Exploring the influence of medical staffing and birth volume on observed-to-expected cesarean deliveries: a panel data analysis of integrated obstetric and gynecological departments in Germany.
Uloženo v:
| Název: | Exploring the influence of medical staffing and birth volume on observed-to-expected cesarean deliveries: a panel data analysis of integrated obstetric and gynecological departments in Germany. |
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| Autoři: | Stöcker A; Faculty of Human Sciences and Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, University of Cologne, Cologne, Germany. arno.stoecker@ukbonn.de.; Center for Health Services Research Cologne, Interfaculty Institution of the University of Cologne, Cologne, Germany. arno.stoecker@ukbonn.de.; Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, University Hospital Bonn, Bonn, Germany. arno.stoecker@ukbonn.de., Pfaff H; Faculty of Human Sciences and Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, University of Cologne, Cologne, Germany.; Center for Health Services Research Cologne, Interfaculty Institution of the University of Cologne, Cologne, Germany., Scholten N; Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, University of Cologne, Cologne, Germany.; Center for Health Services Research Cologne, Interfaculty Institution of the University of Cologne, Cologne, Germany.; Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, University Hospital Bonn, Bonn, Germany., Kuntz L; Department of Business Administration and Health Care Management, Faculty of Management, Economics and Social Sciences, University of Cologne, Cologne, Germany.; Center for Health Services Research Cologne, Interfaculty Institution of the University of Cologne, Cologne, Germany. |
| Zdroj: | The European journal of health economics : HEPAC : health economics in prevention and care [Eur J Health Econ] 2025 Aug; Vol. 26 (6), pp. 987-1022. Date of Electronic Publication: 2025 Jan 21. |
| Způsob vydávání: | Journal Article |
| Jazyk: | English |
| Informace o časopise: | Publisher: Springer-Verlag Country of Publication: Germany NLM ID: 101134867 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1618-7601 (Electronic) Linking ISSN: 16187598 NLM ISO Abbreviation: Eur J Health Econ Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Berlin : Springer-Verlag, c2001- |
| Výrazy ze slovníku MeSH: | Cesarean Section*/statistics & numerical data , Obstetrics and Gynecology Department, Hospital*/statistics & numerical data , Personnel Staffing and Scheduling*/statistics & numerical data, Humans ; Female ; Germany ; Pregnancy ; Adult ; Obstetrics |
| Abstrakt: | Competing Interests: Declarations. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose. Ethics approval: Not applicable. Introduction: Cesarean deliveries account for approximately one-third of all births in Germany, prompting ongoing discussions on cesarean section rates and their connection to medical staffing and birth volume. In Germany, the majority of departments integrate obstetric and gynecological care within a single department. Methods: The analysis utilized quality reports from German hospitals spanning 2015 to 2019. The outcome variable was the annual risk-adjusted cesarean section ratio-a metric comparing expected to observed cesarean sections. Explanatory variables included annual counts of physicians, midwives, and births. To account for case number-related staffing variations, full-time equivalent midwife and physician staff positions were normalized by the number of deliveries. Uni- and multivariate panel models were applied, complemented by multiple instrument variable analyses, including two-stage least square and generalized method of moments models. Results: Incorporating data from 509 integrated obstetric departments and 2089 observations, representing 2,335,839 deliveries with 720,795 cesarean sections (over 60% of all inpatient births in Germany), multivariate model with fixed effects revealed a statistically significant positive association between the number of physicians per birth and the risk-adjusted cesarean section ratio (0.004, p = 0.004). Two-stage least square instrument variable analysis (0.020, p < 0.001) and a system GMM estimator models (0.004, p < 0.001) validated these results, providing compelling evidence for a causal relationship. Conclusion: The study established a robust connection between the number of physicians per birth and the risk-adjusted cesarean section ratio in integrated obstetric and gynecological departments in Germany. While the cause of the effect remains unclear, one possible explanation is a lack of specialization within these departments due to the combined provision of both obstetric and gynecological care. (© 2025. The Author(s).) |
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| Grant Information: | 01GY2110 Bundesministerium für Bildung und Forschung |
| Contributed Indexing: | Keywords: Hospital; Inpatient sector; Longitudinal design; Medical staffing; Obstetric care; Organizational management |
| Entry Date(s): | Date Created: 20250121 Date Completed: 20250730 Latest Revision: 20250915 |
| Update Code: | 20250915 |
| PubMed Central ID: | PMC12310771 |
| DOI: | 10.1007/s10198-024-01749-0 |
| PMID: | 39836312 |
| Databáze: | MEDLINE |
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Nájsť tento článok vo Web of Science | Abstrakt: | Competing Interests: Declarations. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose. Ethics approval: Not applicable.<br />Introduction: Cesarean deliveries account for approximately one-third of all births in Germany, prompting ongoing discussions on cesarean section rates and their connection to medical staffing and birth volume. In Germany, the majority of departments integrate obstetric and gynecological care within a single department.<br />Methods: The analysis utilized quality reports from German hospitals spanning 2015 to 2019. The outcome variable was the annual risk-adjusted cesarean section ratio-a metric comparing expected to observed cesarean sections. Explanatory variables included annual counts of physicians, midwives, and births. To account for case number-related staffing variations, full-time equivalent midwife and physician staff positions were normalized by the number of deliveries. Uni- and multivariate panel models were applied, complemented by multiple instrument variable analyses, including two-stage least square and generalized method of moments models.<br />Results: Incorporating data from 509 integrated obstetric departments and 2089 observations, representing 2,335,839 deliveries with 720,795 cesarean sections (over 60% of all inpatient births in Germany), multivariate model with fixed effects revealed a statistically significant positive association between the number of physicians per birth and the risk-adjusted cesarean section ratio (0.004, p = 0.004). Two-stage least square instrument variable analysis (0.020, p < 0.001) and a system GMM estimator models (0.004, p < 0.001) validated these results, providing compelling evidence for a causal relationship.<br />Conclusion: The study established a robust connection between the number of physicians per birth and the risk-adjusted cesarean section ratio in integrated obstetric and gynecological departments in Germany. While the cause of the effect remains unclear, one possible explanation is a lack of specialization within these departments due to the combined provision of both obstetric and gynecological care.<br /> (© 2025. The Author(s).) |
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| ISSN: | 1618-7601 |
| DOI: | 10.1007/s10198-024-01749-0 |