Multi-level Drivers of Disparities in Hispanic Cesarean Delivery Rates in US-Mexico Border States.

BACKGROUND: Hispanic women living along the US-Mexico border have higher cesarean delivery rates than non-Hispanic white women, African American women, and other Hispanic women in the USA. Their rates also exceed those of other Hispanic women in states that border Mexico and non-Hispanic white women along the border. Our objective was to determine the causes of the disparities in border Hispanic cesarean rates. METHODS: Using the 2015 birth certificate file and other sources, we performed a twofold Oaxaca-Blinder decomposition analysis of the disparities in low-risk primary and repeat cesarean rates between Hispanic and non-Hispanic white women in the US-Mexico border counties and Hispanic women residing in nonborder counties of border states. RESULTS: Rates of low-risk primary cesarean among border Hispanic, nonborder Hispanic, and border non-Hispanic white women were 21.1%, 15.0%, and 16.5%, respectively. Higher Hispanic concentration in county of residence, a larger proportion of for-profit hospital beds, and greater poverty accounted for 24.7%, 22.1%, and 11.1% of the border-nonborder Hispanic difference, respectively. No other variable explained more than 5% of the difference. Higher Hispanic concentration, more for-profit beds, less attendance by an MD, higher BMI, and greater poverty explained 60.6%, 42.4%, 42.4%, 27.4%, and 21.3%, respectively, of the Hispanic-non-Hispanic white difference. Hispanic concentration and for-profit beds were also important explanatory variables for low-risk repeat cesareans. CONCLUSION: Efforts to address potentially unnecessary cesareans among Hispanic women on the border should recognize that community demographic and health delivery system characteristics are more influential than maternal medical risk factors.

Are Patients Undergoing an Anterior Cervical Discectomy and Fusion Treated Differently at a Physician-owned Hospital?

STUDY DESIGN: Retrospective case-control study. BACKGROUND: Physician-owned specialty hospitals focus on taking care of patients with a select group of conditions. In some instances, they may also create a potential conflict of interest for the surgeon. The effect this has on the surgical algorithm for patients with degenerative cervical spine conditions has not been determined. METHODS: A retrospective review of all patients who underwent a 1- or 2-level anterior cervical discectomy and fusion between October 2009 and December 2014 at either a physician-owned specialty hospital or an independently owned community hospital were identified. Demographic information, the time course for treatment and the nonoperative treatment regimen were evaluated. RESULTS: In total, 115 patients undergoing surgery at a physician-owned specialty hospital and 149 patients undergoing surgery at an independent community hospital were identified. Demographic data between the groups including the presence of 12 medical comorbidities and insurance status was similar between the groups. The only difference that was identified was that patients at the surgeon-owned hospital were marginally younger than patients who had surgery at the independent hospital (49.7 vs. 50.0, P=0.048). No difference in the median number of months from the onset of symptoms to surgery (6.51 vs. 7.53 mo, respectively; P=0.55), from the onset of symptoms to the preoperative visit (6.02 vs. 6.02, P=0.64), or from the initial surgical consultation to surgery (0.99 vs. 1.02, P=0.31) was identified. No difference in the number of patients who underwent formal physical therapy (72.2% vs. 67.1%, P=0.42) or who had a cervical steroid injection (55.6% vs. 50.3%, P=0.25%) was identified between patients who had surgery at a physician-owned or independent hospital; however, patients who underwent surgery at the physician-owned hospital were more likely to have taken oral anti-inflammatories (93.0% vs. 83.9%, P=0.04). CONCLUSIONS: When comparing hospitals with similar resources, surgeons do not preferentially select younger, healthier patients with higher paying insurance to be treated at the physician-owned hospital. Furthermore, both the time from the onset of symptoms to surgery and the nonoperative treatment regimen were similar between patients treated at the 2 facilities.

[The causes of perinatal death in the health institutions of Mexico City]. / Causas de muerte perinatal en instituciones de salud de la ciudad de México.

We determined the main causes of death in 798 perinatal deaths which took place among 32,701 births at several health institutions in Mexico City during the summer of 1984, in accordance with the Wigglesworth Classification. We evaluated the concordance among the codifiers of the causes, with a 92% result (P less than 0.0001). The main causes of death were: conditions associated to asphyxia and prematurity in all health institutions (public assistance, social security and private hospitals). The distribution according to birth weight showed that, in almost 50% of the deaths due to asphyxiation, the child's birth weight was greater than 2,500 g, which suggests that their were deficiencies in the medical attention given to those children.

[Hospital utilization in Brazil and effect of the measures to reduce hospitalizations]. / Utilização hospitalar no Brasil e o efeito de medidas de contenção do crescimento de hospitalizações.

The purpose of this paper is to discuss the increase and variation of hospital discharges in Brazil. In addition, the effects of recent governmental measures aiming at reducing the accelerated rate of use of in-patient facilities is discussed. A new case-based hospital reimbursement method, introduced late in 1983, was one of these measures, which seemed to have contributed to increase and not to decrease hospitalization. On the other hand, there has been a shift in hospital discharges from the private to the public sector. It is shown that there is a large difference in hospital workload between private and public institutions. While private hospitals in Brazil operate strongly in the specialties of internal medicine, public hospitals are treating more surgical patients. Consequently it seems that private hospitals are treating less complicated cases and public hospitals the most complicated ones.