Back to Search
Start Over
Case mix adjustment of health outcomes, resource use and process indicators in childbirth care: a register-based study
- Source :
- BMC Pregnancy and Childbirth
- Publisher :
- Springer Nature
-
Abstract
- Background Unwarranted variation in care practice and outcomes has gained attention and inter-hospital comparisons are increasingly being used to highlight and understand differences between hospitals. Adjustment for case mix is a prerequisite for meaningful comparisons between hospitals with different patient populations. The objective of this study was to identify and quantify maternal characteristics that impact a set of important indicators of health outcomes, resource use and care process and which could be used for case mix adjustment of comparisons between hospitals. Methods In this register-based study, 139 756 deliveries in 2011 and 2012 were identified in regional administrative systems from seven Swedish regions, which together cover 67 % of all deliveries in Sweden. Data were linked to the Medical birth register and Statistics Sweden’s population data. A number of important indicators in childbirth care were studied: Caesarean section (CS), induction of labour, length of stay, perineal tears, haemorrhage > 1000 ml and post-partum infections. Sociodemographic and clinical characteristics deemed relevant for case mix adjustment of outcomes and resource use were identified based on previous literature and based on clinical expertise. Adjustment using logistic and ordinary least squares regression analysis was performed to quantify the impact of these characteristics on the studied indicators. Results Almost all case mix factors analysed had an impact on CS rate, induction rate and length of stay and the effect was highly statistically significant for most factors. Maternal age, parity, fetal presentation and multiple birth were strong predictors of all these indicators but a number of additional factors such as born outside the EU, body mass index (BMI) and several complications during pregnancy were also important risk factors. A number of maternal characteristics had a noticeable impact on risk of perineal tears, while the impact of case mix factors was less pronounced for risk of haemorrhage > 1000 ml and post-partum infections. Conclusions Maternal characteristics have a large impact on care process, resource use and outcomes in childbirth care. For meaningful comparisons between hospitals and benchmarking, a broad spectrum of sociodemographic and clinical maternal characteristics should be accounted for. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0921-0) contains supplementary material, which is available to authorized users.
- Subjects :
- Register based
medicine.medical_specialty
Care process
Reproductive medicine
Outcomes
Health outcomes
Labor Presentation
03 medical and health sciences
0302 clinical medicine
Case mix index
Nursing
Pregnancy
Risk Factors
Obstetrics and Gynaecology
medicine
Childbirth
Humans
Caesarean section
030212 general & internal medicine
Labor, Induced
Registries
Sweden
Value-based health care
030219 obstetrics & reproductive medicine
business.industry
Cesarean Section
Obstetrics and Gynecology
Risk adjustment
Length of Stay
Delivery, Obstetric
Parity
Outcome and Process Assessment, Health Care
Family medicine
Resource use
Health Resources
Female
Risk Adjustment
Pregnancy, Multiple
business
Case mix adjustment
Maternal Age
Research Article
Subjects
Details
- Language :
- English
- ISSN :
- 14712393
- Volume :
- 16
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- BMC Pregnancy and Childbirth
- Accession number :
- edsair.doi.dedup.....fa192e1b64cb8bd5a30011e992a133d3
- Full Text :
- https://doi.org/10.1186/s12884-016-0921-0