Can Major Systematic Reviews Influence Practice Patterns? A Case Study of Episiotomy Trends

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Author
Shen, Yu-Chu
Sim, Wee Chung
Caughey, Aaron B.
Howard, David H.
Date
2013-06-14Metadata
Show full item recordAbstract
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.
Description
The article of record as published may be found at http://dx.doi.org/10.1007/s00404-013-2904-y
Rights
This 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.Collections
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