Effect of academic affiliation and obstetric volume on clinical outcome and cost of childbirth.
Obstet Gynecol
; 97(4): 567-76, 2001 Apr.
Article
in En
| MEDLINE
| ID: mdl-11275029
ABSTRACT
OBJECTIVE:
To determine whether the academic affiliation and obstetric volume of the delivering hospital has an impact on clinical and economic outcomes.METHODS:
We performed a cross-sectional analysis of data for all births in the State of Maryland during 1996. Acute hospital discharge data were obtained from the publicly available Maryland Health Services Cost Review Commission database. Institutions were classified as community hospitals, community teaching hospitals, and academic medical centers. Principal outcome variables included cesarean birth and complication rates, total hospital charges, and length of stay.RESULTS:
A total of 63,143 cases were identified for analysis. The cesarean delivery rate was lower among academic medical centers, compared with community teaching hospitals and community hospitals (18.4% compared with 24.3% and 21.2%, respectively). After adjustment for patient case-mix, the adjusted odds ratio (OR) for cesarean birth was 0.66 at academic medical centers and 1.23 at community teaching hospitals compared with community hospitals (P <.01). Rates of episiotomy and serious complications were lower at academic medical centers compared with community hospitals. Adjusted total hospital charges were lower and length of stay was shorter for community hospitals compared with academic medical centers ($2937 compared with $3564 and 2.2 days compared with 2.5 days, respectively).CONCLUSION:
Hospital academic affiliation was an important predictor of clinical outcomes. Better clinical outcomes were found primarily among patients at academic medical centers, although these institutions demonstrated moderately higher resource utilization, compared with community hospitals.
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Collection:
01-internacional
Database:
MEDLINE
Main subject:
Organizational Affiliation
/
Outcome Assessment, Health Care
/
Delivery, Obstetric
/
Academic Medical Centers
/
Hospitals, Community
/
Hospitals, Teaching
Type of study:
Health_economic_evaluation
/
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Female
/
Humans
/
Pregnancy
Country/Region as subject:
America do norte
Language:
En
Journal:
Obstet Gynecol
Year:
2001
Document type:
Article
Affiliation country:
United States
Publication country:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA