DIFFERENCES IN OBSTETRICAL INTERVENTION RATES BETWEEN DUTCH HOSPITALS

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.