INSTITUTIONAL INFLUENCES ON THE PRIMARY CESAREAN-SECTION RATE IN UTAH, 1992 TO 1995

OBJECTIVES: Our purpose was to evaluate institutional and organization al influences on cesarean section rates in Utah and to adjust such rat es for differences in patient acuity. STUDY DESIGN: Data on cesarean s ection rates were derived from the Utah Hospital Discharge Database an d adjusted for patient acuity by correcting raw cesarean rates for tho se patients undergoing cesarean section meeting regional gestational a ge transport criteria. RESULTS: When analyzed by means of 1-way analys is of variance, the following factors had a significant negative corre lation (P < .05) with cesarean section rate: presence of a newborn int ensive care unit and maternal-fetal medicine subspecialists, presence on the medical staff of obstetrician-gynecologist(s) as opposed to fam ily physicians only, delivery volume > 1500/y, urban location, and 24- hour in-house anesthesiology. When cesarean rates were corrected for a cuity, facilities with maternal-fetal medicine specialists and a newbo rn intensive care unit had significantly lower rates (P < .001) and mo re uniform rates than otherwise similar institutions. CONCLUSIONS: Mor e medically sophisticated physicians and institutions have lower cesar ean rates when patient acuity is taken into account.