Pm. Elferinkstinkens et al., DIFFERENCES IN OBSTETRICAL INTERVENTION RATES BETWEEN DUTCH HOSPITALS, European journal of obstetrics, gynecology, and reproductive biology, 53(3), 1994, pp. 165-173
Within the framework of the project 'Obstetric Peer Review' (Verloskun
dige Onderlinge Kwaliteitsspiegeling, VOKS) differences between Dutch
hospitals concerning various obstetrical interventions were investigat
ed. Using data of the Perinatal Database of the Netherlands from hospi
tals with at least 2000 newborns in the 5-year period 1987-1991, remar
kable differences in frequencies of labour induction, caesarean sectio
n and vaginal operative deliveries can be shown, even when these inter
ventions were considered within homogeneous subgroups with respect to
pregnancy- or delivery-related complications. The incidence of caesare
an section (and labour induction and vaginal operative delivery) appea
red to depend more on the specific hospital policy than might be expla
ined by populations differences alone. These intervention differences
between hospitals clearly demonstrated the need to carry out a multiva
riate analysis to compare hospitals in a relevant and unbiased way, wh
ile adjusting for these population differences. This will estimate the
intervention risks in a way which allows a fair comparison of hospita
l intervention policies.