Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
Leonard Davis Institute of Health Economics, Philadelphia, PA, USA.
Birth. 2021 Mar;48(1):44-51. doi: 10.1111/birt.12508. Epub 2020 Nov 10.
Birth is the most common reason for hospitalization in the United States. Hospital variation in maternal outcomes is an important indicator of health care quality. Spontaneous vaginal birth (SVB) is the most optimal birth outcome for the majority of mothers and newborns. The purpose of this study was to examine hospital-level variation in SVB overall and among low-risk women in a four-state sample representing 25% of births in the United States in 2016.
Women giving birth in California, Pennsylvania, New Jersey, and Florida were identified in 2016 state discharge abstracts. Patient data were merged with hospital data from the American Hospital Association's (AHA) 2016 Annual Survey. Overall and low-risk SVB rates were calculated for each hospital in the sample and stratified by bed size, teaching status, rurality, birth volume, and state.
Our final sample included 869 681 women who gave birth in 494 hospitals. The mean overall SVB rate in the sample was 61.1%, ranging from 16.8% to 79.9%. The mean low-risk SVB rate was 78% and ranged from 34.6% to 93.3%. Variation in SVB rates cut across all the hospital structural characteristic strata.
The wide variation in SVB rates indicates significant room for improvement in this maternal quality metric. Our finding, that hospitals of all types and locations had both low and high SVB rates, suggests that excellent maternal outcomes are possible in all hospital settings. The variation in SVB rates across hospitals warrants research into modifiable hospital factors that may be influencing SVB rates.
分娩是美国住院的最常见原因。产妇结局的医院差异是医疗质量的一个重要指标。大多数母亲和新生儿的最佳分娩结果是自然阴道分娩（SVB）。本研究的目的是在美国 2016 年占分娩总数 25%的四个州（加利福尼亚州、宾夕法尼亚州、新泽西州和佛罗里达州）的样本中，检查 SVB 总体和低危产妇的医院水平差异。
从 2016 年州分娩记录中确定在加利福尼亚州、宾夕法尼亚州、新泽西州和佛罗里达州分娩的妇女。将患者数据与美国医院协会（AHA）2016 年年度调查的医院数据合并。计算了样本中每个医院的整体和低危 SVB 率，并按床位数、教学状态、农村程度、分娩量和州进行分层。
我们的最终样本包括 869681 名在 494 家医院分娩的妇女。样本中总体 SVB 率的平均值为 61.1%，范围为 16.8%至 79.9%。低危 SVB 率的平均值为 78%，范围为 34.6%至 93.3%。SVB 率的差异跨越了所有医院结构特征的层次。
SVB 率的广泛差异表明，在这一产妇质量指标方面有很大的改进空间。我们的发现表明，所有类型和地点的医院都有低和高的 SVB 率，这表明在所有医院环境中都可以实现出色的产妇结局。医院之间 SVB 率的差异表明，可能有一些可改变的医院因素影响 SVB 率，需要对此进行研究。
