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Risk-adjusted primary cesarean delivery rates for managed care plans in New York State, 1998
P J Roohan1, R E Josberger, F C Gesten
1NewYork State Department of Health, Office of Managed Care, Albany 12237, USA. pjr02@health.state.ny.us
Maternal and Child Health Journal
|October 19, 2001
Summary
Risk adjustment significantly changes the comparison of primary cesarean delivery rates in managed care plans. This method provides a more accurate evaluation than crude rates by accounting for patient factors.
Area of Science:
- Healthcare Management
- Public Health
- Maternal Health
Background:
- Crude rates of primary cesarean deliveries in managed care plans may not accurately reflect performance due to unaddressed patient variations.
- Risk adjustment is crucial for equitable comparison of healthcare quality metrics.
Purpose of the Study:
- To compare the impact of risk adjustment methodologies versus crude rates in assessing primary cesarean delivery rates.
- To evaluate primary cesarean delivery rates in managed care plans after controlling for demographic and clinical factors.
Main Methods:
- Utilized 1998 Quality Assurance Reporting Requirements (QARR) data from managed care plans.
- Matched Medicaid and commercial populations to the New York State Department of Health Vital Statistics birth file.
- Employed logistic regression to adjust for maternal education, age, race/ethnicity, obstetrical history, and comorbidities.
Main Results:
- Crude Medicaid analysis: 4 plans significantly lower, 1 higher than the 9.5% statewide rate. Risk-adjusted: 1 plan lower, none higher.
- Crude commercial analysis: 7 plans lower, 4 higher than the 16.3% statewide rate. Risk-adjusted: 3 plans lower, 3 higher.
Conclusions:
- Risk adjustment provides a more accurate comparison of primary cesarean delivery rates among managed care plans.
- Publication of accurate rates can guide clinicians in managed care to improve health outcomes.