Finkler M D, Wirtschafter D D
Lawrence University, Appleton, WI 54912, USA.
J Perinatol. 1997 Mar-Apr;17(2):148-55.
The objective of this study was to examine whether the mode of obstetric delivery is related to resource costs, case mix, maternal length of stay, or neonatal morbidity. Patients (27,289) who delivered babies at nine hospitals within one health maintenance organization in 1989 were the source of data. Case-mix adjustment and outcome measures (maternal length of stay and neonatal morbidity) were computed from discharge abstract indicators, whereas cost data (direct professional hours) came from departmental financial reports. Costs and outcomes were adjusted by regression analysis for differences in case mix and then compared by correlation analysis. Neither adjusted nor unadjusted cesarean-section rates and obstetric cost per case were significantly correlated over the range of observed cesarean-section rates. Aggregate cesarean-section rates and outcome indicators were also statistically unrelated. Cesarean-section rate variation across hospitals was unrelated to the observed variation in obstetric costs, which were closely related to variations in staffing and less closely to differences in patient case mix and scale.
本研究的目的是探讨产科分娩方式是否与资源成本、病例组合、产妇住院时间或新生儿发病率相关。1989年在一个健康维护组织内的九家医院分娩的27289名患者是数据来源。病例组合调整和结局指标（产妇住院时间和新生儿发病率）根据出院摘要指标计算得出，而成本数据（直接专业工时）来自部门财务报告。通过回归分析对病例组合差异进行成本和结局调整，然后通过相关分析进行比较。在观察到的剖宫产率范围内，调整后的和未调整的剖宫产率及每例产科成本均无显著相关性。总体剖宫产率与结局指标在统计学上也无关联。各医院间剖宫产率的差异与观察到的产科成本差异无关，产科成本差异与人员配备差异密切相关，与患者病例组合和规模差异的相关性较小。
