| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
ORIGINAL RESEARCH |
From the Department of Obstetrics and Gynecology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; the Department for Planning and Marketing, the Johns Hopkins Hospital, Baltimore, Maryland; and the Department of Obstetrics and Gynecology, the University of Arizona Health Sciences, Tucson, Arizona.
Address reprint requests to: Francisco A. R. Garcia, MD, MPH University of Arizona Health Sciences Center 1501 North Campbell Avenue, P.O. Box 245078 Tucson, AZ 85724 E-mail: fcisco{at}u.arizona.edu
Objective: To determine whether the academic affiliation and obstetric volume of the delivering hospital has an impact on clinical and economic outcomes.
Methods: We performed a cross-sectional analysis of data for all births in the State of Maryland during 1996. Acute hospital discharge data were obtained from the publicly available Maryland Health Services Cost Review Commission database. Institutions were classified as community hospitals, community teaching hospitals, and academic medical centers. Principal outcome variables included cesarean birth and complication rates, total hospital charges, and length of stay.
Results: A total of 63,143 cases were identified for analysis. The cesarean delivery rate was lower among academic medical centers, compared with community teaching hospitals and community hospitals (18.4% compared with 24.3% and 21.2%, respectively). After adjustment for patient case-mix, the adjusted odds ratio (OR) for cesarean birth was 0.66 at academic medical centers and 1.23 at community teaching hospitals compared with community hospitals (P < .01). Rates of episiotomy and serious complications were lower at academic medical centers compared with community hospitals. Adjusted total hospital charges were lower and length of stay was shorter for community hospitals compared with academic medical centers ($2937 compared with $3564 and 2.2 days compared with 2.5 days, respectively).
Conclusion: Hospital academic affiliation was an important predictor of clinical outcomes. Better clinical outcomes were found primarily among patients at academic medical centers, although these institutions demonstrated moderately higher resource utilization, compared with community hospitals.
This article has been cited by other articles:
|
|
 |
|
  J. J. Chang, D. M. Stamilio, and G. A. Macones Effect of Hospital Volume on Maternal Outcomes in Women with Prior Cesarean Delivery Undergoing Trial of Labor Am. J. Epidemiol., March 15, 2008; 167(6): 711 - 718. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Robbins, T. M. Bird, J. M. Tilford, J. A. Reading, M. A. Cleves, M. E. Aitken, C. M. Druschel, and C. A. Hobbs Reduction in Newborns With Discharge Coding of In Utero Alcohol Effects in the United States, 1993 to 2002 Arch Pediatr Adolesc Med, December 1, 2006; 160(12): 1224 - 1231. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. K. Nicholson, H. E. Fox, L. A. Cooper, D. Strobino, F. Witter, and N. R. Powe Maternal Race, Procedures, and Infant Birth Weight in Type 2 and Gestational Diabetes. Obstet. Gynecol., September 1, 2006; 108(3): 626 - 634. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. S. Romano, S. Yasmeen, M. E. Schembri, J. M. Keyzer, and W. M. Gilbert Coding of Perineal Lacerations and Other Complications of Obstetric Care in Hospital Discharge Data Obstet. Gynecol., October 1, 2005; 106(4): 717 - 725. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Merenstein, B. Egleston, and M. Diener-West Lengths of Stay and Costs Associated With Children's Hospitals Pediatrics, April 1, 2005; 115(4): 839 - 844. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 International Working Party to Promote and Revital Academic medicine: the evidence base BMJ, October 2, 2004; 329(7469): 789 - 792. [Full Text] [PDF]
|
|
|
|
 |
|
 A. S. Covey and G. E Friedlaender Financing Graduate Medical Education: Sorting Out the Confusion J. Bone Joint Surg. Am., August 1, 2003; 85(8): 1594 - 1604. [Full Text] [PDF]
|
|
|
|
|
|
A. M. Weber and L. Meyn Episiotomy Use in the United States, 1979-1997 Obstet. Gynecol., December 1, 2002; 100(6): 1177 - 1182. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. C. Klein, A. Spence, J. Kaczorowski, A. Kelly, and S. Grzybowski Does delivery volume of family physicians predict maternal and newborn outcome? Can. Med. Assoc. J., May 1, 2002; 166(10): 1257 - 1263. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
