Date of Conferral

2016

Degree

Ph.D.

School

Public Health

Advisor

Vibha Kumar

Abstract

Approximately 35.1% of live births for the state of Georgia were delivered by the cesarean delivery procedure with significant variation among hospitals. The purpose of this research was to develop a population-based hospital profiling methodology for study of the cesarean delivery procedure. This was a retrospective, observational design, using a 2012 linked dataset that included maternity deliveries from all nonfederal hospitals. The research was guided by Robson 10 Group Classification System, propensity score methodologies, and ethical precepts, for the development of hospital profiles and the study of variations in the cesarean delivery procedure. Key research questions aimed to determine whether hospital profiling methodologies differed according to risk adjustment methods and statistical techniques. Propensity score matching with stratification methods aimed to determine whether there were differences in patient treatment effects on the cesarean delivery outcome. Findings suggested there was a significant difference in hospital ranks and model effects according to the statistical technique and the risk adjustment methods applied. Propensity score matching with stratification demonstrated an increased risk of the cesarean delivery procedure across strata, with the majority of high risk patients situated in the 90th percentile ranges and questionable utilization practice among other strata. Applying profiling methodologies at the facility and population level could advance statewide quality improvement programs for the timely reduction in the variation of inappropriate utilization of the cesarean delivery procedure.

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