Localio A R, Lawthers A G, Bengtson J M, Hebert L E, Weaver S L, Brennan T A, Landis J R
Center for Biostatics and Epidemiology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey 17033.
JAMA. 1993 Jan 20;269(3):366-73.
To investigate whether an association exists between the probability of a cesarean delivery and the level of malpractice claims risk faced by hospitals and physicians.
Survey of computerized discharge data linked with physician and hospital malpractice claims records based on stratified, random sample of hospitals.
Acute care hospitals in New York State in 1984.
All deliveries (60 490) at 31 hospitals.
After controlling for the clinical risk of a cesarean delivery, patient socioeconomic status, and physician and hospital characteristics, cesarean delivery was positively associated with physician malpractice premiums (odds ratio [OR], 3.00; 95% confidence interval [CI], 2.13 to 4.24 for the difference between upstate and New York City levels), with the number of physician claims opened per 100 physicians at the hospital level (OR, 1.15; 95% CI, 1.02 to 1.30 for a 1-SD change), and with the number of hospital claims opened per 1000 discharges (OR, 1.26; 95% CI, 1.10 to 1.43 for a 1-SD change). Measures of physician-perceived risk of suit also showed a significant association with cesarean delivery (OR, 1.96; 95% CI, 1.53 to 2.52, upstate vs New York City). Within hospitals, there was no significant association (OR, 1.15; P = .126) between the odds of cesarean delivery and the claims history (none vs one or more) of an individual physician.
Results support previous speculations of a positive association between malpractice claims risk and the rate of cesarean delivery.
调查剖宫产概率与医院及医生面临的医疗事故索赔风险水平之间是否存在关联。
基于医院分层随机样本，对与医生和医院医疗事故索赔记录相关联的计算机化出院数据进行调查。
1984年纽约州的急症医院。
31所医院的所有分娩病例（60490例）。
在控制了剖宫产的临床风险、患者社会经济状况以及医生和医院特征后，剖宫产与医生医疗事故保险费呈正相关（比值比[OR]为3.00；95%置信区间[CI]，纽约州北部与纽约市水平差异为2.13至4.24），与医院层面每100名医生开启的医生索赔数量呈正相关（OR为1.15；95%CI，标准差变化1时为1.02至1.30），与每1000例出院开启的医院索赔数量呈正相关（OR为1.26；95%CI，标准差变化1时为1.10至1.43）。医生感知的诉讼风险指标也显示与剖宫产有显著关联（OR为1.96；95%CI，纽约州北部与纽约市相比为1.53至2.52）。在医院内部，剖宫产几率与个体医生的索赔历史（无索赔与有一项或多项索赔）之间无显著关联（OR为1.15；P = 0.126）。
结果支持了先前关于医疗事故索赔风险与剖宫产率之间存在正相关的推测。
