VARIATION IN OBSTETRIC CARE WITHIN AND BETWEEN HOSPITAL LEVELS IN FINLAND

Objective In obstetrics, both area and hospital variation has previous ly been documented for operative procedures, but not for other treatme nts or diagnostic procedures. This study investigated the extent of va riation in care during pregnancy, at birth and after birth. Design and methods The variation was studied by hospitals (n = 52) by hospital l evel. To account for differences in women's background characteristics , logistic regression analyses were done. The data came from the 1991 Finnish Birth Register which records data on all births (n = 64 171). Results All interventions and care practices studied varied notably fr om one hospital to another, with the variation usually being greater w ithin hospitals of the same level than between hospitals of different levels. Each of the seven non-operative interventions showed a larger variation than did each of the four operative interventions. Standardi sation for mothers' background characteristics did not eliminate this variation. Some interventions, but not all, were clustered in the same hospitals. Conclusions Such large variation indicates a need for furt her studies on the benefits of obstetric interventions and of care pra ctices, and on better application of research results to obstetric car e.