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American Journal of Medical Quality, Vol. 17, No. 3, 113-117 (2002)
DOI: 10.1177/106286060201700306
© 2002 American College of Medical Quality

Risk-Adjustment of Cesarean Delivery Rates: A Practical Method for Use in Quality Improvement

Alan M. Peaceman, MD

Division of Maternal and Fetal Medicine, Northwestern University Medical School, Chicago, Ill, ampO66{at}northwestern.edu

Joe Feinglass, PhD

Division of General Internal Medicine, Northwestern University Medical School, Chicago, Ill and Institute for Health Services Research and Policy Studies, Northwestern University, Evanston, Ill

Larry M. Manheim, PhD

Institute for Health Services Re-search and Policy Studies, Northwestern University, Evanston, Ill

Risk-adjustment of cesarean birthrates has been hampered by inadequacies in the existing secondary data sources or by the need for extensive chart review. This study presents an efficient risk-adjustment model for cesarean birth, based on easily retrievable ICD-9 codes and clinical risk factors least influenced by physician practice style. Data are presented for mothers undergoing 7322 deliveries from 1997-1998 at a large academic medical center with a cesarean birth rate of 15.9%. Multiple logistic regression was used to predict the likelihood of cesarean delivery controlled for maternal age, 10 risk factors identified through ICD-9 coding, and 3 additional clinical variables (nulliparity, birth weight, and gestational age) derived from a perinatal (birth certificate) database. All risk factors were significant predictors of cesarean birth, producing an area under the receiver-operating characteristic curve of 0.86 and a 60-fold increase in cesarean delivery from highest to lowest deciles of predicted risk. This methodology can be used widely for quality improvement without the need for extensive chart review.

Key Words: Cesarean delivery • childbirth • maternal health • risk-adjustment


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