caa a22 4500 397516568 CHVBK 20180308164620.0 cr unu---uuuuu 161202s1995 xx s 000 0 eng 10.1093/eurpub/5.2.116 doi (NATIONALLICENCE)oxford-10.1093/eurpub/5.2.116 A population-based analysis of variation in Caesarean birth rates [Elektronische Daten] [JUHA TEPERI, ILMO KESKIMÁKI, ELINA HEMMINKI, RISTO ERKKOLA, JOUNI MERILÄNEN] Our aim was to find hospital characteristics and indicators of clinical practice patterns associated with hospital Caesarean birth rates. The data were derived from the national Finnish Birth Registry for 1987 and 1988 (n=120,277). In addition to hospital-specific Caesarean birth rates, rates in geographically defined hospital service areas were used. This was done to control for selection due to referrals. Few hospital characteristics examined were associated with Caesarean birth rates. There was a negative relationship between the hospital service area-specific rate, but not between the hospital specific rate and the size and level of the hospital. This was due to a referral system in which small, level I hospitals manage mainly low-risk deliveries. High Caesarean birth rates were characterized by frequent operations among normal birth weight, full-term deliveries and for dystoda. The relative excess of Caesareans was seen only at times convenient for surgery. Low Caesarean birth rates were characterized by less Caesareans for all major indications and at all times of the day and week. We conclude that insufficient adaptation of clinical practice patterns to fit a low-risk case mix in a hospital may lead to unnecessary operations. High Caesarean birth rates are not characterized by aggressive management of risks, but by a dispersion of operations among the normal population. © European Journal of Public Health ORIGINAL ARTICLES ON OTHER TOPICS nationallicence Caesarean section nationallicence dystocia nationallicence physician's practice patterns nationallicence referral and consultation nationallicence small area analysis nationallicence TEPERI JUHA Health Services Research Unit, National Research and Development Centre for Welfare and Health (STAKES), Helsinki and Department of Public Health, University of Helsinki aut KESKIMÁKI ILMO Health Services Research Unit, National Research and Development Centre for Welfare and Health (STAKES), Helsinki aut HEMMINKI ELINA Health Services Research Unit, National Research and Development Centre for Welfare and Health (STAKES), Helsinki and Department of Public Health, University of Helsinki aut ERKKOLA RISTO Department of Obstetrics and Gynecology, Turku University Hospital aut MERILÄNEN JOUNI Health Services Research Unit, National Research and Development Centre for Welfare and Health (STAKES), Helsinki aut The European Journal of Public Health Oxford University Press 5/2(1995), 116-122 1101-1262 5:2<116 1995 5 eurpub https://doi.org/10.1093/eurpub/5.2.116 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1093/eurpub/5.2.116 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- TEPERI JUHA Health Services Research Unit, National Research and Development Centre for Welfare and Health (STAKES), Helsinki and Department of Public Health, University of Helsinki aut NATIONALLICENCE 700 1- KESKIMÁKI ILMO Health Services Research Unit, National Research and Development Centre for Welfare and Health (STAKES), Helsinki aut NATIONALLICENCE 700 1- HEMMINKI ELINA Health Services Research Unit, National Research and Development Centre for Welfare and Health (STAKES), Helsinki and Department of Public Health, University of Helsinki aut NATIONALLICENCE 700 1- ERKKOLA RISTO Department of Obstetrics and Gynecology, Turku University Hospital aut NATIONALLICENCE 700 1- MERILÄNEN JOUNI Health Services Research Unit, National Research and Development Centre for Welfare and Health (STAKES), Helsinki aut NATIONALLICENCE 773 0- The European Journal of Public Health Oxford University Press 5/2(1995), 116-122 1101-1262 5:2<116 1995 5 eurpub Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-oxford