Evaluating the appropriateness of care: a study of cesarean section rates

The Maryland Hospital Associations Quality Indicator Project was initiated in 1987 to evaluate ten inpatient care outcome indicators. One of these indicators, cesarean sections, has been a primary focus of the project's efforts thus far. Data on 270 C-sections performed in six Maryland hospitals were gathered and analyzed by a committee that included expert clinicians and representatives from medical societies. A protocol for C-sections was then developed listing the elements that required documentation in the records of patients having C-sections. For monitoring purposes, the protocol was converted into a data collection and evaluation form that was subsequently tested for its validity and practical value. The pilot test showed that the form was a viable tool for collecting information and that the direction and magnitude of association between data elements was as expected.