Anesthesia provider model, hospital resources, and maternal outcomes

Objective. Determine the ability of anesthesia provider model and hospital resources to explain maternal outcome variation. Data Source/Study Setting. 1,141,641 obstetrical patients from 369 hospitals that reported at least one live birth in 2002 in six representative states. Study Design. Logistic regression of death, anesthesia complication, nonanesthesia maternal complication, and obstetrical trauma for all patients and those having cesarean deliveries on anesthesia provider model, obstetrical and anesthesia, and patient variables. Data Collection/Extraction Methods. Data was assembled from information given by hospitals to state agencies and from a 2004 survey of obstetrical organization resources. Principal Findings. Anesthesia complication rates in anesthesiologist-only hospitals were 0.27 percent compared with 0.23 percent in certified registered nurse anesthetist (CRNA) only hospitals. Rates among other provider models varied from 0.24 to 0.37 percent with none statistically different from the anesthesiologist-only hospitals. A similar pattern was observed for rates of other outcomes. Multivariate analysis found no systematic differences between hospitals with anesthesiologist-only models and models using CRNAs. There was no consistent pattern of association of other hospital or patient characteristics with outcomes. Conclusion. Hospitals that use only CRNAs, or a combination of CRNAs and anesthesiologists, do not have systematically poorer maternal outcomes compared with hospitals using anesthesiologist-only models. Key Words. Anesthesia, maternal outcomes, quality of health care, clinical competence
The impact of anesthesia provider credentials on patient outcomes has been a research topic and the subject of policy debates for more than 40 years (Kane and Smith 2004). Although [...]