Can Major Systematic Reviews Influence Practice Patterns? A Case Study of Episiotomy Trends
Sim, Wee Chung
Caughey, Aaron B.
Howard, David H.
MetadataShow full item record
Purpose Episiotomy is one of the most commonly performed procedures among women of childbearing age in the United States. In 2005, a major systematic review conducted by Hartmann and colleagues recommended against routine use of episiotomy and was widely covered in the media. We assessed the impact of the Hartman et al. study on episiotomy trend. Methods Based on 100 % hospital discharge data from eight states in 2003–2008, we used interrupted time series regression models to estimate the impact of the Hartman et al. review on episiotomy rates. We used mixed-effects regression models to assess whether interhospital variation was reduced over time. Results After controlling for underlying trend, episiotomy rates dropped by 1.4 percentage points after Hartman et al. publication (p\0.01 for spontaneous delivery; p\0.1 for operative delivery). The publication has smaller effect on government hospitals as compared to private hospitals. Mixed effects models estimated negative correlation between cross-time and cross-hospital variations in episiotomy rates, indicating reduced cross-hospital variation over time. Conclusions Our results suggested that there has been a gradual decline in episiotomy rates over the period 2003–2008, and that synthesis of evidence showing harms from routine episiotomy had limited impact on practice patterns in the case of episiotomy. The experience of episiotomy illustrates the challenge of using comparative effectiveness and evidenced-based medicine to reduce use of unnecessary procedures.
The article of record as published may be found at http://dx.doi.org/10.1007/s00404-013-2904-y
RightsThis publication is a work of the U.S. Government as defined in Title 17, United States Code, Section 101. Copyright protection is not available for this work in the United States.
Showing items related by title, author, creator and subject.
The Extratropical Transition of Tropical Cyclones. Part II: Interaction with the Midlatitude Flow, Downstream Impacts, and Implications for Predictability Keller, Julia H.; Grams, Christian M.; Riemer, Michael; Archambault, Heather M.; Bosart, Lance; Doyle, James D.; Evans, Jenni L.; Galarneau, Thomas J.JR.; Griffin, Kyle; Harr, Patrick A.; Kitabatake, Naoko; McTaggart-Cowan, Ron; Pantillon, Florian; Quinting, Julian F.; Reynolds, Carolyn A.; Ritchie, Elizabeth A.; Torn, Ryan D.; Zhang, FuQing (American Meteorological Society, 2019-04);The extratropical transition (ET) of tropical cyclones often has an important impact on the nature and predictability of the midlatitude flow. This review synthesizes the current understanding of the dynamical and ...
Optimal Long-Run Talent Management of the Department of Defense Acquisition Workforce in Response to COVID-19: A Dynamic Programming Approach Ahn, Tom; Menichini, Amilcar (Monterey, California. Naval Postgraduate School, 2021-05-10); SYM-AM-21-099As the economic impact of the COVID-19 pandemic lingers, with the speed of recovery still uncertain, the state of the civilian labor market will impact the public sector. Specifically, the relatively stable and insulated ...
Optimal Long-Run Talent Management of the Department of Defense Acquisition Workforce in Response to COVID-19: A Dynamic Programming Approach [video] Ahn, Tom; Menichini, Amilcar (Monterey, California. Naval Postgraduate School, 2021-05-19); SYM-AM-21-121As the economic impact of the COVID-19 pandemic lingers, with the speed of recovery still uncertain, the state of the civilian labor market will impact the public sector. Specifically, the relatively stable and insulated ...