Institutional influences on the primary cesarean section rate in Utah, 1992 to 1995, ,

Objectives: Our purpose was to evaluate institutional and organizational influences on cesarean section rates in Utah and to adjust such rates for differences in patient acuity. Study Design: Data on cesarean section rates were derived from the Utah Hospital Discharge Database and adjusted for patient acuity by correcting raw cesarean rates for those patients undergoing cesarean section meeting regional gestational age transport criteria. Results: When analyzed by means of 1-way analysis of variance, the following factors had a significant negative correlation (P< .05) with cesarean section rate: presence of a newborn intensive care unit and maternal-fetal medicine subspecialists, presence on the medical staff of obstetrician-gynecologist(s) as opposed to family physicians only, delivery volume >1500/y, urban location, and 24-hour in-house anesthesiology. When cesarean rates were corrected for acuity, facilities with maternal-fetal medicine specialists and a newborn intensive care unit had significantly lower rates (P< .001) and more uniform rates than otherwise similar institutions. Conclusions: More medically sophisticated physicians and institutions have lower cesarean rates when patient acuity is taken into account. (Am J Obstet Gynecol 1998;179:841-5.)