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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - C-sections and hospital characteristics
T2 - a long term analysis on low-risk deliveries
AU - Joaquim, Inês
AU - Pereira, Luís Nobre
AU - Nunes, Carla
AU - Mateus, Céu
PY - 2022/12/14
Y1 - 2022/12/14
N2 - Background: Policymakers aim to reduce C-section (CS) rates, due to well documented overtreatment. However, little is known about how hospital characteristics relate to their c-section rates on low-risk deliveries (CSR-LRD). Methods: CSR-LRD were computed using inpatient data from all Portuguese National Health Service hospitals (2002-2011). Linear and Fractional Response Models were estimated to quantify the relationship between CSR-LRD and a set of hospital characteristics: hospital size, type (exclusively obstetrics or not), Neonatal Intensive Care Unit (NICU) availability, obstetrician-to-obstetric bed ratio, and teaching status. Results: CSR-LRD increased from 11.7% (2002) to 14.1% (2008), declining to 12.5% in 2011. While larger hospitals and hospitals with NICU had higher CSR-LRD rates, teaching status and obstetrician-to-obstetric bed ratio had no significant effect. Adjusted estimates, controlling for those four characteristics, indicate 91% of the variation in the CSR-LRD is left unexplained. Conclusion: Hospital characteristics do not explain variation in CSR-LRD rates. Further studies considering medical practice, financial incentives to hospitals and/or physicians, and patient education are needed.
AB - Background: Policymakers aim to reduce C-section (CS) rates, due to well documented overtreatment. However, little is known about how hospital characteristics relate to their c-section rates on low-risk deliveries (CSR-LRD). Methods: CSR-LRD were computed using inpatient data from all Portuguese National Health Service hospitals (2002-2011). Linear and Fractional Response Models were estimated to quantify the relationship between CSR-LRD and a set of hospital characteristics: hospital size, type (exclusively obstetrics or not), Neonatal Intensive Care Unit (NICU) availability, obstetrician-to-obstetric bed ratio, and teaching status. Results: CSR-LRD increased from 11.7% (2002) to 14.1% (2008), declining to 12.5% in 2011. While larger hospitals and hospitals with NICU had higher CSR-LRD rates, teaching status and obstetrician-to-obstetric bed ratio had no significant effect. Adjusted estimates, controlling for those four characteristics, indicate 91% of the variation in the CSR-LRD is left unexplained. Conclusion: Hospital characteristics do not explain variation in CSR-LRD rates. Further studies considering medical practice, financial incentives to hospitals and/or physicians, and patient education are needed.
KW - Original Paper
KW - Caesarean sections
KW - Hospital resources
KW - Low-risk
KW - Fractional response models
U2 - 10.1007/s43999-022-00014-2
DO - 10.1007/s43999-022-00014-2
M3 - Journal article
VL - 1
JO - Research in Health Services & Regions
JF - Research in Health Services & Regions
SN - 2730-9827
IS - 1
ER -