1. Comparing Methods of Identifying Outlying Nurses in Audits of Low-Risk Cesarean Delivery Rates.
- Author
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Edmonds, Joyce K., Woodbury, Samuel R. BA, Lipsitz, Stuart R. ScD, Weiseth, Amber DNP, -OB, Farrell, Maureen E., Shah, Neel T., Greene, Naomi, and Gregory, Kimberly D.
- Subjects
NURSING audit ,MEDICAL quality control ,AUDITING ,CONFIDENCE intervals ,MATERNITY nursing ,RETROSPECTIVE studies ,HOSPITAL nursing staff ,QUALITY assurance ,DESCRIPTIVE statistics ,CESAREAN section ,JOB performance ,DATA analysis software - Abstract
Background: The low-risk cesarean delivery (CD) rate is an established performance indicator for providers in maternity care for quality improvement purposes. Purpose: Our objectives were to assess nurse performance using adjusted nurse-level CD rates and to compare methods of identifying nurse outliers. Methods: We conducted a retrospective, cohort study of 6970 births attended by 181 registered nurses in one hospital's maternity unit. Adjusted and unadjusted nurse-level CD rates were compared and agreement between 3 definitions (statistical, top decile, over a benchmark) of outliers calculated. Results: Adjusted nurse-level CD rates varied from 5.5% to 53.2%, and the unadjusted rates varied from 5% to 50%. Risk adjustment had little impact on the ranking of nurses, and outliers were consistently identified by 3 definitions. Conclusions: Trade-offs between statistical certainty and feasibility need to be considered when classifying nurse outliers. Findings can help target interventions to improve nurse performance. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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