Cesarean section rates: effects of participation in a performance measurement project

Abstract

Background: A decade-old indicator-based research initiative, Maryland's Quality Indicator (QI) Project, analyzed data for cesarean section rates among its approximately 1,100 voluntarily participating hospitals. It was posited that continuous participation in this performance measurement initiative would be associated with decreased primary and repeat C-section rates.

Methods: A retrospective study compared a group of 110 hospitals that reported on the C-section indicator continuously between 1991 and 1996 with a group of hospitals that did not continuously report data on the C-section rate.

Results: Among the 110 continuously participating hospitals in the QI Project, the total C-section rate declined from 22.5% in 1991 to 19.4% in 1996 (p < .01). For this same group, the primary C-section rate declined from 15.8% to 13.9% (p < .01), and the repeat C-section rate declined from 75.0% to 61.2% between 1991 and 1996 (p < .01). The comparison group of 957 hospitals that did not continuously participate in C-section reporting between 1991 and 1996 did not experience a statistically significant difference in total C-section rates during this time (from 21.2% in 1991 to 20.7% in 1996). In attempting to investigate alternative explanations for these results, a subsequent analysis of eight hospital variables potentially related to cesarean delivery rates found no significant differences between the two groups.

Conclusions: This study provides support for the positive association between continuous participation in a performance measurement project and performance improvement.