Variation in the rates of operative delivery in the United States
ABSTRACT This study was undertaken to examine the national and regional rates of operative delivery among almost one quarter million births in a single year in the nation's largest healthcare delivery system, using variation as an arbiter of the quality of decision making.
We compared the variation in rates of primary cesarean and operative vaginal delivery in facilities of the Hospital Corporation of America during the year 2004.
In 124 facilities representing almost 220,000 births during a 1-year period, the primary cesarean and operative vaginal delivery rates were 19% +/- 5% (range 9-37) and 7% +/- 4% (range 1-23). Within individual geographic regions, we consistently found variations of 200-300% in rates of primary cesarean delivery and variations approximating an order of magnitude for operative vaginal delivery.
Within broad upper and lower limits, rates of operative delivery in the United States are highly variable and suggest a pattern of almost random decision making. This reflects a lack of sufficient reliable, outcomes-based data to guide clinical decision making.
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ABSTRACT: Objective To compare the percentage of operative vaginal delivery (OVD) among all publicly funded maternity hospitals in Ireland and to develop quality control performance tables to facilitate national benchmarking. Methods The analysis included deliveries of neonates weighing 500 g or more in publicly funded hospitals in Ireland in 2010. Information was obtained from the Irish National Perinatal Reporting System. Maternities delivering in 1 private hospital or at home, and those with unknown parity were excluded. Mean ± SD OVD rates were calculated per hospital. Quality control tables were devised. Results In 2010, there were 75 600 deliveries, of which 73 029 met the inclusion criteria. The number of deliveries per hospital ranged from 1284 to 9759. The OVD rate per hospital was 15.3 ± 2.6% (range, 11.7–20.4%). The OVD rate was 29.1% among primigravidas (n = 30 468) compared with 6.7% among multigravidas (n = 42 561) (P < 0.001). Using quality control tables, 52.6% (n = 10) and 31.6% (n = 6) of hospitals were more than 1 SD outside the national mean for forceps and ventouse delivery, respectively. Conclusion Wide variations were found in both the range of OVD and instrument choice among maternity hospitals in Ireland, raising questions about practice and training in contemporary obstetrics.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 06/2014; DOI:10.1016/j.ijgo.2013.12.009 · 1.56 Impact Factor
Conference Paper: Tools available for implementing AVIP[Show abstract] [Hide abstract]
ABSTRACT: Consideration is given to analysis and design techniques that are presently available for evaluating the mechanical design integrity of electronic equipment for reliable operation in severe thermal, vibration, and shock environments. These techniques can be considered as the tools that are required to implement an avionics integrity program (AVIP) successfully. These tools are a knowledge of fatigue damage, physical properties of materials, and methods for determining thermal and vibration forces and stresses. It is shown how these tools can be used to ensure the mechanical design integrity and reliability of the avionic equipment required to operate in harsh military environments for extended time periodsDayton Chapter Symposium, 1988. 'Avionics Integrity Program'., Ninth Annual IEEE/AESS; 12/1988
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ABSTRACT: Description and illustration of a new centric diatom (Thalassiosirales) from Lake Malawi, East Africa: Stephanodiscus nyassaeKnee et Casper nov. Spec., a species related to Stephanodiscus mülleriKlee et Casper: (1992).02/1996; 146(s 3–4). DOI:10.1016/S0003-9365(96)80016-9