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Alternative strategies for controlling rising cesarean section rates
1Department of Biomedical and Environmental Health Sciences, University of California, School of Public Health, Berkeley 94720.
JAMA
|February 2, 1990
Summary
Cesarean section rates surged in the US, prompting six strategies for reduction. Hospital-based educational programs show promise, but more research is needed to compare all methods.
Area of Science:
- Obstetrics and Gynecology
- Health Services Research
- Public Health Policy
Background:
- Cesarean section rates in the United States dramatically increased from 5.5% in 1970 to 24.4% in 1987.
- This rise has caused significant concern and spurred the development of various proposals to curb its use.
Purpose of the Study:
- To review and compare six proposed or adopted strategies aimed at reducing cesarean section rates.
- To identify the most effective and feasible strategies for controlling the increasing use of cesarean sections.
Main Methods:
- Review of six distinct strategies: education/peer evaluation, external review, public rate dissemination, physician payment changes, hospital payment changes, and malpractice reform.
- Analysis of strategies based on assumptions about clinical decision-making, physician autonomy, and implementation.
Main Results:
- Educational efforts, particularly formal programs within individual hospitals, have been the most widely promoted and appear most successful.
- Significant research gaps exist in conclusively comparing the impact and feasibility of all six strategies.
Conclusions:
- While hospital-based educational programs show potential, further research is essential to definitively assess and compare the effectiveness of all proposed cesarean section reduction strategies.
- Comparative studies are needed to guide policy and practice in controlling cesarean section rates.