Risk-adjustment of cesarean delivery rates: A practical method for use in quality improvement

Alan M. Peaceman*, Joe Feinglass, Larry M. Manheim

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Risk-adjustment of cesarean birthrates has been hampered by inadequacies in the existing secondary data sources or by the need for extensive chart review. This study presents an efficient risk-adjustment model for cesarean birth, based on easily retrievable ICD-9 codes and clinical risk factors least influenced by physician practice style. Data are presented for mothers undergoing 7322 deliveries from 1997-1998 at a large academic medical center with a cesarean birth rate of 15.9%. Multiple logistic regression was used to predict the likelihood of cesarean delivery controlled for maternal age, 10 risk factors identified through ICD-9 coding, and 3 additional clinical variables (nulliparity, birth weight, and gestational age) derived from a perinatal (birth certificate) database. All risk factors were significant predictors of cesarean birth, producing an area under the receiver-operating characteristic curve of 0.86 and a 60-fold increase in cesarean delivery from highest to lowest deciles of predicted risk. This methodology can be used widely for quality improvement without the need for extensive chart review.

Original languageEnglish (US)
Pages (from-to)113-117
Number of pages5
JournalAmerican Journal of Medical Quality
Issue number3
StatePublished - 2002


  • Cesarean delivery
  • Childbirth
  • Maternal health
  • Risk-adjustment

ASJC Scopus subject areas

  • Health Policy


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