TY - JOUR
T1 - Risk adjustment for inter-hospital comparisons of caesarean section rates in Taipei municipal hospitals
AU - Hsu, Chun Chyang
AU - Shieh, Guahn Ren
AU - Wu, Chuan Song
AU - Shen, Hsi che
AU - Tang, Chao Hsiun
N1 - Funding Information:
The authors would like to express their sincere gratitude for the technical assistance in the processing of the data by the Bureau of National Health Insurance. The authors would also like to thank Taipei City Hospital, Zhong Xing Branch as well as the National Science Council (NSC-93-2416-H-038-005) for their financial support.
PY - 2006/8
Y1 - 2006/8
N2 - Background: This study sets out to determine whether adjustments for specific patient caesarean delivery risk factors have an affect on the assessment of performance rates among the municipal hospitals of Taipei City. Methods: Analysis of National Health Insurance (NHI) claims data, linked with birth certificate data, was undertaken on a cohort of 27,693 live births in the six general hospitals of the Taipei Medical Hospital System (TMHS) between 1999 and 2001. Using multivariable logistic regression modeling of the risk factors independently associated with caesarean deliveries, an expected caesarean delivery rate was constructed for each of the hospitals. By contrasting observed rates with expected rates to quantify the magnitude of the deviation from average practice, a measurement similar to relative risk (RR) was also constructed for each hospital. Results: The observed rates for two of the six hospitals examined fell within the expected 95% confidence interval (CI), two were above the expected upper limit, and two were below the expected lower limit. The RR ranking of Hospitals A (RR = 1.08, CI = 1.01-1.15) and C (RR = 1.01, CI = 1.00-1.03) improved from first to second, and third to fourth, whilst the RR of Hospitals B (RR = 1.09, CI = 1.05-1.14) and D (RR = 1.02, CI = 0.99-1.06) worsened from second to first, and fourth to third, respectively. The RR rankings of Hospitals E (RR = 0.92, CI = 0.88-0.96) and F (RR = 0.80, CI = 0.77-0.84) were the same as the observed rates. Conclusions: Caesarean delivery rate profiles, or hospital comparisons without risk adjustment, may be methodologically biased and may lead to unfair judgments by healthcare purchasers.
AB - Background: This study sets out to determine whether adjustments for specific patient caesarean delivery risk factors have an affect on the assessment of performance rates among the municipal hospitals of Taipei City. Methods: Analysis of National Health Insurance (NHI) claims data, linked with birth certificate data, was undertaken on a cohort of 27,693 live births in the six general hospitals of the Taipei Medical Hospital System (TMHS) between 1999 and 2001. Using multivariable logistic regression modeling of the risk factors independently associated with caesarean deliveries, an expected caesarean delivery rate was constructed for each of the hospitals. By contrasting observed rates with expected rates to quantify the magnitude of the deviation from average practice, a measurement similar to relative risk (RR) was also constructed for each hospital. Results: The observed rates for two of the six hospitals examined fell within the expected 95% confidence interval (CI), two were above the expected upper limit, and two were below the expected lower limit. The RR ranking of Hospitals A (RR = 1.08, CI = 1.01-1.15) and C (RR = 1.01, CI = 1.00-1.03) improved from first to second, and third to fourth, whilst the RR of Hospitals B (RR = 1.09, CI = 1.05-1.14) and D (RR = 1.02, CI = 0.99-1.06) worsened from second to first, and fourth to third, respectively. The RR rankings of Hospitals E (RR = 0.92, CI = 0.88-0.96) and F (RR = 0.80, CI = 0.77-0.84) were the same as the observed rates. Conclusions: Caesarean delivery rate profiles, or hospital comparisons without risk adjustment, may be methodologically biased and may lead to unfair judgments by healthcare purchasers.
KW - Caesarean delivery
KW - Risk-adjustment
KW - Taiwan
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U2 - 10.1016/j.ejogrb.2005.10.016
DO - 10.1016/j.ejogrb.2005.10.016
M3 - Article
C2 - 16325330
AN - SCOPUS:33746869359
SN - 0301-2115
VL - 127
SP - 190
EP - 197
JO - European Journal of Obstetrics and Gynecology and Reproductive Biology
JF - European Journal of Obstetrics and Gynecology and Reproductive Biology
IS - 2
ER -