化的工具。本研究的目的是修订和验证一种专门用于衡量剖宫产过度使用的医院文化的调查工具。
一组临床医生和研究人员从已验证的调查中编制了一个项目库，增加了新创建的项目，并进行了四轮迭代修订和整合。从加利福尼亚州的 79 家医院招募了妇产科医生、家庭医生、助产士、麻醉师和产房护士。探索性因素分析用于减少调查项目的数量，并确定潜在的结构，为子量表的形成奠定基础。验证性因素分析在另外 31 家医院中评估了可靠性。泊松回归评估了每家医院在每个项目上的平均得分与剖宫产率之间的关联。
共有来自 70 家医院的 1718 人参与了探索性因素分析。最终的劳动文化调查（LCS）由 29 个项目和六个子量表组成：“减少剖宫产过度使用的最佳实践”、“对阴道分娩的恐惧”、“单位微观文化”、“医生监督”、“产妇代理”和“剖宫产安全”。
修订后的 LCS 是一种有效且可靠的工具，可用于衡量与剖宫产率相关的结构。这些发现支持了先前的研究，即医院文化是可衡量的，临床医生的态度可以预测临床医生的行为。我们的调查独有的是分娩和产房单位微观文化的结构。
