EFFECT OF EXTERNAL PEER-REVIEW ON CESAREAN DELIVERY RATES - A STATEWIDE PROGRAM

Objective: To assess the effectiveness of a joint-specialty society an d health department statewide peer-review program to reduce cesarean r ates. Methods: Forty-five of the 165 hospitals with active delivery se rvices were reviewed between 1989 and 1993. Differences in total and r epeat cesarean rates and vaginal birth after cesarean (VBAC) rates wer e compared by hospital review status using Student t tests and linear regression for the years before and after completion of the program. R esults: Reviewed hospitals reduced their total cesarean rate by 3% and repeat cesarean rate by 0.7%, and increased their VBAC rate by 14.6% compared with nonreviewed hospitals, for which the respective reductio n in rates was 1%, 0.6%, and 12.7%. Statistically, there was no differ ence between reviewed and nonreviewed hospitals in terms of rate chang es. Conclusion: This joint-specialty society and health department pee r review had no apparent impact on cesarean rates.