MedicalResearch.com Interview with:
Dr. Sarah Elizabeth Little, MD
Department of Obstetrics and Gynecology
Brigham and Women’s Hospital
Medical Research: What is the background for this study? What are the main findings?
Dr. Little: This study investigates the variation in cesarean delivery rates across hospital services areas (a geographic unit designed by the Dartmouth Atlas to represent local markets for primarily hospital-based medical services). We looked at whether variation in cesarean delivery rates was related to broader variation in overall medical spending and utilization in that area, which we measured with Medicare spending and hospital use at the end-of-life. We found that an area’s cesarean delivery rate was correlated with these other measures; in other words, the hospital services areas that are doing the most cesarean deliveries are the same ones that are spending more and doing more to non-obstetric patients as well.
Medical Research: What should clinicians and patients take away from your report?
Dr. Little: Cesarean delivery rates are highly correlated to the Medicare spending and utilization patterns in an area. Cesarean deliveries and Medicare spending are of course on different patient populations. Rather we hypothesize that these Medicare variables may reflect the “medical practice culture” of an area. Given this correlation, it may be that interventions aimed at lowering the rate of cesarean delivery in the U.S. that are focused more broadly on the medical practice culture of an area may ultimately be more successful in the long run than interventions focused more narrowly on obstetric patients and providers alone.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Little: Future research should confirm these findings by looking at other measures of an area’s medical practice culture and seeing whether these are also correlated with variations in cesarean delivery. Research should also look at whether or not interventions aimed at lowering the rate of cesarean delivery could be tied in with initiatives aimed more broadly at changing medical practice culture.
Dr. Sarah Elizabeth Little, MD (2016). Higher C-Section Rates Correlated With Increased Medicare Spending