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J Perinatol. 2019 Jul;39(7):904-910. doi: 10.1038/s41372-019-0373-2. Epub 2019 Apr 5.

Hospital contribution to variation in rates of vaginal birth after cesarean.

Author information

1
University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA. jourdan.triebwasser@pennmedicine.upenn.edu.
2
University of Pennsylvania Perelman School of Medicine, Department of Obstetrics and Gynecology, Philadelphia, PA, USA. jourdan.triebwasser@pennmedicine.upenn.edu.
3
University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA.
4
University of Michigan, Department of Surgery, Ann Arbor, MI, USA.
5
University of Michigan, Department of Emergency Medicine, Ann Arbor, MI, USA.
6
University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.
7
University of Michigan, Department of Urology, Ann Arbor, MI, USA.

Abstract

OBJECTIVE:

To determine the influence of delivery hospital on the rate of vaginal birth after cesarean (VBAC).

STUDY DESIGN:

This retrospective cohort study used claims data from Blue Cross and Blue Shield of Michigan. Women with a prior cesarean and a singleton livebirth between 2012 and 2016 were included. We calculated the hospital-specific risk-standardized VBAC rates and median odds ratio as a measure of variation.

RESULT:

Hospital-level adjusted rates varied nearly tenfold (3.7%-35.5%). Compared to the lowest volume hospitals (1st quartile), the likelihood of VBAC increased for those in the 2nd (adjusted OR 2.75 [95% CI 1.23-6.17]), 3rd (adjusted OR 3.73 [95% CI 1.59-8.75]), and 4th quartiles (adjusted OR 2.9 [95% CI 1.11-7.72]). The median OR suggested significant variation by hospital after adjustment.

CONCLUSION:

The delivery hospital itself explains a large amount of the variation in rates of VBAC after adjustment for patient and hospital characteristics.

PMID:
30952949
PMCID:
PMC6592715
[Available on 2020-01-01]
DOI:
10.1038/s41372-019-0373-2

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