Abstract：
BACKGROUND: The Joint Commission uses nulliparous, term, singleton, vertex, cesarean delivery (NTSV-CD) rates to assess hospitals\' perinatal care quality through the Cesarean Birth measurement (PC-02). However, these rates are not risk-adjusted for maternal health factors, putting this measure at odds with the risk adjustment paradigm of most publicly reported hospital quality measures. Here, the authors tested whether risk adjustment for readily documented maternal risk factors affected hospital-level NTSV-CD rates in a large health system.
METHODS: Included were all consecutive NTSV pregnancies from January 2019 to April 2023 across 10 hospitals in one health system. Logistic regression, adjusting for age, obesity, diabetes, and hypertensive disorders. was used to calculate hospital-level risk-adjusted NTSV-CD rates by multiplying observed vs. expected ratios for each hospital by the systemwide unadjusted NTSV-CD rate. The authors calculated intrahospital risk differences between unadjusted and risk-adjusted rates and calculated the percentage of hospitals qualifying for different reporting status after risk adjustment using the 30% Joint Commission reporting threshold rate.
RESULTS: Of 23,866 pregnancies, 6,550 (27.4%) had cesarean deliveries. Across 10 hospitals, the number of deliveries ranged from 393 to 7,671, with unadjusted NTSV-CD rates ranging from 21.0% to 30.5%. Risk-adjusted NTSV-CD rates ranged from 21.5% to 30.4%, with absolute intrahospital differences in risk-adjusted vs. unadjusted rates ranging from -1.33% (indicating lower rate after risk adjustment) to 3.37% (indicating higher rate after risk adjustment). Three of 10 (30.0%) hospitals qualified for different reporting statuses after risk adjustment.
CONCLUSIONS: Risk adjustment for age, obesity, diabetes, and hypertensive disorders is feasible and resulted in meaningful changes in hospital-level NTSV-CD rates with potentially impactful consequences for hospitals near The Joint Commission reporting threshold.
METHODS: Included were all consecutive NTSV pregnancies from January 2019 to April 2023 across 10 hospitals in one health system. Logistic regression, adjusting for age, obesity, diabetes, and hypertensive disorders. was used to calculate hospital-level risk-adjusted NTSV-CD rates by multiplying observed vs. expected ratios for each hospital by the systemwide unadjusted NTSV-CD rate. The authors calculated intrahospital risk differences between unadjusted and risk-adjusted rates and calculated the percentage of hospitals qualifying for different reporting status after risk adjustment using the 30% Joint Commission reporting threshold rate.
RESULTS: Of 23,866 pregnancies, 6,550 (27.4%) had cesarean deliveries. Across 10 hospitals, the number of deliveries ranged from 393 to 7,671, with unadjusted NTSV-CD rates ranging from 21.0% to 30.5%. Risk-adjusted NTSV-CD rates ranged from 21.5% to 30.4%, with absolute intrahospital differences in risk-adjusted vs. unadjusted rates ranging from -1.33% (indicating lower rate after risk adjustment) to 3.37% (indicating higher rate after risk adjustment). Three of 10 (30.0%) hospitals qualified for different reporting statuses after risk adjustment.
CONCLUSIONS: Risk adjustment for age, obesity, diabetes, and hypertensive disorders is feasible and resulted in meaningful changes in hospital-level NTSV-CD rates with potentially impactful consequences for hospitals near The Joint Commission reporting threshold.
摘要：
背景：联合委员会使用未产，term,单身人士,顶点,剖宫产率（NTSV-CD）通过剖宫产分娩测量（PC-02）评估医院围产期护理质量。然而,这些比率没有根据产妇健康因素进行风险调整，使这一措施与大多数公开报告的医院质量措施的风险调整范式不一致。这里,作者测试了在大型卫生系统中,针对容易记录的孕产妇风险因素进行的风险调整是否会影响医院水平的NTSV-CD发生率.
方法：包括2019年1月至2023年4月在一个卫生系统中的10家医院中的所有连续NTSV怀孕。Logistic回归，调整年龄，肥胖，糖尿病,和高血压疾病。通过将观察值与观察值相乘来计算医院级别的风险调整后NTSV-CD率根据全系统未调整的NTSV-CD率，每家医院的预期比率。作者计算了未调整率和风险调整率之间的医院内风险差异，并使用30％联合委员会报告阈值率计算了风险调整后符合不同报告状态的医院百分比。
结果：在23,866次怀孕中，6,550（27.4%）例剖宫产。在10家医院中，分娩数量为393至7,671例,未调整的NTSV-CD比率为21.0%至30.5%.风险调整后的NTSV-CD率范围从21.5%到30.4%，在风险调整后的医院内绝对差异与未调整的利率范围从-1.33%(表明风险调整后利率较低)到3.37%(表明风险调整后利率较高)。风险调整后，10家医院中有三家(30.0%)符合不同的报告状态。
结论：年龄的风险调整，肥胖，糖尿病,和高血压疾病是可行的，并导致医院级NTSV-CD发生率发生有意义的变化，对联合委员会报告阈值附近的医院产生潜在的影响。
方法：包括2019年1月至2023年4月在一个卫生系统中的10家医院中的所有连续NTSV怀孕。Logistic回归，调整年龄，肥胖，糖尿病,和高血压疾病。通过将观察值与观察值相乘来计算医院级别的风险调整后NTSV-CD率根据全系统未调整的NTSV-CD率，每家医院的预期比率。作者计算了未调整率和风险调整率之间的医院内风险差异，并使用30％联合委员会报告阈值率计算了风险调整后符合不同报告状态的医院百分比。
结果：在23,866次怀孕中，6,550（27.4%）例剖宫产。在10家医院中，分娩数量为393至7,671例,未调整的NTSV-CD比率为21.0%至30.5%.风险调整后的NTSV-CD率范围从21.5%到30.4%，在风险调整后的医院内绝对差异与未调整的利率范围从-1.33%(表明风险调整后利率较低)到3.37%(表明风险调整后利率较高)。风险调整后，10家医院中有三家(30.0%)符合不同的报告状态。
结论：年龄的风险调整，肥胖，糖尿病,和高血压疾病是可行的，并导致医院级NTSV-CD发生率发生有意义的变化，对联合委员会报告阈值附近的医院产生潜在的影响。
