Comparative effectiveness in medicine: analysis of episiotomy practice patterns
Chung, Sim Wee
Howard, David H.
MetadataShow full item record
This thesis provides empirical evidence to demonstrate or disprove claims that findings from a major systematic review published in 2005, have led to further declines in practices of episiotomy. The study uses data from the Healthcare Cost and Utilization Project: State Inpatient Databases (HCUP SID) and American Hospital Association (AHA) annual surveys. The sample consists of 648,141 patients from 897 hospitals between 2003 and 2008. Both fixed and random effects models are specified to estimate the effects of the JAMA publication, hospital characteristics including interaction terms and patient compositions on episiotomy rates. In addition the study analyzes variation of practice patterns to examine whether the JAMA publication has the desirable impact on clinical practices. The results show that the declining episiotomy trends accelerate marginally after the JAMA publication. Hospitals do not also appear to respond differentially to the JAMA publication for most hospital characteristics, except for hospital sizes, maternity ward turnover and ownership structure. The analysis of practice pattern variation suggests that practice variations by volumes are declining but variances of episiotomy rates remain substantial. More effective strategies should be formulated to reach out to different audiences to bridge the gap between research evidences and clinical practices on episiotomy.
Approved for public release; distribution is unlimited
Showing items related by title, author, creator and subject.
NPS Acquisition Research Program (2005-05-01); NPS-AM-05-004A close tie exists between defense acquisition practice and acquisition training.'' Acquisition practice entails exercising skills and techniques in project management, contracting, logistics, test and evaluation, and other ...
Allocating overhead costs in a Navy Working Capital Fund environment : an analysis and comparison of current Navy policy and private sector practice Schulte, Steven H. (Monterey, California: Naval Postgraduate School, 1999-06);This thesis was developed in response to Naval Air Warfare Aircraft Division (NAWCAD) management's desire to explore alternative overhead allocation practices in order to better understand their organization's cost ...
Sanders, Scot Thomas. (Austin, Texas. University of Texas at Austin, 2000);The Construction Industry Institute (CII) has identified 11 best practices that have shown significant value in improving performance on construction projects. One of these practices is Project Change Management (PCM) . ...